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From the 9/3/2021 release of VAERS data:

Found 661,087 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 178 out of 6,611

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VAERS ID: 1515765 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-25
Onset:2021-07-29
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 LA / IM

Administered by: Senior Living       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: Breakthrough positive case. Received Moderna vaccine on 1/28/2021 and second dose on 3/25/2021. Symptomatic on 7/28/2021 Tested 7/29/2021 Positive result 7/30/2021 No contact with center in over 10 days- still a breakthrough case.


VAERS ID: 1515768 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-27
Onset:2021-07-29
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 04L20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Malaise, 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: OTC Cold Meds
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SARS-CoV2-PCR
CDC Split Type:

Write-up: COVID positive testing with symptoms after complete vaccination.


VAERS ID: 1515782 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra, Otzela, Tylenol, Ibuprofen
Current Illness:
Preexisting Conditions: Mitral valve prolapse, Psoriasis
Allergies: bee stings
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 20 to 30 seconds after receiving the vaccine. My head felt very hot and heavy. like a balloon it felt like it wanted to pop. Then my neck felt it was be squeezed and I had hives on my neck. The pharmacist gave me a shot of Epipen in my left thigh and 911 was called to take me to the hospital. I was taken to medical facility. they gave me Pepcid, Solumedrol and Benadryl.


VAERS ID: 1515932 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-26
Onset:2021-07-29
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (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: aspirin, 81 mg, PO (oral), qDay carvedilol 25 mg oral tablet, 3.125 mg, PO (oral), bid Coenzyme Q10, 200 mg, PO (oral), qDay, lisinopril, 20 mg, PO (oral), bid, Hold for Surgery magnesium oxide, 400 mg, PO (oral), qDay terazosin, 10 mg, P
Current Illness:
Preexisting Conditions: Hyperlipidemia Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pulmonary Embolism


VAERS ID: 1515960 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 2 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Anxiety, Chest pain, Chills, Condition aggravated, Fatigue, Fluid retention, Headache, Lymph node pain, Lymphadenopathy, Musculoskeletal stiffness, Pyrexia, Rash macular, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: The first Covid moderna shot on 3/30/2021. Covid shot was to left arm. Lymph nodes on right side of body became swollen to the s
Other Medications: Levothyroxine Buspirone
Current Illness: Hypothyroidism and anxiety
Preexisting Conditions: Hypothyroidism and anxiety
Allergies: None
Diagnostic Lab Data: None went to ER. Doctor on shift said she wasn?t concerned after 60 second medical exam and was discharged.
CDC Split Type:

Write-up: Lymph node to left Scilla swollen larger than a golf ball. Painful and tender to the touch. Feels like there?s fluid in the ?golf ball?. Fever of 103 which subsided. A very Stiff neck which has not gone away. Fatigue. Extreme anxiety. Red dots on my back. Chest pain which subsided. A headache that comes and goes. Chills which come and go. Tremors of my torso (couldn?t stop shaking for a few hours this started around 13 hours post-vaccination). Tremors subsided.


VAERS ID: 1516167 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chest discomfort, Chest pain, Chills, Heart rate irregular, Hyperhidrosis, Hypoaesthesia, Injection site pain, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Muscle pain in right arm at onset of vaccine, unresolved. Chills, sweats, tingling and numbness of all hands, feet and limbs, 8-12 hours after shot, resolved within 24 hours. Chest pain, chest tightness, weakness and irregular heartbeat, onset +/- 48 hours after vaccine, unresolved.


VAERS ID: 1516180 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Dysgeusia, Headache
SMQs:, Taste and smell 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe Headache lasting for 12 hours. 12 hours post injection severe chills lasting for 3 hours. Metallic taste in mouth lasting 1 hour.


VAERS ID: 1516185 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Injection site pain, Injection site swelling, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin 40mg per day Oxycodone with Acetaminophen 10/325mg up to 6 times per day Trazodone 50mg per day Atenolol with Chlorthalidone 100/25mg per day Duloxetine 60mg per day Euthyrox 75mcg per day
Current Illness: Anxiety, chronic pain, ulcerative colitis
Preexisting Conditions: Anxiety, chronic pain, ulcerative colitis
Allergies: None on file
Diagnostic Lab Data: None performed.
CDC Split Type:

Write-up: Patient has not sought treatment. Within 24 hours of second dose of vaccine being administered she experienced body aches all over that were significant but not debilitating, pain and swelling in the right arm at the site of injection, and developed a temperature of 101.2 F. Using over the counter medication to mitigate higher temperature.


