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

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

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 177 out of 8,753

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VAERS ID: 1817850 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 LA / 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: 1817853 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 LA / 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: 1817855 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 LA / 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: 1817856 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 LA / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1817979 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 LA / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1817999 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1818002 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 LA / 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: 1818041 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-31
Onset:2021-10-14
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802570 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Atelectasis, Blood creatinine increased, Blood culture negative, Blood electrolytes decreased, Blood phosphorus decreased, Blood potassium decreased, Blood sodium decreased, COVID-19, Chest X-ray abnormal, Complication associated with device, Condition aggravated, Cough, Depressed level of consciousness, Electrocardiogram QT prolonged, Exposure to SARS-CoV-2, Fatigue, Haemoglobin decreased, Hyponatraemia, Hypotension, Lung infiltration, Plateletcrit, Pneumonia, Pyrexia, SARS-CoV-2 test positive, Tachycardia, Vomiting, White blood cell count normal
SMQs:, Torsade de pointes/QT prolongation (narrow), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: baclofen (LIORESAL) 10 MG tablet Brompheniramine-Phenylephrine (DIMETAPP COLD/ALLERGY PO) budesonide (RHINOCORT ALLERGY) 32 MCG/ACT nasal spray cetirizine (ZYRTEC) 1 MG/ML oral solution diphenhydrAMINE (BENADRYL) 12.5 MG/5ML liquid fluticas
Current Illness: 10.13.21 - fever and cough
Preexisting Conditions: Spastic diplegic cerebral palsy Fetal alcohol syndrome Foley catheter in place Spina bifida of lumbar region with hydrocephalus Feeding by G-tube Microcephalic Slow gastric motility Gastrojejunostomy tube status Seasonal allergies Wheelchair bound S/P cecostomy Chronic constipation Neurogenic bladder Cecostomy status Gastrostomy tube in place Dystrophic nail Dental plaque Tooth position anomaly involving crowding of teeth Muscle spasticity Contracture of elbow joint, right Melena Hypoglycemia COVID-19 Community acquired pneumonia, unspecified laterality Environmental allergies
Allergies: Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (10.14.21-10.17.21); COVID-19 positive (10.14.21); fully vaccinated Discharge Provider: DO Primary Care Provider: DO Admission Date: 10/14/2021 Discharge Date: Oct 17, 2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute kidney injury [N17.9] Pneumonia of left lower lobe due to infectious organism [J18.9] COVID-19 [U07.1] Acute pneumonia [J18.9] Cough [R05.9] Community acquired pneumonia, unspecified laterality [J18.9] HOSPITAL COURSE: This is a 28 y/o female with past medical history significant for spastic cerebral palsy, fetal alcohol syndrome, microcephaly, spina bifida, and chronic constipation with noted cecostomy tube. Patient currently resides at home under the care of her mother/DPOA. Patient was brought into the ED on 10/14 due to concerns of vomiting, cough, and possible blood coming out of her GJ tube. Mother reported patient''s symptoms started a few days prior to presentation. She stated that patient had been coughing and spiking low grade fevers. Mom also reported concerns regarding potential aspiration event at home. Patient is strict NPO with feeding tube in place. Grandson in the home recently tested positive for COVID thus mother was concerned patient may have this as well. Patient is fully vaccinated for COVID-19 however. Additionally mother reported what appeared to be blood coming out of her G tube. It appears patient has had issues with this in the past. Last EGD was noted to be in March of this year and was negative for any source of bleeding at that time. Otherwise mother reported that patient appeared fatigue and less alert/interactive then her baseline. Upon arrival to the ED, patient was noted to be febrile/tachycardic/hypotensive. She was not hypoxic. Basic labs were obtained and notable for normal WBC, Hg of 8.8 which is patient''s baseline, Na-130, AKI with Cr of 1.4, K-3.3, PCT-1.63, and positive COVID PCR. Patient underwent further evaluation with CXR which demonstrated mild left basilar atelectasis vs infiltrate. There was no evidence of significant COVID pneumonia. Patient received IVFs, Rocephin/Azithromycin, and IV protonix. IM was then asked to admit for further care. Following admission, patient was continued on Rocephin and Doxycycline due to concern for bacterial pneumonia with potential aspiration as mother reported aspiration episode at home. Azithromycin was discontinued due to prolonged Qtc. Blood cultures were obtained on admission and remained negative during hospital stay. Patient did not appear to have any significant respiratory compromise from COVID. AKI and hyponatremia resolved with IVFs. Hg was trended closely and dropped somewhat to 7.7 but overall remained stable. There was no evidence of bloody output from feeding tube. Patient was initially placed on IV Protonix. GI was consulted and given there was no evidence of ongoing bleeding, endoscopy was not recommended. Nutrition managed tube feeds. Electrolytes including potassium and phos were low during hospitalization and were aggressively replaced. Patient otherwise improved back to baseline at time of discharge. She was noted to be alert, smiling, and interactive with mother. She will be discharged on Ceftin/Doxy to complete a total of 5 days of Abx. Mother was instructed to have patient follow up with PCP. Patient should have repeat labs including CBC, BMP, Mg, and Phos drawn within a few days of discharge.


VAERS ID: 1818057 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-03
Onset:2021-10-14
   Days after vaccination:225
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Back injury, COVID-19, COVID-19 pneumonia, Chronic obstructive pulmonary disease, Condition aggravated, Contusion, Cough, Crepitations, Cystitis, Exposure to SARS-CoV-2, Gastrooesophageal reflux disease, Haematuria, Hypophagia, Hypoxia, Mental status changes, Pyrexia, SARS-CoV-2 test positive, Urinary tract infection, Urine output decreased
SMQs:, Acute renal failure (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific dysfunction (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tubulointerstitial diseases (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet Calcium Carb-Cholecalciferol (CALCIUM 600+D3) 600-800 MG-UNIT TABS CRANBERRY PO docusate (COLACE) 100 MG capsule loperamide (IMODIUM) 1 MG/5ML solution mirabegron ER (MYRBETRIQ) 50 MG 24 hr tablet mirta
Current Illness: 9.14.21 - ED: UTI symptoms - acute cystitis with hematuria started on Bactrim 10.2.21 - ED: Lumbar contusion / back injury 10.10.21 - 10.12.21 - ED -- $g hospitalized: UTI, altered mental status, weakness, COPD, GERD (Ceftin) 10.14.21 - pulse ox < 91% since hospital discharge, fever, weakness, decreased intake/output, crackles (ED -- $g hospitalized)
Preexisting Conditions: Chronic obstructive pulmonary disease Gastroesophageal reflux disease Osteoarthritis of hip Keratoacanthoma Scoliosis Hyperlipidemia IBS (irritable bowel syndrome) Tobacco dependence Actinic keratoses Barrett esophagus ED (erectile dysfunction) Esophageal dysfunction Erectile dysfunction Elevated PSA Dehydration SIRS (systemic inflammatory response syndrome) Rhabdomyolysis Depression Urinary retention Bacteriuria Prostate cancer Generalized weakness Urinary tract infection associated with indwelling urethral catheter Physical deconditioning COVID-19 Altered mental status, unspecified Urinary tract infection Hypoxia Pneumonia due to COVID-19 virus Generalized weakness Protein-calorie malnutrition, severe
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (10.14 - 10.19.21); COVID-19 positive (10.14.21); fully vaccinated (3.3.21) Admission Date: 10/14/2021 Discharge Date: 10/19/2021 COVID-19 Assessment & Plan Patient''s home caregiver was positive for COVID-19. Patient has been vaccinated as positive for COVID. He is room air Will discontinue remdesivir and Decadron Continue isolation during hospitalization Patient is felt to be stable from a respiratory standpoint and will discontinue further laboratory monitoring related to COVID DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Hypoxia COVID-19 Pneumonia due to COVID-19 virus HOSPITAL COURSE: The patient is an 87-year-old gentleman recently discharged from our facility for suspected urinary tract infection who returns with complaints of ongoing weakness and cough. On admission the patient was discovered to be suffering from COVID pneumonia. During the patient''s previous admission discussions were had on sending the patient to subacute rehab based on his weakness. At that time the patient was not amendable to subacute rehab and was subsequently discharged home. Family reports they have had a difficult time caring for him as they have become ill with COVID as well. The patient was initially started on Decadron, however he was quickly weaned to room air if felt to be stable from a respiratory standpoint. While hospitalized the patient has adamantly refused subacute rehab and will not go to facilities. Additionally, family has stated they are unable to care for the patient at home due to them recovering from COVID. Over the last couple days there has been talk about discharging home with home care along with discussions of hospice care. The patient and family have agreed to move the patient into hospice care. The patient will be discharged today to be admitted with Hospice.


VAERS ID: 1818063 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Cough, Headache, Pain
SMQs:, Anaphylactic reaction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none up to 1 month prior, but had COVID infection 2 months pri
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body (arms, shoulders, sides, back) aches and headache, as well as occasional odd discomfort in left side of chest, that started during the late evening of 10/14/21 and continued until the early morning of 10/16/21. Occasional mild cough that began after the aches (if i remember correctly) and continues to this day (10/26/21). I had a COVId infection in August 2021 (positive PCR test on 8/17/21). Based on my reaction to the first shot and studies indicating strong immune response to the first shot for previously infected people, Dr. recommended that I be considered for exemption to my employer''s mandate requiring 2 shots.


VAERS ID: 1818071 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-10
Onset:2021-10-14
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 2 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Bladder catheter removal, Bladder catheterisation, COVID-19, COVID-19 pneumonia, Condition aggravated, Cough, Dyspnoea, Fall, Illness, SARS-CoV-2 test positive, Urinary retention
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet allopurinol (ZYLOPRIM) 100 MG tablet ALPRAZolam (XANAX) 0.5 MG tablet Cholecalciferol (VITAMIN D-3) 5000 UNITS TABS clonazePAM (KLONOPIN) 0.5 MG tablet cloZAPine (CLOZARIL) 100 MG tablet cloZAPine (CLOZ
Current Illness: NA
Preexisting Conditions: Down syndrome Pernicious anemia Acquired hypothyroidism Gout without tophus Recurrent falls Vitamin B12 deficiency Osteoarthritis Schizophrenia
Allergies: Paliperidone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized 10.12.21-10.21.21; COVID-19 positive (10.14.21); Fully Vaccinated Admission Date: 10/12/2021 Discharge Date: Oct 20, 2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Weakness [R53.1] COVID-19 virus infection [U07.1] Pneumonia due to COVID-19 virus [U07.1, J12.82] HOSPITAL COURSE: This is a 48-year-old male with Down syndrome who lives in a home. He presented to the emergency room with cough shortness of breath weakness and recurrent falls. He was also found to have acute urinary retention in the emergency department which required Foley catheter placement. He was treated with 5 days of IV Remdesivir, Or Ceftin, and also received IV Decadron daily throughout his hospital stay. He was seen by Physical therapy during his hospital stay for his weakness and recurrent falls. I did not require oxygen during his hospital stay. He was seen by Dr, urology, who felt the urinary retention was psychogenic. The Foley catheter was removed on October 20 and the patient did not have voiding problems after was removed. When he returned to the home he no longer required quarantine. There were no changes in his medical regimen. He was at his baseline functional status similar to that prior to the onset of his acute illness.


VAERS ID: 1818180 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-27
Onset:2021-10-14
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Hospitalized due to Covid


VAERS ID: 1818211 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-10-06
Onset:2021-10-14
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Vaccine positive rechallenge, Vertigo
SMQs:, Vestibular 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: Pfizer covid 19
Other Medications:
Current Illness: No
Preexisting Conditions: History of vertigo
Allergies: None
Diagnostic Lab Data: Had an MRI after second dose
CDC Split Type:

Write-up: Vertigo after all three dose of Pfizer covid 19 vaccine. Seen by PCP. Waiting to see neurologist


VAERS ID: 1818268 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-12
Onset:2021-10-14
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, Atelectasis, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Cough, Fatigue, Goitre, Hypotension, Laboratory test abnormal, Lung opacity, Oxygen saturation decreased, Pneumonia, Pulmonary fibrosis, SARS-CoV-2 test positive, Ultrasound head, Ultrasound scan abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet amLODIPine (NORVASC) 5 MG tablet diphenhydramine-acetaminophen (TYLENOL PM EXTRA STRENGTH) 25-500 MG TABS gabapentin (NEURONTIN) 300 MG capsule levothyroxine (SYNTHROID) 100 MCG tablet lidocaine (LIDODE
Current Illness: 9.23.21: Ultrasound Head and Neck Soft Tissue (Non-toxic multinodular goiter)
Preexisting Conditions: Chronic back pain GERD (gastroesophageal reflux disease) Hyperlipemia Hypertension Hypothyroidism Arthritis Diverticular disease Gout
Allergies: Hydrocodone-acetaminophenHallucinations MorphineNausea Only, Hallucinations Hmg-coa-r InhibitorsOther, Joint Pain LovastatinMyalgia TramadolNausea Only
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (10.14-10.17); COVID-19 positive (10.14.21); Fully vaccinated Discharge Provider: Doctor Primary Care Provider at Discharge: Doctor Admission Date: 10/14/2021 Discharge Date: 10/17/2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus COVID-19 HOSPITAL COURSE: Patient is an 85-year-old female who presented to the emergency department on 10/14/2021 with chief complaint of fatigue, weakness and a cough. In the emergency department, patient was initially hypotensive. Lab work was obtained which revealed AKI. Patient was positive for COVID-19. Chest x-ray revealed streaky bilateral opacities most suggestive of infection in the left lower lobe with additional chronic atelectasis and scarring. Patient did desaturate with ambulation on room air. She was admitted to the Internal Medicine Service. She was started on Decadron. She was given gentle IV hydration with improvement in her acute kidney injury. Patient improved during her stay. PT/OT evaluated the patient recommended home with assist. Patient was recommended follow-up primary care physician. She was discharged home in stable condition.


VAERS ID: 1818316 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-12
Onset:2021-10-14
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Acute respiratory failure, Asthenia, Blood sodium decreased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Cough, Dyspnoea, Fatigue, Hypotension, Hypoxia, Lung opacity, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive, Surgery, Wheezing
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (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), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler amoxicillin (AMOXIL) 500 MG capsule fluticasone (FLONASE) 50 MCG/ACT nasal spray Fluticasone-Salmeterol,sensor, (AIRDUO DIGIHALER) 55-14 MCG/ACT AEPB lisi
Current Illness: 10.4.21 - called PCP - has mucus accumulation; cough; runny nose; congestion Hospitalization - 10.14.21 - 10.17.21: Acute Respiratory failure Seeking care again at the time of this reporting - currently in the ED 10.26.21
Preexisting Conditions: Diverticulosis Basal cell carcinoma, unspecified site Asthma Atrial fibrillation Bleeding disorder Hearing loss Heart disease Senile macular degeneration Skin cancer
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Currently in the ED 10.26.21; Hospitalized (10.14-10.17); COVID-19 positive (10.14.21); fully vaccinated Admission Date: 10/14/2021 Discharge Date: 10/17/2021 PRESENTING PROBLEM: Hypoxia [R09.02] Acute respiratory failure with hypoxia [J96.01] Pneumonia due to COVID-19 virus [U07.1, J12.82] HOSPITAL COURSE: Patient is an 85-year-old male who presented to the emergency department on 10/14/2021 with chief complaint of shortness of breath and cough. Patient is fully vaccinated with Moderna. In the emergency department, patient was hypoxemic and placed on supplemental oxygen. Lab work revealed a sodium of 126. Chest x-ray showed bilateral subtle opacities consistent with COVID 19 pneumonia. Patient was admitted to the Internal Medicine Service. Patient was started on Decadron. He was outside the window for remdesivir. Patient did improve during his stay. He was able to be weaned off of supplemental oxygen. PT/OT evaluated the patient recommended home with assist. Patient was recommended follow up his primary care physician. He was discharged home in stable condition. In ED CURRENTLY at hospital 10.26.21. Was seen in urgent care setting first: Patient is a 85 y.o. male who presents to the Urgent Care with FATIGUE (and weak covid pos 10/14 ) Patient prior to surgery today for weakness. He reports that at 14 he was admitted to the hospital for home med and discharge and 17. He reports since leaving the hospital he has worsened and developed increasing weakness. He reports that he did have a cough but this has improved. He reports that he initially also had some abdominal pain and this has also improved. He reports currently ages has generalized weakness and fatigue. He reports he is covered vaccinated. Patient reports his blood pressure was low at home. He denies any fevers, chills, chest pain, shortness of breath, nausea, vomiting, diarrhea, dysuria, urinary frequency, or any other complaints. Patient reports he has been using his home inhalers in use his rescue inhaler earlier this morning. Patient is a 85-year-old male. He is alert, oriented with no signs acute distress. Patient''s blood pressure is 103/88 for major vital signs within normal limits. On exam patient does speak clearly and in full sentences overall seems short of breath. Upper lung fields and expiratory wheezes but remainder of lung fields are clear. Abdomen soft and nontender without rebound tenderness or guarding. Posterior oropharynx is clear and patent formation membranes are moist. Her major patient exam was unremarkable. Discussed with patient are limited testing availability is here in the Urgent Care and benefits of the emergency department. Discussed with him my concerns for possible electrolyte abnormalities or worsening of the pneumonia. Patient verbalized understanding of this he like to go to bladder emergency department for further evaluation and treatment. Patient was discharged with his wife in stable condition.


VAERS ID: 1818333 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-20
Onset:2021-10-14
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Aspiration, Asthenia, COVID-19, Chest X-ray abnormal, Computerised tomogram head normal, Confusional state, Dyspnoea, Dysstasia, Gait disturbance, Hypoxia, Infection, Liver function test increased, Mental status changes, Pneumonitis aspiration, Procalcitonin normal, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive, Transaminases increased, Ultrasound liver normal, White blood cell count normal
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amiodarone (PACERONE) 200 MG tablet aspirin 81 MG tablet atorvastatin (LIPITOR) 10 MG tablet B Complex Vitamins (VITAMIN-B COMPLEX PO) cholecalciferol (VITAMIN D3) 1000 units Coenzyme Q10 (COQ10) 100 MG CAPS cyanocobalamin (VITAMIN B-12) 10
Current Illness: 10.14.21: Seen in Urgent Care - weakness, congestion, fever, altered mental status;
Preexisting Conditions: CVA (cerebral infarction) x 2 - Carotid arterial disease - R-70-90%, L- 50 % DM (diabetes mellitus) - Diet Controlled Pacemaker Hypercholesterolemia Bladder outflow obstruction - S/S Elevated PSA DDD (degenerative disc disease), lumbar Arthritis, lumbar spine PVC (premature ventricular contraction) Carotid stenosis Cardiomyopathy Mitral regurgitation Hypersomnia, organic Renal insufficiency Hypothyroidism due to medication Hypotension - Ace induced (Intolerant) Benign prostatic hyperplasia CAD in native artery Leg pain LBBB (left bundle branch block) Sigmoid volvulus Chronic combined systolic and diastolic heart failure AMS (altered mental status)
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (10.14.21 - 10.21.21); COVID-19 positive (10.14.21); Fully Vaccinated Admission Date: 10/14/2021 Discharge Date: Oct 21, 2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Transaminitis Hypoxia Generalized weakness AMS (altered mental status) COVID-19 virus infection COVID-19 HOSPITAL COURSE: Patient is an 87-year-old male with past medical history of hypothyroidism, type 2 diabetes, chronic systolic heart failure status post pacemaker, history of CVA with residual left-sided weakness, wheelchair bound who presented to the hospital with COVID-19 infection. Patient was fully vaccinated. Patient was admitted to the hospital due to altered mental status and generalized weakness in the setting of a scope infection. Patient was not hypoxic but for a brief moment during admission. The patient was globally weak and had progressive difficulty ambulating at home until the 20th brought into the ER. In the ER he was found to have elevated LFTs, general weakness. Neurology was consulted who recommended CT of the head which was unremarkable aside from chronic changes. Chest x-ray was done which showed no cardiopulmonary disease. due to his LFT elevation of the liver ultrasound was performed which showed no evidence of portal vein thrombosis. Patient was a candidate for monoclonal antibody therapy which he received and tolerated well. For about 20 the patient had an aspiration event, became more confused, and had 1 fever. Chest x-ray showed aspiration pneumonitis, white blood cell count was normal, procalcitonin was normal. Patient recovered quickly, never required oxygen. Short of breath was consulted who recommended NPO while the patient was confused, this resolved and the patient was able to advance back to a general diet prior to discharge. patient was evaluated by Physical therapy and Occupational therapy who recommended subacute rehab given the patient''s profound weakness in the setting of his recent infection. Patient was unable to stand without significant assistance. The patient''s wife and daughter were insistent that the patient would do better at home and wanted to set up home health nursing and were adamant that they can''t care for the patient better at home than at rehab. Patient''s daughter was heavily involved in the patient''s care, she was very concerned about specifically his thyroid medication and felt that missing a few doses of his thyroid medication contributed significantly to his acute decompensation in the hospital. Given has improvement in mental status, improvement in his vitals, he was afebrile, he was tolerating a general diet, and received adequate therapy for his COVID-19 infection the patient was considered stable for discharge home with home health care with the family support. I discussed with the daughter that the patient be brought back if caring for him at home becomes unsafe, overwhelming, or cumbersome for the patient and her family. Patient and family were in agreement this plan discharge home in stable condition


VAERS ID: 1818376 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-03-05
Onset:2021-10-14
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Polymerase chain reaction
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Cycle threshold of 28.1 on 10/14/21
CDC Split Type:

Write-up: Hospitalization due to COVID-19 Reported per Moderna COVID-19 Vaccine EUA


VAERS ID: 1818402 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-24
Onset:2021-10-14
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Atrial flutter, Blood magnesium decreased, Blood test abnormal, Electrocardiogram abnormal, Fatigue, Heart rate increased, Interchange of vaccine products, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Medication errors (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ? Synthroid 15mcg ? Rythmol 150mg every 8 hours ? Lopressor 100mg every 12 hours ? Cozaar 50mg every 12 hours ? Norvasc 5mg every 12 hours ? Baby Aspirin 81mg ? Calcitriol 2.5 mcg 4 days a week M,W,F,Sat ? Laxative 2 Senna twice a daily ?
Current Illness: N/A
Preexisting Conditions: kidney failure (dialysis), Atrial fibrillation (pacemaker), osteoporosis
Allergies: Compazine, sulfa medications,
Diagnostic Lab Data: Blood panel - levels normal, some abnormal because of kidney failure Thyroid - normal 10/15/2021 ECG - confirmed atrial flutter (follow up 10/27/2021)
CDC Split Type: vsafe

Write-up: First two shots were Moderna; Booster shot was Pfizer This happened way after the vaccine was given, 2-3 weeks after. I noticed my heart rate sped up and then it went into atrial flutter. I went to see the nurse practitioner and it was confirmed atrial flutter. My heart rate was 105. I felt very weak and tired. My legs were really weak. No headache. That was basically it and I was tired because the heart rate was going too fast. They upped the rythmol from 150 to 225mg every 8 hours as needed and that helped. She checked my thyroid and that was normal. We did magnesium and it was a little high but its always been that way between 0.2-0.4 for a couple months now . I had a blood panel and that was abnormal but everything else was normal, because of renal failure. We just increased rythmol and that seemed to do the trick. The outcome was helpful because I?m back to my old self but I have the increased medication. Follow up ECG 10/27/2021 Follow up with NP 11/30/2021 Received flu shot 10/6/2021


VAERS ID: 1818478 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dissociation, Dizziness, Heart rate increased, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: Metformin 600 mg twice daily Lisinopril 40 mg once daily
Current Illness: Bipolar Diso HTN Diabetes Mellitus
Preexisting Conditions: Bipolar Disorder HTN Diabetes
Allergies: none known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The client complained of "Feeling detached from her surrounding, nausea, dizzy, fatique, feeling heart rate and breathing had increased. Client was oriented, skin color pink, Vital signs: 12:59- b/p 140/100, p 92, regular rr 22, 1:00 pm b/p 140/95 p 80 rr 24. Client was moved to another room so she could put her head down. 1:15 b/p140/85 p 85 rr 22 . Client expressed she was feeling better. She expressed concerns about her daughter becoming sick once again with COVID and that she was going to be tested. She also expressed that she was going to a co-workers funeral the next day. Pt refused further medical care however was encouraged to go home early. She agreed and was escorted to her Supervisor for discharge home.