VAERS ID: 1516195 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / IM

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

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

Write-up: Patient was feeling a little lightheaded after the vaccine. The patient was able to walk to the waiting area and have a seat and then became pale, laid back in the chair and closed her eyes. She said she was feeling light headed. Pulse and breathing were normal at the time. Patient stated they were feeling a little better after a couple of minutes and needed to use the restroom facilities. I helped the patient along with her mother to the bathroom. After closing the door to the bathroom the patient''s mom called for help and stated the patient had passed out. A pharmacy technician called 911 as I attended to the patient and parent. The daughter was responsive (alert and oriented) when I got there and stated she was feeling better. After a couple of minutes laying on the floor the patient was able to sit up on the floor. After a couple more minutes the patient was helped up and was able to use the restroom and returned to the waiting area and sat in a chair until the paramedics arrived. The patient was still a little lightheaded and had not eaten or drank anything that day. The paramedics arrived and checked vitals. The patient was taken to the emergency department for further evaluation - I would assume the ED did a VAERS report on this potentially too


VAERS ID: 1516198 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril, famotidine, pravastatin, loratadine, desvenlafaxine, buspirone, levetiracetam, montelukast, promethazine, metoclopramide, aptiom. levothyroxine, advair, metoprolol, potassium, depakote
Current Illness: N/A
Preexisting Conditions: hx of seizures, asthma, hypertension
Allergies: bupropion, Compazine, fuaifenesin, Januvia, Keflex, premarin, metformin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient had a seizure shortly after vaccination. Taken by ambulance to nearest hospital


VAERS ID: 1516202 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 RA / IM

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

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

Write-up: After receiving the injection the patient temporarily passed out while in the chair. The patient regained consciousness and was able to walk to the waiting room and have a seat. The patient was given a cold pack and placed on the back of the neck and face to help with feeling warm.


VAERS ID: 1516348 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Fall, Injection site pain, Loss of consciousness, Pallor, Tinnitus, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Glaucoma (broad), Hypertension (narrow), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient had received the vaccine and moved to the waiting area for the 15 minutes. He started getting pale, blurring vision, ringing in the ears, and having more pain near the shot. We tried to move him to a chair that had 2 arms on it for his safety. In moving him to that chair he fell to the ground and in his words "he blacked out" for a moment, maybe a couple of seconds. We moved him to laying on his back with his knees bent on the ground. We gave him water, a granola bar, and a wet paper towel for his forehead. Maybe 5 minutes after he fell he tried sitting up and was a little dizzy. After sitting for awhile he was able to stand up. We had him sit in the waiting area for an additional 15 minutes and took his blood pressure which was high 144/84. We had called his dad by this time and his brother came to pick him up. We advised him to drink plenty of water for the rest of the evening and to get a good meal, he thought spaghetti would work. The patient really thought he had a panic attack.


VAERS ID: 1516355 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Joint swelling, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ADVIL
Current Illness:
Preexisting Conditions:
Allergies: NO
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient complains of chills, nausea, headache swollen shoulder she said she took advil and norco but no relief


VAERS ID: 1516375 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7489 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Blood pressure increased, Body temperature increased, Fatigue, Feeling hot, Headache, Mobility decreased, Musculoskeletal discomfort, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Same as usual,: Multivitamin, vitamin C and water soluble CBD
Current Illness: Positive COVID-19 test on July 13th
Preexisting Conditions: N/A
Allergies: Camphor Penicillin
Diagnostic Lab Data: Contacted PCP, told to monitor for ear pain, changes in vision, shortness of breath and/or tightness in chest and immediately go to ER if any present themselves.
CDC Split Type:

Write-up: At about 3:13am, approximately 12 hours after the injection, I awoke with a level 7 headache, some joint discomfort and feeling warm. At 6:13, my temperature was 101.7, BP was 141/88, Blood O2 94% and pulse rate of 97bpm with headache increased to level 9, all joints ached, very little energy and utterly fatigued. As of 9:13pm on 7/30, headache is at a 5, fever has reduced to very low grade at 97.6, BP was down to 124/81, blood O2 was 97% and pulse rate was 67 after staying in bed nearly 30 hours.


VAERS ID: 1516383 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-23
Onset:2021-07-29
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Menstruation irregular, Pleurisy
SMQs:, Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Fertility 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: Aleve
Current Illness: None
Preexisting Conditions: None
Allergies: Nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain for at least 2 days Diagnosed as pleurisy Irregular menstrual period


VAERS ID: 1516384 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dry mouth, Feeling abnormal, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Dry mouth, low grade fever, groggy and weird feeling


VAERS ID: 1516537 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abortion spontaneous, Human chorionic gonadotropin, Maternal exposure during pregnancy, Progesterone
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (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: Benadryl, albuterol, Pepcid, melatonin, Lexapro, klonopin, simethicone
Current Illness: None
Preexisting Conditions: Asthma
Allergies: None
Diagnostic Lab Data: Hcg and progesterone levels to confirm lack of pregnancy
CDC Split Type:

Write-up: Pregnancy loss 2 days after receiving 2nd dose


VAERS ID: 1516538 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

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

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

Write-up: Vaccine was administered too soon, first dose was administered on 7/16/21 and second dose was administered 13 days later on 7/29/21. VAR was completed and signed off by technician but pharmacist had not performed data entry and DUR on vaccination before administered.