VAERS ID: 1818480 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Developed huge monkey bubble, (size of golf ball under skin where shot was injected). 5 days of pain until the bubble started to go down. Took Ibuprofen to help reduce the swelling. Pain went away in about 5 days, bubble finally reduced after 2 weeks.


VAERS ID: 1818511 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fatigue, Head discomfort, Headache, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular 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: Client confirmed none
Current Illness: None noted
Preexisting Conditions: Anaphylaxis to shellfish RNs assessed patient the day of the covid administration. Another staff member was also a witness. I made 4 attempts at calling the client were attempted on 10/14 at 03:30, 10/18 at 0130, 10/19 11:32, 10/26 at 01:30 client did not answer messages were left with my name, Health Department and Follow up with the covid vaccination.
Allergies: Shellfish-anaphylaxis
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 13:37: 90BPM (140/100)One emesis, nausea, light-headedness, tired, fatigue; 14:41 70 BPM (114/80), headache pressure/tired


VAERS ID: 1818747 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-10-08
Onset:2021-10-14
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Neck pain, Pain, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra
Current Illness:
Preexisting Conditions: Fatty Liver disease
Allergies: Plavix; Prilosec; shellfish
Diagnostic Lab Data: None
CDC Split Type: vsafe

Write-up: Pain in arm got worse and traveled to shoulder and neck, and down arm to elbow 6 days later.


VAERS ID: 1818769 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-04
Onset:2021-10-14
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035CZ14 / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna vaccine 03/21 Covid Arm
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives all over the body, started October 14th, currently on day 13. Still have hives, severity has lessened


VAERS ID: 1819179 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: moderna was stored in colder temperatures than suggested. Contacted moderna, vaccine is viable.


VAERS ID: 1819180 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: moderna was stored in colder temperatures than suggested. Contacted moderna, vaccine is viable.


VAERS ID: 1819183 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna was stored in colder temperatures than suggested. Contacted Moderna, vaccine is viable.


VAERS ID: 1819210 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Hypoaesthesia, Increased appetite, Injection site hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Numbness at shot site and entire arm for approximately 8 hours. Chills on and off for 2 days. Weakness and excessive appetite even when full for 23days.


VAERS ID: 1819232 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 8841 / UNK LA / SYR

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

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

Write-up: The patient was administered a COVID shot without consent. The patient had been scheduled a flu vaccination. Once arriving at the Pharmacy, the provider did not confirm any information, gave the patient the shot, and only afterwards realized a mistake had been made.


VAERS ID: 1819390 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Listless, Malaise, Mobility decreased, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (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), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Baby Asprin 81mg Hydrochlorathiazide 12.5mg Methimazole 5mg, Lisinopril 20mg. Krill Oil 750mg Schiff MegaRed
Current Illness: none. Received a seasonal flu vaccine about 05 Oct 2021
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Symptoms: Fever of 103F for four days, onset one day after vaccination. Nausea, listlesness, generally ill and bedridden


VAERS ID: 1820441 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Maternal exposure during pregnancy, Product administered to patient of inappropriate age
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: administered to a patient 17 years of age; Pregnant; This spontaneous prospective pregnancy case was reported by a nurse and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (administered to a patient 17 years of age) and MATERNAL EXPOSURE DURING PREGNANCY (Pregnant) in a 17-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 019F21A) for COVID-19 vaccination. No Medical History information was reported. On 14-Oct-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. The patient''s last menstrual period was on an unknown date and the estimated date of delivery was 31-Mar-2022. On 14-Oct-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (administered to a patient 17 years of age) and MATERNAL EXPOSURE DURING PREGNANCY (Pregnant). On 14-Oct-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (administered to a patient 17 years of age) and MATERNAL EXPOSURE DURING PREGNANCY (Pregnant) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. ? No treatment information was provided. No underlying medical conditions identified. CC:This case concerns a 17 year old pregnant female with unknown LMP, EDC and weeks gestation and no reported history who experienced the non-serious unlisted events of Maternal exposure during pregnancy and Product administered to patient of inappropriate age the day of dose 1 of mRNA-1273. Re-challenge is not applicable as dose 2 not scheduled yet. Benefit-risk relationship of mRNA-1273 is not affected by this report.; Sender''s Comments: This case concerns a 17 year old pregnant female with unknown LMP, EDC and weeks gestation and no reported history who experienced the non-serious unlisted events of Maternal exposure during pregnancy and Product administered to patient of inappropriate age the day of dose 1 of mRNA-1273. Re-challenge is not applicable as dose 2 not scheduled yet. Benefit-risk relationship of mRNA-1273 is not affected by this report.


VAERS ID: 1820450 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 3 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Accidental overdose, Bedridden, Chills, Contusion, Feeling of body temperature change, Headache, Illness, Neck pain, Nervousness, Off label use, Vaccination site discolouration, Vaccination site mass, Vaccination site pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Drug abuse and dependence (broad), Accidents and injuries (narrow), Arthritis (broad), Medication errors (narrow), 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: Latex allergy (medication sensitivities including latex)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: lump where shot was given; lump is discolored/initially was reddishpurple but now is reddish-brown like a bruise.; now is reddish-brown like a bruise; stayed in bed all day; became sick for 3 days; back of her neck was hurting; got hot and cold; had chills; top of her head was hurting/headache; injection site pain under left arm; Accidental overdose; Off label use; got nervous; This spontaneous case was reported by a consumer and describes the occurrence of NERVOUSNESS (got nervous), ILLNESS (became sick for 3 days), NECK PAIN (back of her neck was hurting), FEELING OF BODY TEMPERATURE CHANGE (got hot and cold) and BEDRIDDEN (stayed in bed all day) in a 71-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 048F21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Latex allergy (medication sensitivities including latex). On 14-Oct-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 14-Oct-2021, the patient experienced NERVOUSNESS (got nervous), ACCIDENTAL OVERDOSE (Accidental overdose) and OFF LABEL USE (Off label use). On 15-Oct-2021, the patient experienced ILLNESS (became sick for 3 days), NECK PAIN (back of her neck was hurting), FEELING OF BODY TEMPERATURE CHANGE (got hot and cold), CHILLS (had chills), HEADACHE (top of her head was hurting/headache) and VACCINATION SITE PAIN (injection site pain under left arm). On 16-Oct-2021, the patient experienced BEDRIDDEN (stayed in bed all day). On 18-Oct-2021, the patient experienced VACCINATION SITE MASS (lump where shot was given), VACCINATION SITE DISCOLOURATION (lump is discolored/initially was reddishpurple but now is reddish-brown like a bruise.) and CONTUSION (now is reddish-brown like a bruise). The patient was treated with PARACETAMOL (TYLENOL) for Headache, at a dose of UNK, qid. On 14-Oct-2021, ACCIDENTAL OVERDOSE (Accidental overdose) and OFF LABEL USE (Off label use) had resolved. In October 2021, ILLNESS (became sick for 3 days) had resolved. On 18-Oct-2021, BEDRIDDEN (stayed in bed all day) was resolving. At the time of the report, NERVOUSNESS (got nervous), NECK PAIN (back of her neck was hurting), FEELING OF BODY TEMPERATURE CHANGE (got hot and cold), VACCINATION SITE MASS (lump where shot was given), VACCINATION SITE DISCOLOURATION (lump is discolored/initially was reddishpurple but now is reddish-brown like a bruise.), CONTUSION (now is reddish-brown like a bruise), CHILLS (had chills), HEADACHE (top of her head was hurting/headache) and VACCINATION SITE PAIN (injection site pain under left arm) outcome was unknown. Concomitant medications were not reported. Patient lump was about the size of a dime. The patient has gained 25 lbs. This case was linked to MOD-2021-355953 (Patient Link).


VAERS ID: 1820657 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 LA / IM

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

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

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


VAERS ID: 1820681 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / IM

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

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

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


VAERS ID: 1820682 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / IM

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

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

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


VAERS ID: 1820899 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 LA / IM

Administered by: Pharmacy       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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1820901 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 LA / IM

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

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

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


VAERS ID: 1820942 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-15
Onset:2021-10-14
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chronic obstructive pulmonary disease, Condition aggravated, Cough, Dyspnoea, Fibrin D dimer increased, Myocardial necrosis marker, Oxygen saturation decreased, Pain, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Current Home Medications 1. aspirin 81 mg oral tablet : 1 tab(s) orally once a day 2. atorvastatin 40 mg oral tablet : 1.5 tab(s) orally once a day 3. carvedilol 12.5 mg oral tablet : 1 tab(s) orally 2 times a day 4. Entresto 49 mg-51 mg or
Current Illness:
Preexisting Conditions: COPD CHF hyptertension
Allergies: none known
Diagnostic Lab Data: 9:21 PM patient will have an IV established and some baseline blood work including cardiac enzymes and D-dimer. He will have chest x-ray and given Decadron for respiratory disport. He was placed on supplemental oxygen and his oxygen saturations are in the high 80s at the present time. He seems to be resting comfortably. He will require admission for further care and treatment. 11:07 PM patient remains comfortable and is oxygenating at 92% on 4 L nasal cannula. Blood work does reveal an elevated D-dimer of over 3000 which will necessitate CTA of the chest for further evaluation to rule out underlying pulmonary embolism. Patient will be admitted for further care and treatment
CDC Split Type:

Write-up: Patient is a 71-year-old male who tested positive for Covid 7 days ago. Began having cough and shortness of breath 2 weeks ago. He was seen in the emergency room 7 days ago and treated for COPD but he ultimately tested positive for Covid. Patient did go through a course of Levaquin and steroid. He presents back to the emergency room tonight concerned about decreasing oxygen levels despite being on home O2 at 4 L. Patient states his oxygen saturations were in the low 70s at home on oxygen. He increased his oxygen to 4 L/min however his oxygen saturations only went up to 84%. Patient presented to the emergency room by private auto and his oxygen level on presentation was 60%. He denies fever or chills. He does admit to some generalized aches and pains and generalized weakness. Denies chest pain. Patient also has a history of COPD, congestive heart failure and hypertension.


VAERS ID: 1821036 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-12
Onset:2021-10-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Pelvic pain, Swelling, Vaginal haemorrhage
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control, ibuprofen
Current Illness: NA
Preexisting Conditions: NA
Allergies: Flagyl, Keflex, tree nuts, stone fruits, salmon, scallops
Diagnostic Lab Data:
CDC Split Type:

Write-up: I am having severe vaginal bleeding, pelvic pain, and swelling.


VAERS ID: 1821049 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Musculoskeletal stiffness, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, vitamin D-3, Nortriptyline 50 mg od, Biotin, multivitamin, Calcium with vit D, omeprazole, estradiol transdermal patch, singulair, famotidine 40 mg od, Flonase, baclofen 10 mg bd
Current Illness: no
Preexisting Conditions: asthma, MS, migraines, acid reflux
Allergies: Phenergan, penicillin
Diagnostic Lab Data: no
CDC Split Type: vsafe

Write-up: The day after the vaccination, 10/14/2021, arm swelled up and sore. On the 6th, the arm appeared to be more swollen, and tight and I called my PCP. He phoned in Prednisone and instructed me, if the swelling did not calm down to go the ER to check for a possible blood clot. The swelling and the tightness resolved with the Prednisone within 2 days.


VAERS ID: 1821055 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-25
Onset:2021-10-14
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Herpes zoster, Neck pain, Neuralgia, Pain, Pain in extremity, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

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

Write-up: I got a Flu Shot ten days after the third dose of the vaccine. Seventeen days after getting the vaccine I developed Shingles. I had extreme neck shoulder and arm pain. It was very bad and I thought I had a disc problem. It started on a Thursday and I developed a rash across my right chest and across my right shoulder blade and down my right arm. It was in the front and the back of my chest and back. I saw my doctor and was Prescribed Valtrex and antiviral. I saw another doctor who gave me Gabapentin for the nerve pain. It has been a little over two weeks and I still have some rash and some tiredness as well as some pain. I had Chicken Pox as a child but I had not had a Shingles Vaccine.


VAERS ID: 1821213 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 4 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Extra dose administered, Injection site pain, Palpitations, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, shortness off breath, heart palpitations, significant pain at the injection site. Effects lasted 36-48 hours and were evident after both vaccinations. I am retired military and have received many shots most people will never receive, including the full Anthrax series and Plague, but I have never had this kind of a reaction from any vaccine.