VAERS ID: 1516717 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient received first dose of Pfizer COVID vaccine at one of our pharmacy off-site COVID clinics held at University. He reported not having any previous vaccinations. However, when I went back to the hub/spoke store (the pharmacy that we run all the paperwork at from off-site clinic post-clinic), his insurance rejected the Pfizer vaccine stating "Per patient history, pt has received both doses." I did a central search for all pharmacies and found that he had gotten the Janssen vaccine 03/20/2021 that was entered at another hub/spoke pharmacy post-clinic. I immediately called the patient, the patient answered and stated that he "doesn''t remember getting the J&J vaccine but maybe he actually did" and apologized. He reported no adverse effects at that time (this was around 6 hours post-vaccine administration that I made this discovery), and I plan to follow-up again to check in with him in case he has problems. I informed him that "although the CDC provides considerations for a mixed series in exceptional circumstances, this is still considered an administration error that required reporting and a mixed series is not authorized under the vaccine Emergency Use Authorization." I also informed him that it is not advised to give any additional doses.


VAERS ID: 1516719 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-23
Onset:2021-07-29
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Joint swelling
SMQs:, 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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Methimazole 15mg daily, sertraline 50mg daily, Claritin 10mg daily, omeprazole 20mg daily
Current Illness: None
Preexisting Conditions: Graves? disease
Allergies: Vancomycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderate joint pain and joint swelling. Vaccination was 7/23, joint pain began 7/28.


VAERS ID: 1516720 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-07-27
Onset:2021-07-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Oedema peripheral
SMQs:, Cardiac failure (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: Codeina
Diagnostic Lab Data:
CDC Split Type:

Write-up: Inflammation right axillary.


VAERS ID: 1516725 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: patient wrote "immunocompromised / cardiac transplant recipient" on VAR
Allergies: NKA
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Patient received first dose of Pfizer COVID vaccine at one of our Pharmacy off-site COVID clinics held at the University. He reported not having any previous vaccinations. However, when I went back to the hub/spoke store (the pharmacy that we run all the paperwork post-clinic), his insurance rejected the Pfizer vaccine stating "Per patient history, pt has received both doses." I did a central search for all Pharmacist and found that he had gotten the Janssen vaccine 03/20/2021 that was entered at another hub/spoke pharmacy post-clinic. I immediately connected him to other discrepancy patient from this clinic that we were having problems running paperwork for and discovered this patient has the same phone number as the patient I just spoke to regarding this exact same error. He is the son, and I very vividly remember giving him his vaccination because I commented on his health condition he wrote "immunocompromised / cardiac transplant recipient" saying to him "I am very surprised you haven''t already gotten your COVID vaccine! You should have been first in line earlier this year." I called the patient, knowing it was his father''s phone number and I would likely be speaking to him again. Pt. answered again and still stated that "doesn''t remember him and his son getting the J&J vaccine but maybe they actually did" and apologized again. He reported pt. was having no adverse effects at that time (this was around 6 hours post-vaccine administration that I made this discovery), and I plan to follow-up again to check in with him in case either of them have problems. I informed him again that "although the CDC provides considerations for a mixed series in exceptional circumstances, this is still considered an administration error that required reporting and a mixed series is not authorized under the vaccine Emergency Use Authorization." I also informed him that it is not advised to give any additional doses.


VAERS ID: 1516730 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Fatigue, Headache, Myalgia, Night sweats, Oropharyngeal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Night Sweats Cough Soar Throat Muscle Aches Headache Feel Tired


VAERS ID: 1517350 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-01-29
Onset:2021-07-29
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Cycle threshold of 39.9 on 7/29/21 Total antibody (+) and IgG antibody (-) on 7/29/21 Antigen positive on 7/30/21
CDC Split Type:

Write-up: Hospitalization on COVID-19 reported per vaccine EUA


VAERS ID: 1517352 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-02-11
Onset:2021-07-29
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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: CKD4
Allergies:
Diagnostic Lab Data: Cycle threshold 17.7 on 7/30/21
CDC Split Type:

Write-up: Hospitalization from COVID-19 Reported per vaccine EUA


VAERS ID: 1517697 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Puerto Rico  
Vaccinated:0000-00-00
Onset:2021-07-29
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PRJNJFOC20210763615

Write-up: BODY ACHES; FATIGUE; FEVER; HEADACHE; This spontaneous report received from a patient concerned a 39 year old old of unspecified 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: 1816022 expiry: UNKNOWN) dose was not reported, administered on 29-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 29-JUL-2021, the subject experienced body aches. On 29-JUL-2021, the subject experienced fatigue. On 29-JUL-2021, the subject experienced fever. On 29-JUL-2021, the subject experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the fatigue, fever, headache and body aches was not reported. This report was non-serious.