VAERS ID: 1821216 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-06
Onset:2021-10-14
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness unilateral, Blood test normal, Cerebral infarction, Echocardiogram, Echocardiogram normal, Ejection fraction, Ejection fraction decreased, Electrocardiogram normal, Gene mutation identification test negative, Laboratory test normal, Magnetic resonance imaging abnormal, Mitral valve incompetence, Protein C, Protein S abnormal, Protein S normal, Retinal artery occlusion, Retinal injury, Scan with contrast normal, Tricuspid valve incompetence, Ultrasound Doppler normal
SMQs:, Cardiac failure (narrow), Liver-related coagulation and bleeding disturbances (narrow), Haemorrhage laboratory terms (broad), Ischaemic 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), Pulmonary hypertension (narrow), Accidents and injuries (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (narrow), Retinal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: lisinopril, methylprednisolone, meloxicam
Current Illness: Lower back pain,
Preexisting Conditions: early stage hyptertension
Allergies: potential cipro allergy
Diagnostic Lab Data: Full battery of stroke tests, blood work, genetic tests, cardiograms, etc. The only abnormal finding was Protein S and Protein C activity. Antigen levels were normal, but activity and function were out of reference frame. PROTEIN S ACTIVITY ? Final result ?10/19/2021 6:48 AM ? Component Value Ref Range Performed At Pathologist Signature PROTEIN S ACTIVITY 49 77 ? 143 % PROTEIN C FUNCTION ? Final result ?10/19/2021 6:48 AM ? Component Value Ref Range Performed At Pathologist Signature PROTEIN C FUNCTIONAL 28 70 ? 130 %
CDC Split Type:

Write-up: Patient is a 39 y.o. male with PMHx significant for recently diagnosed HTN, who presented to hospital on 10/14 with sudden onset monocular vision loss in right eye s/p intra?arterial tPA injection into right ophthalmic artery. MRI showed subacute/acute small infarction in right frontal corona radiata. TEE does show potential fibroelastoma on MV leaflet but otherwise workup without obvious cause of CRAO. ?neck vessels patent?. TTE ?10/15/2021? normal left ventricular size normal left ventricular systolic function; ejection fraction ?2D? = 63% normal left ventricular diastolic function normal right ventricular size normal right ventricular function no evidence for valvular aortic stenosis minimal valvular mitral regurgitation inadequate tricuspid regurgitation to assess right ventricular systolic pressure no evidence for interatrial shunt; agitated saline contrast performed: no evidence of intracardiac or intrapulmonary shunt, color Doppler performed: no flow demonstrated no evidence for pericardial effusion Etiology: Undetermined at this time. No significant atherosclerosis. Concern for embolic origin. Vision in right eye has returned to about 95%, but some level of permanent retina damage due to the oclusion.


VAERS ID: 1821403 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 3 - / -

Administered by: Public       Purchased by: ?
Symptoms: Axillary pain, Dyspepsia, Fatigue, Headache, Heart rate increased, Immunodeficiency, Lymphadenopathy, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific dysfunction (narrow), Eosinophilic pneumonia (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Thyroid medication
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Doctor made note, recommend compression socks for the leg problem and said that since the under arm swelling had diminished since I got the second shot,ok. The same events happened with the second dose as with the booster.
CDC Split Type:

Write-up: Swelling and soreness under arm armpit., Left leg muscle soreness, headaches, racing heartbeat,acid indigestion, body soreness and fatigue.


VAERS ID: 1821572 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-02
Onset:2021-10-14
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / UNK - / -

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

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

Write-up: COVID 19


VAERS ID: 1821610 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-01
Onset:2021-10-14
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / UNK - / -

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

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

Write-up: COVID 19


VAERS ID: 1821699 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Injection site pruritus, Injection site swelling, Skin tightness
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrocortisone, Lasix, Adderall, Cymbalta, Flonase, Symbicort.
Current Illness: None
Preexisting Conditions: Steroid Dependant, Hypothyroid, Unknown Autoimmune Disorder, Hypertension, Hypercholesterolemia.
Allergies: None Known
Diagnostic Lab Data: No tests. Read that it was called Covid Arm online and didn''t go to doctor.
CDC Split Type:

Write-up: The injection site was sore much faster. By the next morning my upper arm started swelling and the muscle swelled so much my skin was tight. There was also muscle pain and the skin itched. Skin felt like it was going to bust open. It lasted about 6 days then was better each day until day 9 when it was back to normal.


VAERS ID: 1821720 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: No Adverse Event. Vaccination Administration Error: We received Moderna Vaccine on 9/2/2021 from our local health. The expiration date for Lot # 005C21A was 10/22/2021. We were under the impression that we had until 10/22/2021 to use the vaccine. The vaccine was properly stored in the refrig. with the data logger to ensure temperatures remained within range. No excursions occurred. We learned today (10/27/2021) from the local health department, that we should have discarded the vaccine (Lot # 005C21A) on 10/2/2021 (30-days after receivership with refrig. storage). We were instructed to contact Moderna, this was done today. During this call the writer was informed that we would hear Medical Affairs Team with further instructions on how to handle this matter. We have informed out local health dept of our contact to Moderna regarding this issue.


VAERS ID: 1821742 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: No Adverse Event Vaccination Administration Error: We received Moderna Vaccine on 9/2/2021 from our local health department. The expiration date for Lot # 005C21A was 10/22/2021. We were under the impression that we had until 10/22/2021 to use the vaccine. The vaccine was properly stored in the refrig. with a data logger attached to ensure temperatures remained within required range. No excursions occurred. We learned today (10/27/2021) from the local health department, that we should have discarded the vaccine (Lot # 005C21A) on 10/2/2021 (30-days after receivership with refrig. storage). We were instructed to contact Moderna Tx, LLC. this was done today. During this call this writer was informed that we would hear from the Medical Affairs Team to obtain further instructions regarding how to handle this issue.


VAERS ID: 1821843 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-09
Onset:2021-10-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Dyspnoea, Dysuria, Fatigue, Respiration abnormal, Respiratory symptom, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test negative, Secretion discharge, Urine analysis 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), Respiratory failure (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine; atorvastatin; prednisone; aspirin; zolpidem
Current Illness: None
Preexisting Conditions: COPD; Sarcoidosis
Allergies: None
Diagnostic Lab Data: 10/15/2021: Covid test-negative; urine test- negative
CDC Split Type: vsafe

Write-up: I had respiratory problems such as difficulty breathing, a lot of coughing, and I had mucus. I had some fatigue. My lungs were very loud. My breathing was very bad and loud. It sounded like a car engine. At first I went to an urgent care on 10/15/2021. I had no fever or chills, but a runny nose for several days. I had a mild cough and congestion. I didn''t have any acute distress or respiratory distress. They gave me an albuterol inhaler, and I was prescribed Cipro. Then I went to the ER on 10/16/2021. I had shortness of breath, and wheezing. They increased my prednisone to 60mg a day. I was also having difficulty urinating. I took the cipro one night and then I stopped taking the cipro because my doctor said to stop taking it because it may be the cause of my wheezing.


VAERS ID: 1821888 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Blood pressure increased, Blood test, Blood thyroid stimulating hormone normal, Computerised tomogram thorax, Computerised tomogram thorax abnormal, Decreased appetite, Dehydration, Diarrhoea, Differential white blood cell count, Dizziness, Drug screen negative, Electrocardiogram abnormal, Fatigue, Flushing, Full blood count normal, Glomerular filtration rate normal, Headache, Heart rate increased, Injected limb mobility decreased, Injection site pain, Insomnia, Limb discomfort, Metabolic function test, Metabolic function test normal, Migraine, Myalgia, Nausea, Neck pain, Pain, Pain in extremity, Palpitations, Paraesthesia, Pyrexia, SARS-CoV-2 test negative, Sinus tachycardia, Taste disorder, Tremor, Troponin I, Troponin I normal, Urine analysis normal, Ventricular extrasystoles, Weight decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Ventricular tachyarrhythmias (narrow), Pseudomembranous colitis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow), Hypokalaemia (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: daily vitamin
Current Illness: None
Preexisting Conditions: Asthma, IBS
Allergies: shrimp, kiwi, sulfa antibiotics, miconazole
Diagnostic Lab Data: CT CTA THORAX W/WO CONTRAST 10/20/2021 DRUG SCREEN COMPREHENSIVE URINE 10/20/2021 POINT OF CARE TESTING PANEL 10/20/2021 CBC WITH DIFFERENTIAL 10/20/2021 BASIC METABOLIC PANEL 10/20/2021 TSH 10/20/21 TROPONIN I 10/20/2021 EGFR 10/20/21 ECG 12-LEAD 10/20/2021 BASIC METABOLIC PANEL 10/18/2021 CBC WITH DIFFERENTIAL 10/18/2021 URINALYSIS AUTO ONLY 10/18/2021 POCT SARS-COV-2, ANTIGEN 10/18/2021
CDC Split Type:

Write-up: First afternoon: weird taste in mouth, tingling hand, pain in arm (hurts to lift and heavy feeling), dizzy, fever of 99 F (norm is 97.7). Day 2: Difficulty sleeping night before, arm hurt to even touch from shoulder to elbow, headache which turned into a migraine by the end of the day, pulse ranged from 85 to 104 bpm while sitting (normal pulse mid-60s to mid-70s resting) , skin pink and flushed (legs, arms, stomach, chest, face, etc.), loss of appetite and nausea. Tremors in hands. Pain in neck. Day 3: Difficulty sleeping continued, arm starting to feel better, head still hurt, still no appetite (down 2.4 lbs), still fever of 99.1. High pulse and tremors in hands and arms. Day 4: Difficulty sleeping still. Temperature was normal that morning. Arm hurt way worse all the way from my deltoid to my shoulder. I could barely use my arm. Pulse still will not go down below 85 bpm. Tremors in hands especially bad when I woke up and my heart felt like it was racing. Still flush. Decided to take blood pressure, it came up as 189/111 on my wrist blood pressure monitor, double checked it using a arm blood pressure reader about a half hour later it came up as 129/86. Which is still a lot higher than my normal but closer. Ate some lunch which caused diarrhea within the hour. Day 5: Still difficulty sleeping, pulse still high, arm hurts up in the shoulder and between where my shoulder meets my body. Called Teledoc who told me to go to Urgent Care. My temperature there was 99.1. They ran several tests such as bloodwork, covid test, urinalysis, and EKG. The PA said test were normal all but the EKG stating I have PVCs and she referred me to a cardiologist. Day 6: Still difficult sleeping, arm finally feeling almost back to normal, weighed in at 130 lbs (3.8 lbs less than normal), temperature of 99.3, pulse still really high. Day 7: Slep even less, heart was pounding, decided to go to the hospital. When I arrived heart rate was at 145 bpm and a blood pressure of 132/99. I was admitted. They ran a bunch of tests and put me on an IV. The IV seemed to be helping. Apparently I was very dehydrated. They said I had Sinus Tachycardia. I was feeling better and blood pressure and pulse were back to acceptable levels so they discharged me. Still tired but feeling better afterwards. Day 8: Still exhausted. Pulse getting down into the 70s if I stay still, but if I do anything like wash dishes it''s back up to around 130 bpm. Eating more normal now.


VAERS ID: 1821943 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site pruritus, Injection site rash, Injection site swelling, Injection site warmth, Muscular weakness, Skin tightness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

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

Write-up: From date I got the vaccine, I had a quarter sized welt at the injection site for about four to five days and on the sixth day, it became half dollar size and increasingly and still red and hard. It itched very badly for about 12 days. After the 12th day, I could tell the site was more swollen, my skin was very tight, and my arm felt weak. That night, it was very uncomfortable for me to go to bed (aching, throbbing, and numbness). On the 13th day, I noticed the area was now the size of my hand, still very hot, and painful to the touch. The site also had a ring where my golf ball bump was and where it looked like whatever was causing the stress ?popped? under my arm and now it looks like I have a puddle on my upper arm.


VAERS ID: 1821989 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Eye disorder, Hyperhidrosis, Hypotension, Nervousness, Presyncope
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Corneal disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Patient admitted she was very nervous for vaccine. Took a moment to calm down. After receiving vaccine started feeling dizzy, trouble keeping eyes open. Moved patient to a private area. Provided water and apple juice. Took BP. 94/63 mmHg. Patient requested ice packs because feeling sweaty and diaphoretic. Provided ice packs. Repeat BP 101/75 mmHg. Patient is a young healthy female, likely low baseline BP. Patient reported feeling better and departed. Likely vasovagal response due to being nervous and "insult" of needle in arm.