VAERS ID: 1517929 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Headache, Lip swelling, Malaise, Pyrexia
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Graves'' disease (Not being treated at the moment, diagnosed about 4 years.); Penicillin allergy; Sulfonamide allergy
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210729; Test Name: Body temperature; Result Unstructured Data: 100.6 F
CDC Split Type: USJNJFOC20210763195

Write-up: UPPER LIP SWELLING; OVERALL UNWELL FEELING; FEVER OF 100.6 F; HEADACHE; This spontaneous report received from a patient concerned a 34 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included graves disease due to hyperthyroidism, penicillin allergy, and sulfonamide allergy. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, and expiry: UNKNOWN) dose was not reported, administered on 29-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 29-JUL-2021, the subject experienced upper lip swelling. On 29-JUL-2021, the subject experienced overall unwell feeling. On 29-JUL-2021, the subject experienced fever of 100.6 f. On 29-JUL-2021, the subject experienced headache. Laboratory data included: Body temperature (NR: not provided) 100.6 F. Treatment medications included: paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from fever of 100.6 f on 29-JUL-2021, was recovering from overall unwell feeling, and headache, and had not recovered from upper lip swelling. This report was non-serious.


VAERS ID: 1517936 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Headache, Pain, Pain in extremity, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Alcohol use (1 drink every other weekend.); Non-smoker
Preexisting Conditions: Comments: Patient had no past medical history. Patient had no known allergies Patient had no drug abuse or illicit drug usage. Patient received multivitamin as past drug.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210763428

Write-up: SHAKING; BODY ACHES; SEVERE CHILLS; SORENESS IN ARM AT INJECTION SITE; BAD HEADACHE; This spontaneous report received from a patient concerned a 56 year old female. The patient''s weight was 125 pounds, and height was 65 inches. The patient''s concurrent conditions included alcohol user, and non smoker, and other pre-existing medical conditions included patient had no past medical history. patient had no known allergies patient had no drug abuse or illicit drug usage. patient received multivitamin as past drug. The patient was previously treated with betamethasone dipropionate for psoriasis, citalopram for anxiety, depression, ergocalciferol, and ascorbic acid. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 1820095 expiry: UNKNOWN) dose was not reported, administered on 28-JUL-2021 17:15 for prophylactic vaccination. No concomitant medications were reported. On 29-JUL-2021, the subject experienced shaking. On 29-JUL-2021, the subject experienced body aches. On 29-JUL-2021, the subject experienced severe chills. On 29-JUL-2021, the subject experienced soreness in arm at injection site. On 29-JUL-2021, the subject experienced bad headache. Treatment medications (dates unspecified) included: paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from shaking, and severe chills on 29-JUL-2021, and had not recovered from bad headache, body aches, and soreness in arm at injection site. This report was non-serious.


VAERS ID: 1518199 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-07-23
Onset:2021-07-29
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cymbalta
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fatigue Large bump at injection site after 7 days


VAERS ID: 1518356 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-27
Onset:2021-07-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye swelling, Injection site pain, Lip swelling, Mouth swelling, Swelling face, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Site: Pain at Injection Site-Mild, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Medium, Additional Details: PATIENT CAME TO THE PHARMACY 2 DAYS AFTER THE VACCINE WAS GIVEN TO REPORT SWOLLEN LIP. SHE WAS UNSURE IF IT WAS VACCINE RELATED OR SOMETHING ELSE.


VAERS ID: 1518358 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 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: 1518365 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Swelling at Injection Site-Mild


VAERS ID: 1518375 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Injection site pain, Paraesthesia, Presyncope
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Mild, Systemic: Dizziness / Lightheadness-Severe, Systemic: tingling on feet and fingers-Medium, Additional Details: diagnosis at urgent care states pt had a vasovagal attack


VAERS ID: 1518382 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / -

Administered by: Public       Purchased by: ?
Symptoms: Hypotension, Malaise, Pain
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Low blood pressure for 2 days after shot 90/50 multiple readings throughout the 2 days of general malaise and body aches Blood pressure returned to normal readings on third day after shot 120/76 all other symptoms returned to normal


VAERS ID: 1518395 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: troponin 20.5
CDC Split Type:

Write-up: myocarditis, chest pain, elevated troponin


VAERS ID: 1518411 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-01
Onset:2021-07-29
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A` / 2 AR / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Ultrasound Doppler, Venous thrombosis limb
SMQs:, Embolic and thrombotic events, venous (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Risperdol, Mirtazipine, Celexa levothyroxixne, depakote, dexilant and pepcid 20
Current Illness:
Preexisting Conditions: mood issues, scoliosis, reflux
Allergies: Dairy allergies, lactose intollerant
Diagnostic Lab Data: Ultrasound determined blood clot diagnosis.
CDC Split Type:

Write-up: Post Tibial venous blood clot. This is a first time blood clot. Patient went to urgent care because oi tenderness of the calf area. Physician thought it was either cellulitis or blood clot. Blood clot was determined after ultrasound.


VAERS ID: 1518425 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, 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: PATIENT ADVISED TO GET ANTIBODY TESTING IN TWO WEEKS
CDC Split Type:

Write-up: NO ADVERSE EVENT EXPERIENCED BY PATIENT, BUT VACCINE VIAL HAD BEEN PUNCTURED 20 HOURS PRIOR TO VACCINE AND KEPT IN REFRIGERATOR


VAERS ID: 1518430 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PATIENT NOTIFIED AND ADVISED TO OBTAIN ANTIBODY TESTING IN TWO WEEKS
CDC Split Type:

Write-up: No adverse event experienced by patient, but vaccine vial was punctured 20 hours and kept in refrigerator prior to vaccination.


VAERS ID: 1518432 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: minocycline 100mg/day
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: A few minutes after the injection, pt. passed out and started to have a seizure, it lasted 10-15 seconds. Once she woke up, she laid down for 30-40 minutes, and was able to leave and in ok condition.


VAERS ID: 1518434 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 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: none
CDC Split Type:

Write-up: vaccine was administered out of recommended storage conditions


VAERS ID: 1518439 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Headache, Hypotension, Insomnia
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: Medical Cannabis (CBD)
Current Illness: rhinitis
Preexisting Conditions:
Allergies: acetaminophen, ppenicillin, NSAIDs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Symtoms appear 48h later: *Shortness of breath *headaches *low pressure *insomnia


VAERS ID: 1518443 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, 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: vaccine was administered outside of recommended storage conditions


VAERS ID: 1518455 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, Rash, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Vomiting for over 24 hours followed by a rash and hives on trunk and arms. Itching all over body. Attempted to control with Benadryl but after 24 hours of hives dr called in steroids


VAERS ID: 1518459 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Headache, Pain in extremity, Rash erythematous, Rash pruritic, Vaccination site reaction, Vision blurred
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: synthroid/cytomel/Bystolic
Current Illness: summer cold covid negative test
Preexisting Conditions: Hashimotos and Hypertension
Allergies: tree pollen
Diagnostic Lab Data: None
CDC Split Type:

Write-up: red rash on arm at sight of vaccine - itchy . Pain on right arm for 2 days and on and off headaches some blurred vision


VAERS ID: 1518491 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Diarrhoea, Headache, Loss of consciousness, Nausea, Pyrexia, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Fever, shakes, headaches, nausea, diarea, passing out.


VAERS ID: 1518521 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 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? 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: over 42 days between shot. 1st dose 06/3/21, 2nd dose 07/29/21


VAERS ID: 1518526 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 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? 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: over 42 days between vaccines. 1st dose 06/04/2021, 2nd dose 07/29/21


VAERS ID: 1518606 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: urticaria rash Rx antihistamin


VAERS ID: 1518636 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Unknown  
Location: New York  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Hypotension, Insomnia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt experienced very low blodd pressure, severe chills, could not sleep. wife called ambulance and pt. was admitted to local hospital


VAERS ID: 1518700 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-27
Onset:2021-07-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Swollen right side of lip and cheek, resolved with Benadryl, 7/31/21 woke up at 2 am itching all over, large red, itchy, welts all over body, continued to spread all morning . Received oral prednisone script and started to improve that afternoon.


VAERS ID: 1518726 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Crying, Fatigue, Headache, Heart rate increased, Injection site pain, Oropharyngeal pain, Throat tightness, Tremor
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (broad), Hypoglycaemia (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Enthromycin topical (for acne) Differin gel (topical acne)
Current Illness: None
Preexisting Conditions: Asthma but has not taken any medications in at least two years and has not had any attacks.
Allergies: Cat Dander, feathers, dust, seasonal allergies ( spring and fall ), some cheeses(not identified specifically)
Diagnostic Lab Data:
CDC Split Type:

Write-up: - 11:15am shot administered and went to lobby to wait - 11:20am extreme fatigue started - 11:30am pain in injection site and extreme fatigue - 11:41am extreme fatigue just wanted to eat and go home and sleep, so decided to leave as nothing severe apparent - 11:43am back of throat started hurting and indicated throat feeling tight walked back into Dr. Office - shortly after doctor gave benedryl 12.5mg per 5ml given 15ml and water - asked repeatedly if feeling any different, was able to respond indicating tightness getting worse - was also having chills/shaking - able to speak but was crying from pain in throat and tightness - Dr. Then administered 0.3 mg epi pen - within minutes she did have some relief was able to smile when asked if she wants to eat - heart beat was accelerated but expected per doctor indication of the adrenaline rush from epi pen - Mild shaking still - Ambulance arrived 12:14pm - by around 12:50pm got to er and was feeling much better - observed for several hours later and just had intense fatigue, chills, and headache