VAERS ID: 1823387 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-10-14
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Hypoaesthesia, Magnetic resonance imaging, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 202110; Test Name: MRI; Result Unstructured Data: Negative; Test Date: 202110; Test Name: MRI; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20211051989

Write-up: LEFT ARM STARTED LOSING FEELING AND STRENGTH/LOST AROUND EIGHTY PERCENTAGE OF STRENGTH IN FINGERS; LEFT WRIST FOREARM FEELS NUMB ALONG WITH REAR DELTOID MIDDLE DELTOID/RIGHT PINKY FEELING A BIT NUMB; This spontaneous report received from a patient via a company representative concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 09-OCT-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On OCT-2021, Laboratory data included: MRI (NR: not provided) Negative, Negative. On 14-OCT-2021, the patient experienced left arm started losing feeling and strength/lost around eighty percentage of strength in fingers. On 14-OCT-2021, the patient experienced left wrist forearm feels numb along with rear deltoid middle deltoid/right pinky feeling a bit numb. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from left wrist forearm feels numb along with rear deltoid middle deltoid/right pinky feeling a bit numb, and left arm started losing feeling and strength/lost around eighty percentage of strength in fingers. This report was non-serious.


VAERS ID: 1823635 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-03-15
Onset:2021-10-14
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 2 LA / OT

Administered by: Work       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LIPITOR; ACCUPRIL; CHLORTHALIDONE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cholesterol (Under control); Hypertension (Under control)
Allergies:
Diagnostic Lab Data: Test Date: 20211014; Test Name: PCR; Test Result: Positive ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC202101383206

Write-up: Tested positive for Covid 19; Tested positive for Covid 19; This is a spontaneous report from a contactable consumer or other non hcp (patient). A 50-years-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), dose 1 intramuscular, administered in Arm Right on 22Feb2021 (at the age of 50 years) (Batch/Lot Number: EL3247) as DOSE 1, SINGLE, dose 2 intramuscular, administered in Arm Left on 15Mar2021 (Batch/Lot Number: EL3247) as DOSE 2, SINGLE for covid-19 immunization at Workplace clinic. Medical history included hypertension (Under control), cholesterol from an unknown date and unknown if ongoing). Concomitant medication included atorvastatin calcium (LIPITOR) taken for an unspecified indication, start and stop date were not reported; quinapril hydrochloride (ACCUPRIL) taken for an unspecified indication, start and stop date were not reported; chlorthalidone taken for an unspecified indication, start and stop date were not reported. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had been tested for COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. On 14Oct2021 07:00 the patient experienced tested positive for covid 19. The patient underwent lab tests and procedures which included sars-cov-2 test: positive on 14Oct2021 Nasal Swab. The patient did not receive any treatment for the adverse events. The clinical outcome of the event was recovering at the time of report. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1824844 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Error: Wrong Dose of Vaccine - Too High-


VAERS ID: 1825071 (history)  
Form: Version 2.0  
Age: 1.08  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-11
Onset:2021-10-14
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Anxiety, Cardiac stress test normal, Chest discomfort, Chest pain, Computerised tomogram abdomen normal, Dizziness, Dysphonia, Dyspnoea, Echocardiogram normal, Fatigue, Headache, Heart rate increased, Hypertension, Joint stiffness, Malaise, Muscle spasms, Myocardial necrosis marker normal, Scan with contrast normal
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: See continuation page for medications
Current Illness: See continuation page for health status
Preexisting Conditions: See continuation page for health status
Allergies: Ranitidine
Diagnostic Lab Data: Nuclear Stress Test and Echo did not demonstrate cardiac compromise; Cardiac enzymes were negative; Abdominal CT did not show anything acute.
CDC Split Type:

Write-up: Symptoms: Chest Tightness/Pain, Shortness of Breath, Raspy Voice, Elevated Heart Beat, Elevated Blood Pressure, Stomach Pain, Muscle Cramps, Joint Stiffness, Headache, Dizzy, Anxiety, Tired, Overwhelming Feeling of being Unwell. Treatment: Admitted to Hospital Emergency Room 10/21/2021 @ 10:00 AM, Released 10/23/2021 @ 12:19 PM. Treatment: STOP Amlodipine-Atorvastatin 10-40, START Amlodipine Besylate 10mg, START Atorvastatin Calcium 80mg, START Pantoprazole Sodium 40mg X2.


VAERS ID: 1825220 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-08
Onset:2021-10-14
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 LA / SYR
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acoustic stimulation tests abnormal, Meniere's disease, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hearing impairment (narrow), Vestibular disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prefer not to list
Current Illness: No
Preexisting Conditions: Lyme disease; heart condition
Allergies: Dust; pollen; naproxen
Diagnostic Lab Data: Hearing test results showed Meniere''s disease
CDC Split Type: vsafe

Write-up: I am not sure that they are related, but I was recently diagnosed with Meniere''s disease. I had body aches, a very slight fever that lasted for about 18 hours. I saw my ENT and that is how I was diagnosed.


VAERS ID: 1825241 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-09
Onset:2021-10-14
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast inflammation, Breast pain, Breast swelling, Erythema, Immunodeficiency, Mammogram, Mastitis, Ultrasound scan
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Lipodystrophy (broad), Functional lactation disorders (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rosuvastatin, fish oil, multivitamins, Vitamin D 3
Current Illness: None
Preexisting Conditions: Hypercholesterolemia No other health issues
Allergies: None
Diagnostic Lab Data: Mammogram and breast ultrasound done on Oct 26. ( Negative for cancer)
CDC Split Type:

Write-up: 5 days after receiving COVID booster, inflammation of Left breast in me (65 year old woman) including redness, pain and swelling. 5 Days after symptoms developed, I was examined by Gynecologist and mastitis was diagnosed and treated with antibiotics.


VAERS ID: 1825293 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PERMETHRIN 5 % CREAM, METHIMAZOLE 5 MG , HYDROCODONE 5/325 MG, MOTRIN 600 MG, CIPRO 500 MG, DIFLUCAN 150 MG,
Current Illness: PERMETHRIN 5 % CREAM, METHIMAZOLE 5 MG , HYDROCODONE 5/325 MG, MOTRIN 600 MG, CIPRO 500 MG, DIFLUCAN 150 MG,
Preexisting Conditions: NKA
Allergies: PENICILLIN
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT HAD RASH EMERGE ALL OVER BODY, PT WENT TO DR AND GOT BLOOD WORK DONE. NO ABNORMALITIY IN BLLOD WORK FOUND. PT RECEIVED LORATADINE 10 MG QD


VAERS ID: 1825326 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adnexa uteri pain, Arthritis, Condition aggravated, Crohn's disease, Fatigue, Hyperhidrosis, Immunodeficiency, Malaise, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Gastrointestinal premalignant disorders (narrow), Ischaemic colitis (broad), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cimzia, Famodine, Losartan, vitamin D
Current Illness: none
Preexisting Conditions: Chron''s disease
Allergies: Penicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 24 hours after 3rd injection, had a fever, sweating and body aches that lasted a day. A week later I had a mild crohn''s and arthritis flare up with extreme fatigue and ovarian pains that lasted all week. Just felt unwell overall.


VAERS ID: 1825381 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-10-08
Onset:2021-10-14
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Dizziness, Fatigue, Hypoaesthesia, Muscular weakness, Pain in extremity, Palpitations, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu and Tetanus given same time in September 2020
Other Medications: Calcium, Vitamin D, Vitamin A, B complex, Collagen, zinc
Current Illness: none
Preexisting Conditions: osteopenia, melanoma (resected with clear margins)
Allergies: prior reaction to flu and tetanus vaccine (similar symptoms) , otherwise no allergies
Diagnostic Lab Data: No tests, went to PCP and he referred me to Neurology. Unfortunately long waiting list to get it. Appointment isn''t until January 6th.
CDC Split Type:

Write-up: The morning of the 14th woke up with numbness/tingling in feet with pain in legs, 15th tingling started in lower legs with same pain in legs, 16th tingling all the way up thighs and in hands, had palpitations numerous times through the day, felt like I was going to pass out several times, even while sitting, legs felt very fatigued 17th palpitations went away, but all other symptoms remained the same for several days. When walking up stairs, legs felt very fatigued and I would get burning in the muscles to the point I could only climb 1 flight of stairs before having to rest my legs. Tingling in my hands went away around the 25th. Tingling in upper legs went away around the same time, but the tingling in the feet and lower legs is still present today. Fatigue/weakness in legs improving. Now able to climb 2 flights of stairs with only minimal fatigue, no more burning in the muscles.


VAERS ID: 1825420 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-02
Onset:2021-10-14
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Anticoagulant therapy, Cor pulmonale, Cyanosis, Deep vein thrombosis, Dyspnoea, Dyspnoea exertional, Intensive care, Peripheral swelling, Pulmonary embolism, Scan with contrast abnormal, Thrombectomy, Thrombolysis, Ultrasound Doppler abnormal
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (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), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH of daily tobacco use (25 pack years) and provoked PE/DVT in his early 20''s due to testosterone therapy
Allergies:
Diagnostic Lab Data: CTA chest w/ contrast 10/24/21; Venous Doppler lower extremities 10/24/21; No D-dimer collected.
CDC Split Type:

Write-up: Presented to ED on 10/24 with complaints of worsening dyspnea and peripheral cyanosis. Only recent potential provoking factor identified was receiving 3rd dose of Pfizer mRNA COVID vaccine approximately 22 days prior. Reported 10 days of LLE swelling and 5 days of worsening dyspnea on exertion. CTA chest showed nonocculsive saddle PE with extensive clot burden, cor pulmonale, and possible pulmonary infarction in RUL. Venous doppler showed acute non-occlusive DVT in the RLE. Underwent direct pulmonary thrombectomy and transcatheter thrombolysis on 10/25 with Interventional Radiology. Transferred to ICU due to acute hypoxic respiratory failure after procedure. Started therapeutic anticoagulation with Heparin IV, then transitioned to Apixaban DVT treatment dosing (10mg BID x 7 days, then 5 mg BID).


VAERS ID: 1825496 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-12
Onset:2021-10-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Laboratory test, Lymphadenitis, Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: none
Allergies: Penicillin
Diagnostic Lab Data: I was got some test in order to know this situation.
CDC Split Type:

Write-up: Two days after I got the vaccination I noticed inflammation in the left part of my throat, since that day there are 13 days with inflammation of swollen glands. or lymph nodes.


VAERS ID: 1825627 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO186 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Axillary pain, Breast pain, Lymphadenopathy, Tenderness
SMQs:, Lipodystrophy (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, age 20, swollen airways
Other Medications: Remicade; Actonel; Calcium/Mag/Vit D
Current Illness: None
Preexisting Conditions: Ulcerative Colitis; Advanced Osteoporosis; Fibromyalgia
Allergies: Penicillan; Erythromycin; Flu Shot
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph nodes in left armpit; pain and tenderness to touch in left armpit and side of left breast; some tenderness in right armpit when touched Resolved 7 days after vax


VAERS ID: 1825679 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO186 / 3 LA / IM

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

Write-up: Client complained of itchy, red bumps on left arm after vaccine administration. Benadryl administered. No other symptoms observed. Client felt better after 30 minutes observation period.


VAERS ID: 1825862 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF3184 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Condition aggravated, Electrocardiogram normal, Fatigue, Pain, Palpitations, Skin swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Dose 2-felt fatigue
Other Medications: Omeprazole 20mg 1xday , Amitrittylin 10mg 1xday, Linsopril 10mg 1xday, Synthorid 50mcg 1xday
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: EKG was normal . EKG done 10/28/21- Wasn''t perfect so getting CT scan November 15th, 2021
CDC Split Type: vsafe

Write-up: I was achy took tylenol that relieve it. Got chest pains and heart palpitations, so came and went. Face is also puffy and fatigue. Went to ER


VAERS ID: 1825864 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-28
Onset:2021-10-14
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Occult blood positive
SMQs:, Haemorrhage laboratory terms (narrow), Gastrointestinal haemorrhage (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: EMERGEN-C vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: vagicaine
Diagnostic Lab Data: FIT (fecal occult blood by fit) - positive on 10/14/2021
CDC Split Type: vsafe

Write-up: I just had a FIT (Fecal Immune Test) test that you take every year for blood in your stool, and that was in the first week of October, and I was notified that it came back positive for blood. I haven''t gone yet to see if there''s anything inside my colon. Who knows if it''s related, but I have never had a positive FIT test and I''ve been taking them for years. Updates to come.