VAERS ID: 1518761 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-03
Onset:2021-07-29
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anticoagulant therapy, Arteriogram carotid abnormal, Arteriosclerosis, Atrial septal defect, Cardiac telemetry normal, Carotid arteriosclerosis, Carotid artery stenosis, Cerebrovascular accident, Dysarthria, Echocardiogram abnormal, Electrocardiogram normal, Embolic stroke, Facial paralysis, Hemiparesis, Low density lipoprotein, Magnetic resonance imaging head abnormal, Ultrasound Doppler abnormal, Venogram normal
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Congenital, familial and genetic disorders (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hearing impairment (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: sinemet, glipizide, losartan, sertraline, simvastatin, coumadin, aspirin, biotin
Current Illness: none
Preexisting Conditions: HTN, Hyperlipidemia, parkinsons disease, past hx gonadal vein thrombus 10/20, depression, DM-2
Allergies: latex, pcn
Diagnostic Lab Data: MRI brain with parietal and frontal lobe cva. CT venogram of the pelvis showing resolution of gonadal vein thrombus no atrial fibrillation on ekg or telemetry echocardiogram small pfo cta neck 60 % stenosis of the r ICA, carotid dopplers with no carotid system stenosis and no thrombus. moderate r sided plaque
CDC Split Type:

Write-up: Pt received her 2nd pfizer covid 19 vaccine on 4/3/21 without incident. She presented to the emergency room on 7/29/21 with complaints of sudden facial drooping, L sided weakness and slurred speech and suffered an acute parietal and frontal lobe stroke despite being on coumadin, aspirin and a statin. The cause for the stroke was unclear per neurology. she had no history of atrial fibrillation. Her gonadal vein thrombus for which she was taking the coumadin for since 10/20 was no longer present on imaging and therefore the coumadin was stopped during admission. She had 60 % stable/calcified plaque of her R internal carotid artery but neurology did not feel that was a causative factor. she was also discovered to have a small Patent foramen ovale on echocardiogram but that also was not felt to be causative. Her stroke was embolic in nature. She will continue to take the same dose of aspirin and lipitor on discharge as her ldl is at goal. she remains with L sided weakness, slurred speech and a left facial droop.


VAERS ID: 1518765 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse drug reaction, Injection site pruritus, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Site: Itching at Injection Site-Medium, Systemic: Allergic: Itch Generalized-Medium, Additional Details: Pt is having itching sensation but there are no eruptions on the skin until she actually itches the skin. Pt of any other issues such as trouble breathing. Recommended trying benadryl 25mg today and seeking treatment from urgent care if benadryl does not help.


VAERS ID: 1518781 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect product formulation 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 Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1518795 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypomenorrhoea, Intermenstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adipex, trintellix, polyethylene glycol, magnesium, sodium biscodyl, calcium, vitamin D, prenatal vitamins
Current Illness: None
Preexisting Conditions: Constipation
Allergies: Dairy
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Period began as it should on the evening of July 28; however, it has been extremely light. I have only spotted.


VAERS ID: 1518803 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Depression, Fatigue, Hypogeusia, Hyposmia
SMQs:, Taste and smell disorders (narrow), Depression (excl suicide and self injury) (narrow)

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

Write-up: My taste and smell decreases,Fatigue and a sense of depression/anxiety


VAERS ID: 1518821 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash, Rash pruritic, Rash vesicular
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: vitamins C and D
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none, still ongoing symptoms
CDC Split Type:

Write-up: Pruritic blister like bumps on left shoulder/back, symptoms have lasted 3 days still ongoing


VAERS ID: 1518837 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

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

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

Write-up: 15 year old patient was given a dose of the Janssen covid vaccine. No symptoms were observed. The age of the patient was as well as the date of birth was written on the screening sheet The vaccinators would never checked the name and date of birth of the patient being vaccinated. It was always assumed that the name and date of birth was checked at the screening table where the age of the patient was determined. The persons manning the front desk of the vaccination room would only check the name once.


VAERS ID: 1518847 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

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

Write-up: Patient answered NO to question on the form - Have you ever received a dose of COVID-19 vaccine? Patient did not inform about previous Covid-19 vaccination. It was discovered during billing patient had received covid-19 vaccination J & J on 3/13/21.


VAERS ID: 1518848 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Palpitations, Retching, Vomiting
SMQs:, Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/a
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data: On July 30 (as it was past midnight), at the ER, his heart rate was fine and he was given anti nausea medication and IV fluids. His blood work was normal. He was not able to stop vomiting/dry heaving until the anti nausea medication (Zofran) took effect.
CDC Split Type:

Write-up: Pt. complained of feeling as if his heart was racing. This went on for about an hour, and then he began vomiting uncontrollably. He couldn?t get up off of the floor and was heaving even with nothing left in his stomach.


VAERS ID: 1518863 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: FAINTING, SEIZURE (NOT A FULL SEIZURE, BUT GOT STIFF)


VAERS ID: 1518869 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039C21A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamotrigine 200 mg, lexapro 10 mg, atorvastatin 80 mg, Myrbetriq er 50 mg, clopidogrel 75 mg, vit D3 5000 mg, vit E 400 mg, calcium 1200 mgs, omega 3 1000mg, potassium, abuteral, advair, spireava, B12, donepezil hcl
Current Illness: Chronic COPD, incontinence, dementia, osteoporosis, arthritis
Preexisting Conditions: Chronic COPD, incontinence, dementia, osteoporosis, arthritis
Allergies: Amoxicillin, dairy ( lactose intolerant)
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe itching on trunk ( arms, chest, back) as well as neck and head, by 9 am the next day the hives / rash appeared as small bumps and then turned to raised spreading rash. Called pharmacist and doctor''s office I was advised to treat with Zyrtec and topical steroid. Also applied Cer?ve anti itch cream every few hours. My husband showered and that provided temporary relief. Even the little bit of relief he gets from the Zyrtec doesn?t last more than 8 hours. Its has been 3 days and his symptoms are not resolving. I increased the Zyrtec to 10 mg every 12-15 hours yesterday. Also stopped myrbetriq since pharmacist indicated there is possible contraindications with the antihistamine. .


VAERS ID: 1518933 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure fluctuation, Fall, Gait disturbance, Head injury, Hemiparesis, Hemiplegia, Mobility decreased, Seizure, Walking aid user
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypertension (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Generalised convulsive seizures following immunisation (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: strawberry
Diagnostic Lab Data: unknown. contact hospital
CDC Split Type:

Write-up: Patient felt numb on her left side, she couldn''t move her left leg, was trying to get out of the car at the time but couldn''t she fell and hit her head to the concrete, she was taken to hospital and she has been hospitalized in medical center since then, they did stroke protocol on her and examined heart related issues, she has been having seizures since then for the first time in her life, her blood pressure is not stable either too low or shoots up too high without control. she will be taken to rehab because she can''t move her left side till now. she''s hardly walking with a walker.


VAERS ID: 1518990 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac flutter, Extrasystoles
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Tachyarrhythmia terms, nonspecific (narrow), Hypokalaemia (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: 0
Current Illness: 0
Preexisting Conditions: 0
Allergies: 0
Diagnostic Lab Data: 0
CDC Split Type:

Write-up: Reported heart flutter or skipped beats


VAERS ID: 1519000 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-16
Onset:2021-07-29
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL / 2 RA / IM

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

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

Write-up: covid pos after vaccination


VAERS ID: 1519026 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 AR / IM

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

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

Write-up: She was feeling lightheaded at 6:15PM. The client ambulated and sat in the anti-gravity chair. Vitals obtained at 6:21PM were as follows: HR 55, O2 99%, and automatic BP 108/64. The client was provided water at 6:24 PM and began drinking it. The client denied any other s/s of anaphylaxis. At 6:28PM the client stated the lightheadedness was improving. Client was moved to a reclining position in the anti-gravity chair. Repeat vitals obtained at 6:31PM were as follows: HR 53, O2 99%, automatic BP 110/72. Educated the client and her family on s/s of anaphylaxis, when to seek EMS, and V-safe. Client and her family voiced understanding of this education. Client denied any current medications. No known allergies. Repeat vitals obtained at 6:41 PM were as follows: HR 58, O2 99%, and automatic BP 109/68. The client denied feeling lightheaded at the time. The client left the vaccination site at 6:44PM. The client ambulated unassisted with a steady gait.


VAERS ID: 1519032 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Headache, Hypoaesthesia, Myalgia, Neck pain, Neuralgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (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:
Other Medications: none
Current Illness: none
Preexisting Conditions: None
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shoulder Pain and sever neck pain on left side up the cervical and thoracic spine into head and skull, feels nerve intense plus muscular. Some numbness down left arm.


VAERS ID: 1519090 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Back pain, Disorientation, Dizziness, Flushing, Hypertension, Neck pain, Pain, Pain in extremity, Paraesthesia, Tachycardia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Vestibular disorders (broad), Hypersensitivity (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 5 minutes post injection, pt reported dizziness, tachycardia ("heart beating out of chest"), pain & tingling radiating through injection arm & through left side of neck, acute flushing, hypertension, and disorientation. Thought she might have been feeling her throat swell but wasn''t sure since she has severe anxiety and recent neurological symptoms (ocular headaches). Suggested to administer IM diphenhydramine 50 mg but since pt stated that she has phobia of needles so IM injection may exacerbate symptoms. Since pt''s airways were clear, administered PO benadryl 50mg. After 10 mins, pt reported pain & tingling, extreme tachycardia had subsided but was starting to feel abdominal pain radiating to back. Still felt disorientation. Continued to monitor. After 20 mins post vaccination, decision was made to call EMS (pt previously refused since it was unclear which party would be responsible for EMS services). EMS arrived less than 5 mins later, took BP, and suggested to go to ER. Pt declined being taken by EMS and instead had her mother drop her off. The next day, pt''s mother came back to pharmacy to indicate that pt was treated with additional diphenhydramine and was stable.