VAERS ID: 1826277 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-17
Onset:2021-10-14
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood potassium normal, COVID-19, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Cough, Dyspnoea, Fatigue, Fibrin D dimer increased, Haematocrit increased, Haemoglobin normal, Haemoptysis, International normalised ratio increased, Lung infiltration, Lung opacity, Malaise, Pleural effusion, SARS-CoV-2 test positive
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Warfarin, vitamin B12, levothyroxine, irbesartan, Norco, amlodipine
Current Illness:
Preexisting Conditions: arthritis, atrial fibrillation, eczema, degeneration of lumbar intervertebral disc, lumbar spinal stenosis, GERD, gout, hypertension, hypothyroidism, sleep apnea, skin neoplasm, erectile dysfunction,
Allergies: donepezil, atorvastatin, gabapentin, metoprolol succinate, verapamil
Diagnostic Lab Data: 10/28/21 Hemoglobin: 10.2; hematocrit: 32.3 INR: 2.2 (on warfarin for AFib) D-dimer: 1.17 Potassium: 3.6 Chest X-ray: pulmonary infiltrates CT PE: No evidence of pulmonary embolism; bilateral pulmonary ground glass opacities; small pleural effusions
CDC Split Type:

Write-up: Patient became ill approximately 2 weeks prior to presentation to the ED. Initial symptoms were cough and fatigue. Patient presented to ED with complaints of hemoptysis and shortness of breath. Patient tested positive for COVID-19 on 10/20/21 as an outpatient. Patient has received a fluid bolus and will be admitted to the hospital.


VAERS ID: 1826466 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Headache, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Actos Benicar Dulera Lipitor Metformin Norvasc Pepcid Singulair Wellbutrin Zoloft Vitamin D
Current Illness: None
Preexisting Conditions: Asthma Depression Type 2 Diabetes High blood pressure
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Woke up at 3am with a very severe headache 10 hours after the shot. Lasted all day and I was nauseated and vomiting I called the doctor on call and was told to take Tylenol which I did and started to feel better. The headache lasted for two more days but not nearly as intense


VAERS ID: 1827416 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Vaccination site erythema, Vaccination site induration, Vaccination site pain, Vaccination site pruritus, Vaccination site swelling
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.MOD20213

Write-up: arm tight, arm hard; arm sore; she woke up with her arm 3x its size; arm itchy; arm red; headache; arm where she got the injection became swollen; arm where she got the injection became sore; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE INDURATION (arm tight, arm hard), VACCINATION SITE PAIN (arm sore), VACCINATION SITE SWELLING (she woke up with her arm 3x its size), VACCINATION SITE PRURITUS (arm itchy) and VACCINATION SITE ERYTHEMA (arm red) in a 26-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 14-Oct-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 14-Oct-2021, the patient experienced VACCINATION SITE SWELLING (arm where she got the injection became swollen) and VACCINATION SITE PAIN (arm where she got the injection became sore). On 16-Oct-2021, the patient experienced HEADACHE (headache). On 21-Oct-2021, the patient experienced VACCINATION SITE INDURATION (arm tight, arm hard), VACCINATION SITE PAIN (arm sore), VACCINATION SITE SWELLING (she woke up with her arm 3x its size), VACCINATION SITE PRURITUS (arm itchy) and VACCINATION SITE ERYTHEMA (arm red). At the time of the report, VACCINATION SITE INDURATION (arm tight, arm hard), VACCINATION SITE PAIN (arm sore), VACCINATION SITE SWELLING (she woke up with her arm 3x its size), VACCINATION SITE PRURITUS (arm itchy), VACCINATION SITE ERYTHEMA (arm red), VACCINATION SITE SWELLING (arm where she got the injection became swollen), VACCINATION SITE PAIN (arm where she got the injection became sore) and HEADACHE (headache) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No relevant concomitant medications were reported. No treatment information was provided.


VAERS ID: 1827475 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenopia, Feeling abnormal, Limb discomfort, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (broad), Corneal disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101374915

Write-up: heaviness in legs; tingling; droopiness in face,he doesn''t know if it''s drooping,; feels like her eye is heavy and not closing all the way; This is a spontaneous report from a Pfizer sponsored program. A contactable pharmacist reported that a 46-year-old female patient received bnt162b2 (COMIRNATY), dose 1 via an unspecified route of administration, administered in Arm Left on 14Oct2021 12:45 (Batch/Lot Number: FF2587; Expiration Date: 01Dec2021) as DOSE 1, SINGLE for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. On 14Oct2021, the patient experienced heaviness in legs, tingling, droopiness in face, feels like her eye is heavy and not closing all the way. The events were assessed as serious (medically significant). The outcome of the events was unknown. Follow-up attempts are completed. No further information is expected.; Sender''s Comments: Based on the information currently available, The casual association between the reported events Heaviness in leg, Tingling, Feeling abnormal, Eyes heavy feeling of with suspected vaccine BNT162B2 cannot be completely excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate


VAERS ID: 1827490 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Neck pain, Oropharyngeal discomfort, Pain, Pelvic pain, Pulmonary pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (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: LISINOPRIL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101380315

Write-up: Neck sore; Headache; extremely tired; feverish; achy all over; pelvis/hip joints ached all day; pelvis/hip joints ached all day; Aching in lungs late in day and sharpness in throat when I took a deep breath; Aching in lungs late in day and sharpness in throat when I took a deep breath; This is a spontaneous report from a contactable consumer or other non hcp. A 39-year-old female patient received third dose of BNT162B2 (BNT162B2), via an unspecified route of administration, administered in Arm Left on 13Oct2021 at 12:00 (Batch/Lot number was not reported) as DOSE 3 (BOOSTER), SINGLE for covid-19 immunization. Medical history included High blood pressure from an unknown date. The patient previously received first dose of BNT162B2 on Jan2021 (Batch/Lot No: Unknown. Not available/provided to reporter at the time of report completion) and second dose of BNT162B2 on 05Feb2021 (Batch/Lot No: Unknown. Not available/provided to reporter at the time of report completion) for Covid-19 immunization. Concomitant medication included influenza vaccine (INFLUENZA) taken for an unspecified indication from Feb2021 and lisinopril (LISINOPRIL) taken for an unspecified indication, start and stop date were not reported. The patient experienced neck sore, headache, extremely tired, feverish, achy all over, pelvis/hip joints ached all day and aching in lungs late in day and sharpness in throat when I took a deep breath on 14Oct2021. Outcome of the events was recovered on unspecified date. The lot number for the vaccine, BNT162B2, was not provided and will be requested during follow up.


VAERS ID: 1827499 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101381299

Write-up: red areas on face with swelling of lips; red areas on face with swelling of lips; This is a spontaneous report from a contactable pharmacist. A 32-year-old non-pregnant female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), dose 2 intramuscular, administered in Arm Left on 14Oct2021 (Batch/Lot Number: FE3592) (at the age of 32 years) as DOSE 2, SINGLE for covid-19 immunisation. The patient medical history and concomitant medications were not reported. Historical vaccine included bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), dose 1 on unknown date for covid-19 immunisation. It was unknown if the patient received any other vaccines within 4 weeks prior to the COVID vaccine. The patient experienced red areas on face with swelling of lips on 14Oct2021 with outcome of recovered on Oct2021. Benadryl was used for the event. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, it was unknown if the patient been tested for COVID-19 No follow-up attempts are possible. No further information is expected.


VAERS ID: 1827500 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Chills, Dizziness, Eye pain, Fatigue, Headache, Nausea, Ocular discomfort, Pain, Pain in extremity, Peripheral swelling, Throat tightness, Vomiting
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Vestibular disorders (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LEVOTHYROXINE SODIUM; MULTIVITAMINS [ASCORBIC ACID;ERGOCALCIFEROL;FOLIC ACID;NICOTINAMIDE;PANTHENOL;RETINOL;RIBOFLAVIN;THI; HAWTHORNE BERRY; CALCIUM; BIOTIN; FISH OIL; IRON; CRANBERRY EXTRACT [VACCINIUM MACROCARPON]; D-MANNOSE
Current Illness: Anemic (Had for 20 years, after she had kids.); Asthma (Had it for past 20 years)
Preexisting Conditions: Medical History/Concurrent Conditions: Autoimmune disorder; COVID-19
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101381302

Write-up: throwing up; chills; headache; eyeballs are being stabbed; has weird sensation in her throat and chest, "like a tightening feeling"; body ache; joint hurting; tired; Woozy; Arm hurting; Feels like being stabbed in the eyeballs; has weird sensation in her throat and chest, "like a tightening feeling"; nausea; arm swelled up; This is a spontaneous report from a contactable consumer(Patient). A 54-years-old female patient received booster dose of bnt162b2 (BNT162B2, PFIZER-BIONTECH COVID-19 VACCINE, Formulation: solution for injection, Batch number: not reported/Lot Number: FF2589), via an unspecified route of administration, administered in Arm Left on 14Oct2021, at 11:15 (Age at the vaccination 54-years-old), as DOSE 3 (BOOSTER), SINGLE for covid-19 immunization. Medical history included ongoing asthma and anaemia which had it for past 20 years, after she had kids, covid-19 from 2020 to an unknown date (had covid last year), autoimmune disorder from an unknown date and unknown if ongoing. Concomitant medications included levothyroxine sodium (LEVOTHYROXINE SODIUM, 125 ug, 1x/day, Lot number: 3110365, Expiration: Aug2022), ascorbic acid, ergocalciferol, folic acid, nicotinamide, panthenol, retinol, riboflavin, thiamine hydrochloride (MULTIVITAMINS [ASCORBIC ACID;ERGOCALCIFEROL;FOLIC ACID;NICOTINAMIDE;PANTHENOL;RETINOL;RIBOFLAVIN;THIAMINE HYDROCHLORIDE], Lot number: 16075202, Expiration: Mar2024), crataegus spp. fruit (HAWTHORNE BERRY, 565 mg, 1x/day, Lot number: B244816), calcium (CALCIUM, 600 mg, Lot number: 203PF0018, Expiration: Jan2022), biotin (BIOTIN, 10000 mg, Expiration: Sep2023), fish oil (FISH OIL, 2000mg, Lot number: LWL3061), iron (IRON, 625 mg, 2x/day, Lot number: 2406206, Expiration: Dec2023), vaccinium macrocarpon (CRANBERRY EXTRACT [VACCINIUM MACROCARPON], 130 mg, Lot number: 210953, Expiration: Aug2024), d-mannose (D-MANNOSE, 1300 mg, Lot number: 210953, Expiration: Aug2024) taken for an unspecified indication, start and stop date were not reported. The patient previously received first dose of bnt162b2 (BNT162B2, PFIZER-BIONTECH COVID-19 VACCINE, Formulation: solution for injection, Batch number: not reported/Lot Number: EM9809), via an unspecified route of administration, on 08Feb2021 (Age at the vaccination 54-years-old) as dose 1, single and received second dose via an unspecified route of administration, on 01Mar2021 (Age at the vaccination 54-years-old) as dose 2, single for covid-19 immunization and had no problems. On unspecified date & month of 2021, the patient experienced chest tightness, nausea, feels like being stabbed in the eyeballs, arm swelled up. On 14Oct2021, the patient experienced arm hurting. On 15Oct2021, the patient experienced throwing up, chills, headache, eyeballs are being stabbed, has weird sensation in her throat, "like a tightening feeling", body ache, joint hurting, tired, woozy. The patient received booster shot yesterday. Didn''t have anything with first two shots. They were Pfizer, had no problems. After booster shot, arm was hurting. Usually takes a lot of vitamins at night, before bed. She waited longer to take vitamins. Waited until 12AM. Also takes Levothyroxine, but doesn''t take it at night. As soon as she took her vitamins, she was throwing up, chills, was horrendous Today feels sick. Doesn''t have fever. Had COVID last year and it feels similar to when she first got sick. Clarified she had COVID in 2020 prior to her COVID-19 Vaccinations. Headache is horrendous. Feels like someone is stabbing her eyeballs. Had asthma. Last night, got weird feeling in chest. Felt throat tightening, not really bad, but felt different in throat and chest. This morning that''s better. Doesn''t know if it''s the levothyroxine. Wasn''t on Levothyroxine when she took her first two shots. Wants to know if reaction was because of the vitamins or the levothyroxine. All symptoms were started at 12AM, on 15Oct2021 after she took her vitamins. She couldn''t turn in bed. Symptoms are similar to when she got sick with COVID in 2020. Is still tired Has a weird, off feeling. When she walks, she doesn''t know. Feels a woozy feeling. Nauseous and walking kind of straight. Her throat is a lot better. The clinical outcome of the events headache, arm hurting, eyeballs are being stabbed, chest tightness, tired was not recovered, outcome of the events chills, throat tightness, woozy was recovering, outcome of the events throwing up, nausea, body ache, joint hurting, feels like being stabbed in the eyeballs, arm swelled up was unknown at the time of reporting.


VAERS ID: 1827507 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-10-04
Onset:2021-10-14
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OMEPRAZOLE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Acid reflux (esophageal)
Allergies:
Diagnostic Lab Data: Test Date: 20211014; Test Name: Covid-19; Result Unstructured Data: Test Result:Positive
CDC Split Type: USPFIZER INC202101381419

Write-up: tested positive for COVID-19 but is asymptomatic; tested positive for COVID-19 but is asymptomatic; This is a spontaneous report from a contactable consumer (patient). A 66-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; Batch/Lot number was not reported), dose 3 via an unspecified route of administration on 04Oct2021 (at the age of 66-years-old) as dose 3 (booster), single for COVID-19 immunisation. The patient''s medical history included acid reflux. The patient''s concomitant medications included omeprazole. The patient previously received the first dose on 19Mar2021 and second dose on 09Apr2021 of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; Batch/Lot number was both unknown, not available/provided to reporter at the time of report completion) (at the age of 65-years-old), both for COVID-19 immunisation. The patient tested positive for COVID-19 but was asymptomatic on 14Oct2021. His wife was unvaccinated and contracted COVID pneumonia and was currently in critical condition in the hospital. No treatment was received for the events. The patient underwent lab tests and procedures which included COVID-19: positive on 14Oct2021. Facility where the most recent COVID-19 vaccine was administered was other. It was unknown if the patient receive any other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient has been tested for COVID-19. The outcome of the events was unknown. The lot number for the vaccine, BNT162B2, was not provided and will be requested during follow up.


VAERS ID: 1827519 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Mass, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101383049

Write-up: Chills; slight fever; woozy; aches everywhere; weary; lump under left arm; This is a spontaneous report from a contactable consumer(patient) reported for herself. A 62-year-old non-pregnant female patient received third dose of BNT162B2(PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot Number: FF2590) via an unspecified route of administration, administered in left arm on 13Oct2021 at 16:00 pm (At the age of 62-year-old) as DOSE 3 (BOOSTER), SINGLE for COVID-19 immunization. The patient medical history was not reported. Concomitant medications in 4 weeks included influenza vaccine (FLU) (Batch/Lot Number was unknown) via an unspecified route of administration, administered in right arm on 06Oct2021 taken for an unspecified indication. The patient previously received second dose of BNT162B2(PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot Number: EP6955), via an unspecified route of administration, administered in left arm on 26Mar2021 04:00pm (At the age of 61-year-old) as dose 2, and first dose of BNT162B2(PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot Number: EN6205), via an unspecified route of administration in left arm on 03Mar2021 at 05:15 pm (At the age of 61-year-old ) as dose 1 single for COVID-19 immunization.The patient had not diagnosed with COVID-19 Prior to vaccination and since the vaccination. On 14Oct2021 at 06:00 am, the patient experienced chills, slight fever, woozy, aches everywhere, weary, lump under left arm. The outcome of the events was recovering. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1827522 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-06
Onset:2021-10-14
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Computerised tomogram, Pulmonary thrombosis
SMQs:, Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (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: FLU VACCINE VII
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 202110; Test Name: CT scan; Result Unstructured Data: Test Result:blood clots; Comments: Showing that she had blood clots in her lungs.
CDC Split Type: USPFIZER INC202101383101

Write-up: she had blood clots in her lungs; severe back pain; This is a spontaneous report from a contactable consumer. An 80-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), via an unspecified route of administration on 06Oct2021 (Batch/Lot number was not reported) (at the age of 80 years old) as dose 3 (booster), single for COVID-19 immunisation. The patient was not pregnant at the time of vaccination. The patient medical history was not reported. Concomitant medication included influenza vaccine (FLU VACCINE VII) taken for an unspecified indication, start and stop date were not reported. The patient previously received BNT162B2 for COVID-19 immunisation, the first dose was on 03Feb2021 at 10:30 and the second dose was on 24Feb2021. On 14Oct2021, the patient experienced she had blood clots in her lungs and severe back pain. She was experiencing severe back pain and went to her doctor. A CT scan was performed, showing that she had blood clots in her lungs. Event resulted in Doctor or other healthcare professional office/clinic visit. The treatment included medication. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, it was unknown if the patient had been tested for COVID-19. The outcome of the events was unknown. The lot number for the vaccine, BNT162B2, was not provided and will be requested during follow up.


VAERS ID: 1828403 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-24
Onset:2021-10-14
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 2 LA / IM

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

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

Write-up: Patient called inquiring about booster dose of Pfizer vaccine and it was determined patient had been given Moderna Dose 1 and Dose 2 was given 21 days after first dose instead of 28 days.


VAERS ID: 1828695 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Balance disorder, Emotional distress, Feeling abnormal, Headache, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: no known
Diagnostic Lab Data: Have not seen a doctor yet
CDC Split Type:

Write-up: After receiving the injection I began to have severe body pain to include extreme headache, muscle aches, and fever which lasted about 24 hours. Since then I have not felt right physically (my equilibrium/balance) and my head has felt I guess the best wat to describe it is foggy it has been hard to think clearly and it seems like even my emotions are off I have been very emotional, which is very abnormal for me. I have not seen a doctor yet as I am hoping it clears up in the near future but just wanted to report it in case it doesn''t. I guess my biggest concern is the brain fog feeling that doesn''t seem to be clearing up.


VAERS ID: 1828728 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Areflexia, Blood test normal, Computerised tomogram head normal, Computerised tomogram spine, Discomfort, Hypersensitivity, Hypoaesthesia, Lumbar puncture normal, Magnetic resonance imaging head normal, Magnetic resonance imaging spinal normal, Muscular weakness, Musculoskeletal stiffness, Paraesthesia, Paranasal sinus discomfort, Pharyngeal swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (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, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: prednisone 7mg daily Famotidine 20mg daily naltrexone 4.5mg daily
Current Illness: n/a
Preexisting Conditions: sarcoidosis - pulmonary
Allergies: latex - rash reglan - anaphylaxis ketorolac - anaphylaxis PNC penicillin - nausea/vomiting
Diagnostic Lab Data: MRI of skull to base of lumbar - no findings CT scan head and lower lumbar - no finding spinal tap - no findings blood work - no findings follow up with neurology to see if perm. .damage to nerves
CDC Split Type:

Write-up: Throat swelling after 10mins of shot - heavy steroids to assist in allergic reaction right foot tingling 1 day after shot. Left and right foot tingling day 2 after shot partial numbness in left leg from foot to knee day 3 after shot - still occuring partial numbness in right leg from foot to groin day 3 after shot, loss of reflexes i ankle and knee, severe muscle weakness - still occuring numbness and pressure and stiffness in neck and lower part of back of the head, pressure in sinuses - 30mins after eating since day 4 after shot - still occuring. muscle weakness in right arm day 4 after shot - still occuring


VAERS ID: 1829023 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-05
Onset:2021-10-14
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1829280 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Burning sensation, Dyspnoea, Hyperhidrosis, Hypoaesthesia, Immediate post-injection reaction, Injection site pain, Mobility decreased, Neck pain, Pain, Pain in extremity, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: 10/14/2021: Upon shot, immediate pain in injection site(differed from other shots). Approximately 25 minutes after the shot, pain throughout entire left arm and numbness/tingling in fingertips. Approximately 35 minutes after the shot, sweating and several minutes of shortness of breath. Pain in entire left arm and numbness/tingling in fingertips did not subside. 10/15/2021: Pain in entire left arm and numbness/tingling in fingertips entire days. 10/16/2021: Was awoken to burning/stabbing pain in left arm, neck, shoulder, and back area. Pain affected entire mobility drastically. Was limited in movement and incapacited from normal mobility. 10/17/2021: Was not able to see doctor on 10/16, so went to a clinic. Was prescribed muscle relaxers and 800mg Ibuprofen. Pain was still present, mobility only slightly improved. Numbness and tingling continued. 10/18/2021 through 10/22/2021: Movement/mobility continued to improve. Took the prescribed medications every day as prescribed. Did not participate in normal workout/gym/cardio routines; Took the week off to rest body. 10/23/2021 through 10/24/2021: Stopped taking prescribed medicine. Felt much better. Movement/mobility close to back to normal. 10/25/2021: Woke up with sorness in shot injection area. Entire left arm, shoulder, and neck sore... just not de-mobilizing like last time. Took prescribed muscle relaxer. 10/26/2021 through 10/29/2021: Experiencing dull pain in left chest area. 10/29/2021: Visited primary care physician for follow up to continued adverse effects. THE ABOVE EFFECTS WERE ALL FROM THE FIRST DOSE.


VAERS ID: 1830804 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011P21A / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Malaise, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Sore arm; Felt under the weather; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (Sore arm) and MALAISE (Felt under the weather) in a 70-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 011P21A) for COVID-19 vaccination. No Medical History information was reported. On 14-Oct-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 ml. On 14-Oct-2021, the patient experienced PAIN IN EXTREMITY (Sore arm) (seriousness criterion medically significant) and MALAISE (Felt under the weather) (seriousness criterion medically significant). On 15-Oct-2021, MALAISE (Felt under the weather) had resolved. On 17-Oct-2021, PAIN IN EXTREMITY (Sore arm) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No Concomitant medication details were provided. No Treatment medication details were provided. Company comment: This case concerns a 70 year-old male patient with no medical history provided, who experienced the unexpected events of Pain in extremity and Malaise(seriousness criterion medically significant). Both events occurred on the same day the patient received the third dose of mRNA-1273 (Moderna COVID-19 Vaccine). The following day, Malaise had resolved, with Pain in extremity resolving 2 days after. The reporter did not provide any causality assessments. The rechallenge was unknown as there''s no information available about the first or second dose. The benefit-risk relationship of mRNA-1273 (Moderna COVID-19 Vaccine) is not affected by this report. This case was linked to MOD-2021-362098, MOD-2021-362028 (Patient Link).; Sender''s Comments: This case concerns a 70 year-old male patient with no medical history provided, who experienced the unexpected events of Pain in extremity and Malaise(seriousness criterion medically significant). Both events occurred on the same day the patient received the third dose of mRNA-1273 (Moderna COVID-19 Vaccine). The following day, Malaise had resolved, with Pain in extremity resolving 2 days after. The reporter did not provide any causality assessments. The rechallenge was unknown as there''s no information available about the first or second dose. The benefit-risk relationship of mRNA-1273 (Moderna COVID-19 Vaccine) is not affected by this report.


VAERS ID: 1830818 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Ringing in my ears; This spontaneous case was reported by a consumer and describes the occurrence of TINNITUS (Ringing in my ears) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 14-Oct-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 14-Oct-2021, the patient experienced TINNITUS (Ringing in my ears). At the time of the report, TINNITUS (Ringing in my ears) had not resolved. Not Provided No relevant concomitant medications was reported. Treatment information was not provided. This case was linked to MOD-2021-350843 (Patient Link).


VAERS ID: 1831063 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 RA / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Body temperature, Chills, Dizziness, Fatigue, Flushing, Headache, Heart rate irregular, Hyperhidrosis, Insomnia, Loss of personal independence in daily activities, Pain, Pyrexia, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VITAMIN C [ASCORBIC ACID]; FLAXSEED OIL [LINUM USITATISSIMUM SEED OIL]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Food allergy; Gluten sensitivity; Lactose intolerance
Allergies:
Diagnostic Lab Data: Test Date: 20211014; Test Name: Fever of 102; Result Unstructured Data: Test Result:102 Fahrenheit; Test Date: 20211015; Test Name: Fever of 102; Result Unstructured Data: Test Result:99 Fahrenheit; Comments: Fever dropped down to 99
CDC Split Type: USPFIZER INC202101392036

Write-up: Irregular hearbeat; I was flushed; Fever of 102 Fahrenheit; Was sweating and shaking uncontrollably with chills and constant teeth chattering; Was sweating and shaking uncontrollably with chills and constant teeth chattering; Was sweating and shaking uncontrollably with chills and constant teeth chattering; Had extreme dizziness when sitting up; Weakness in arms and hands and legs; I could not take myself to toilet, needed assistance with transferring, toileting and drinking a glass of water; My neck and temples were throbbing in the veins causing a tremendous headache.; My neck and temples were throbbing in the veins causing a tremendous headache.; I could not sleep; Still feel very fatigued; This is a spontaneous report received from a contactable other healthcare professional (Patient). A 33-years-old female patient received second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot Number: FE3590), via intramuscular route of administration, administered in Arm right on 14Oct2021 10:00 (at the age of 33-years-old) as dose 2, single for COVID-19 immunisation. Medical history included lactose intolerance, sensitivities to animal products and gluten from an unknown date and unknown if ongoing. Concomitant medications included vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]) and flaxseed oil [linum usitatissimum seed oil] (FLAXSEED OIL [LINUM USITATISSIMUM SEED OIL]) taken for an unspecified indication, start and stop date were not reported. Prior to vaccination, was the patient did not diagnosed with COVID-19. Since the vaccination, did not patient been tested for COVID-19. Patient received vaccine facility in Pharmacy or Drug Store. The patient previously received first dose of bnt162b2(PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot Number: 301308A), via intramuscular route of administration, administered in Arm right on 23Sep2021 10:00 (at the age of 33-years-old) as dose 1, single for COVID-19 immunisation. The patient had no COVID prior to vaccination and was not tested to COVID prior to vaccination. The patient got into bed on 14Oct2021 at 10:15 PM and by 10:30 PM and began a full onslaught of symptoms. The patient stated I was flushed, fever of 102 fahrenheit and was sweating and shaking uncontrollably with chills and constant teeth chattering. The patient reported she sweat through 2 frozen ice packs, had extreme dizziness when sitting up, weakness in arms and hands and legs. The patient stated, I could not take herself to toilet, needed assistance with transferring, toileting and drinking a glass of water. My neck and temples were throbbing in the veins causing a tremendous headache. The patient stated, i could not sleep but was afraid to take any medication for how it might react. The patient''s husband assisted her in getting water every 30 mins or so. The chills/shaking lasted until about 4 am. On 15Oct2021 at 6:30 AM the patient had to get up for work, so she took 600 mg OTC ibuprofen which did help her headache. Her fever dropped down to 99 Fahrenheit as well by mid-day on 15Oct2021. Over the last three days she continued to be 1 degree above regular body temperature and still feel very fatigued with a headache and cycles of irregular heartbeat. The patient underwent lab tests and procedures which included body temperature: 102 fahrenheit on 14Oct2021, body temperature: 99 fahrenheit (Fever dropped down to 99) on 15Oct2021. The outcome of the events tremor, chills was reported as recovered on an unknown date in 2021 and while all other events was unknown.


VAERS ID: 1831642 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-10-05
Onset:2021-10-14
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Cough, Diarrhoea, Dyspnoea, Ear pain, Fatigue, Hyperhidrosis, Influenza virus test negative, Lymphadenopathy, Malaise, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test negative, Streptococcus test negative, Viral test negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec 10 mg daily, lisinopril 20 mg daily, omeprazole 20 mg daily, fluvoxamine 50 mg daily, vitamin D 5,000 units daily, multivitamin daily
Current Illness: None
Preexisting Conditions: Asthma/allergies, hypertension, obesity (BMI 37) I know, I?m trying?, anxiety/depression.
Allergies: Amoxicillin-rash, dexamethazone-angioedema/rash, cinnamon-rash, ginger-tongue swelling, walnuts, rash, shrimp-rash, bees-rash/swelling
Diagnostic Lab Data: Covid swabs (10/15, 10/26, 10/29) negative, flu negative, strep negative, viral panel negative for all
CDC Split Type:

Write-up: 2 days after vaccine, armpit pain/swollen nodes left arm, 9 days after vaccine malaise/cough started. Progression of diarrhea, sore throat, headache, severe fatigue, fluctuating fever (high 100.5), sweating, shortness of breath (lowest oxygen reading 93) ear pain. 4 COVID swabs negative (First on 10/15, rapid and send off on 10/26, and viral panel 10/29) strep negative, viral panel negative, flu negative.


VAERS ID: 1831879 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-16
Onset:2021-10-14
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052G21A, 051E21 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: PCOS
Allergies: Penecillin
Diagnostic Lab Data: No test
CDC Split Type:

Write-up: I experienced tachycardia after my second injection and chronic hives after my first injection.


VAERS ID: 1832506 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-02
Onset:2021-10-14
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Pain in extremity, Thrombosis, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OTC supplements: Folic acid 400mcg, Multi-vitamin.
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started getting light spotting about 2 weeks before the time I would expect to get my period. This continued on and off, and then my actual period starting about October 25th. It is a lot heavier than usual - I soak through 3-4 extra heavy overnight pads a day, and there are many dime-to-quarter sized blood clots. Also - I''ve had calf pain since the day after I got the booster and it hasn''t stopped. I did not experience any side effects after my last 2 doses of the vaccine to my knowledge.


VAERS ID: 1832620 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-13
Onset:2021-10-14
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Lymphadenopathy, Metastases to lymph nodes, Neck pain, Pain in extremity, Rash, Swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow)

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

Write-up: intermittent shortness of breath occurring a few hours after vaccination, followed by the onset of an area of swelling above left collarbone (appears consistent with left supraclavicular lymphadenopathy/Virchow Node), left neck pain, onset of rash on bilateral cheeks, temporary left deltoid soreness. Patient has taken OTC advil and symptoms are improving, but lymphadenopathy and rash have not yet fully resolved.


VAERS ID: 1832644 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / 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: 1832928 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pharyngeal swelling, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: The patient reports that almost immediately following the vaccination, she experienced her throat starting to feel scratchy and felt like it was swelling. It quickly stopped swelling and did not block her airway.


VAERS ID: 1833240 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Dysgeusia, Feeling cold, Migraine, Parosmia, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), 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: Botox for migraines
Current Illness: migraines, torticollis
Preexisting Conditions: migraines
Allergies: Imitrex
Diagnostic Lab Data: none
CDC Split Type:

Write-up: severe migraine, fever, chills, vomiting for 6 hrs. smell taste of sulfur that has not stopped and is ongoing


VAERS ID: 1833367 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-09
Onset:2021-10-14
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cerebral venous sinus thrombosis, Computerised tomogram head, Jugular vein thrombosis, Magnetic resonance imaging head, Transverse sinus thrombosis, Venogram
SMQs:, Embolic and thrombotic events, venous (narrow), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: No history
Allergies: None
Diagnostic Lab Data: MRI brain 10/15/21 CT Brain and venogram 10/14/2021
CDC Split Type:

Write-up: Occlusive Dural venous sinus thrombosis involving the right sigmoid sinus and visualized right internal jugular vein with non occlusive dural sinus thrombosis of the right transverse sinus


VAERS ID: 1833423 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-05-06
Onset:2021-10-14
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: DM type 2, hyperlipidemia, HTN, TIA, asthma, GERD
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization for COVID-19 infection.


VAERS ID: 1833949 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-26
Onset:2021-10-14
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Fatigue, Injection site pain, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prednisone; escitalopram; hydrocodone; amlodipine; PRILOSEC; SINGULAIR
Current Illness: N/A
Preexisting Conditions: Osteoarthritis, Degenerative Disc; Polymyalgia Rheumatica
Allergies: Ibuprofen; Chocolate-Migraines
Diagnostic Lab Data: Covid-19 Positive 10/29/2021
CDC Split Type: vsafe

Write-up: Three weeks after getting the third dose of the vaccine I tested positive for Covid-19. I was having trouble breathing and I thought it was Asthma or Allergies. I had to use my inhaler more and I was very tired. I went to the ER for a chest X-Ray. I tested positive on 10/29/2021. Three or four days after the vaccine I had some Pain in my right arm that lasted for a few days. I was prescribed some Xaralto which seems to help my breathing. I had been wearing my mask and none of my acquaintances have tested positive. I also got my Flu Vaccine about ten days after my Booster.


VAERS ID: 1833966 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cellulitis, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: sore swollen arm that got progressively worse over several days, diagnosis of cellulitis


VAERS ID: 1835277 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: South Carolina  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: administered past the expiration date; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (administered past the expiration date) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 050E21A) for COVID-19 vaccination. No Medical History information was reported. On 14-Oct-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 14-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (administered past the expiration date). On 14-Oct-2021, EXPIRED PRODUCT ADMINISTERED (administered past the expiration date) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication was reported. No treatment medication use was reported. This case was linked to MOD-2021-359738 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 26-Oct-2021: Follow up received with No new information as event as reported by primary source includes Updated additional contact information . Start date and expiry date added from initial document which was missed earlier


VAERS ID: 1835280 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F3H1 / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HYDROCHLOROTHIAZIDE; LISINOPRIL
Current Illness: Blood pressure high; Diuretic effect
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: body ache; felt tired/body ache; This spontaneous case was reported by a consumer and describes the occurrence of MYALGIA (body ache) and FATIGUE (felt tired/body ache) in a 77-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 011F3H1) for COVID-19 vaccination. Concurrent medical conditions included Diuretic effect and Blood pressure high. Concomitant products included LISINOPRIL for Blood pressure high, HYDROCHLOROTHIAZIDE for Diuretic effect. On 14-Oct-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 14-Oct-2021, the patient experienced MYALGIA (body ache) and FATIGUE (felt tired/body ache). At the time of the report, MYALGIA (body ache) and FATIGUE (felt tired/body ache) had resolved. No treatment medications were provided. Patient stated that symptoms have resolved since I called. Most recent FOLLOW-UP information incorporated above includes: On 27-Oct-2021: Follow up received contains events Outcome updated and email address of reporter.


VAERS ID: 1835524 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-14
Onset:2021-10-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Immunisation, Myalgia, Nausea, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high (high blood pressure)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101381436

Write-up: Chills; Muscle pain; Sore arm; Tired; Lightheaded; Nausea; 3rd booster dose; This is a spontaneous report from a contactable consumer, the patient. A 67-year-old non-pregnant female patient received the third dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the right arm on 14Oct2021 at 16:30 (at the age of 67-years-old) as a single dose for COVID-19 immunisation. Medical history included high blood pressure. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. Concomitant medications were not reported. The patient received influenza vaccine (MANUFACTURER UNKNOWN) via an unspecified route of administration on 27Sep2021 for immunisation within 4 weeks prior to the COVID vaccine. The patient previously received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EL9262) via an unspecified route of administration on 23Jan2021 (at the age of 66-year-old) and the second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EN6201) via an unspecified route of administration in the right arm on 13Feb2021 (at the age of 66-years-old) as a single dose for COVID-19 immunisation. On 15Oct2021 at 08:00, the patient experienced chills, muscle pain, sore arm, tired, lightheaded and nausea. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events chills, muscle pain, sore arm, tired, lightheaded and nausea was resolving at the time of this report. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1835525 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-10-14
Submitted: 0000-00-00
Entered: 2021-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Swelling, Vaccination site pruritus, Vaccination site swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (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: USPFIZER INC202101381692

Write-up: Swelling at injection site with a 2" diameter; Swelling at injection site with a 2" diameter with itching; Swelling; This is a spontaneous report from a non-contactable consumer, the patient. A 37-year-old non-pregnant female patient received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FC3183) via an unspecified route of administration on an unknown date in 2021 (at the age of 37-years-old) as a single dose for COVID-19 immunisation. Medical history and concomitant medications were not reported. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the COVID vaccine. On 14Oct2021, the patient experienced swelling at injection site with a 2" diameter with itching and swelling. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events swelling at injection site with a 2" diameter with itching and swelling was not resolved at the time of this report. No follow-up attempts are possible. No further information is expected.


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