VAERS ID: 1519265 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Decreased appetite, Electric shock sensation, Fatigue, Feeling abnormal, Feeling cold, Influenza like illness, Loss of personal independence in daily activities, Mobility decreased, Muscular weakness, Neck pain, Pain, Parosmia, Pyrexia, SARS-CoV-2 test negative, Somnolence, Vertigo
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metoprolol hydrochlorothiazide synthroid fish oil vitamin D3 zinc vitamin C multi-vitamin magnesium
Current Illness: gout
Preexisting Conditions: high BP (controlled) Hashimotos Thyroiditis
Allergies: shrimp (sometime severe) codeine talwin vicodin
Diagnostic Lab Data: rapid covid test, NEGATIVE
CDC Split Type:

Write-up: Within approx 11 hours of vaccine woke with severe chills, fever of 103?. This soon progressed to severe body aches, neck & shoulder pain, overall muscle weakness, loss of appetite, zaps of pain at left base of head. Overall felt like a severe flu. Half doses of Ibuprofen & Excedrin had little effect easing symptoms. but reduced fever to 100-101?. iSlept 10.5 hours and stayed in bed 24 hours - too weak to assume activities. After 48 hours took half of Tylenol (250mg). Fever and body aches immediately responded. Had incident of vertigo. Have foggy brain, feeling dusconnected. Began to smell metal (phantom). By 72 hours most symptoms resolve except for general weakness, joint pain, feeling disconnected and groggy, fatigued.


VAERS ID: 1519296 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-12
Onset:2021-07-29
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstrual disorder, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

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

Write-up: Experienced unusual heavy bleeding and heavy clotting that patient had never experienced before with menstrual flow


VAERS ID: 1519302 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes zoster, Musculoskeletal chest pain, Rash, Tenderness
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: armour thyroid, biest cream, testosterone cream, progesterone
Current Illness: none
Preexisting Conditions: hypothyroid and hormone replacement
Allergies: wheat
Diagnostic Lab Data: Seen by PA at above mentioned clinic and diagnosed with shingles. No previous history of shingles; positive for chickenpox as an adolescent.
CDC Split Type:

Write-up: On 7/29/2021 at approximately 1900, I developed right lower rib pain that was very tender to touch; On 8/1/2021, upon waking I discovered a rash in that same area. I went to Health Same Day Clinic at 1100.


VAERS ID: 1519454 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-26
Onset:2021-07-29
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / UNK - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Feeling cold, Nausea, Pain in extremity, Vertigo
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: The first few days, patient had exhaustion and arm pain, which was expected...it seemed to be subsiding a bit, but then Thursday morning he was hit with a wave of fatigue again. He then had severe nausea, was freezing cold, and vertigo. I took his temperature and it was 95.5 degrees. He stayed in bed most of Thursday. By about 4:00 I took his temp again and it was up to 97.1. The low body temp and vertigo was particularly concerning, so I called his Dr and was advised to make this report. He is still extremely fatigued. At this time he has not experienced vertigo or low body temp since Thursday''s episode.


VAERS ID: 1519476 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Headache, Migraine, Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LEvothyroxine 88 mcg prenatal vitamin
Current Illness: postpartum (delivery date 7/13/2021)
Preexisting Conditions: hashimotos hypothyroid
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Severe migraine lasting 10 hours Aches, chills, headache lasting 48 hours


VAERS ID: 1519490 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-07-23
Onset:2021-07-29
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenol/Chloe Escitalopram Potassium Calcium Magnesium Multivitamin Omega 3-6-9 Minerals Herbal cleanser CoQ-10
Current Illness:
Preexisting Conditions: High blood pressure
Allergies: Eggs Dairy Onion
Diagnostic Lab Data:
CDC Split Type:

Write-up: On the 6th day where shot was given pain, red, swollen and itchy.


VAERS ID: 1519491 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-27
Onset:2021-07-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Food allergy, Gastrointestinal disorder, Lower respiratory tract congestion, Pyrexia
SMQs:, Cardiac failure (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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: Ritalin, modafinil, lipitor, amlopidine, azilva, Tylenol, Allegra, Sudafed, Fluticasone
Current Illness: Possible exposure to virus a day or two prior to getting vaccine.
Preexisting Conditions: Sleep apnea, narcolepsy, bronchial asthma
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Constant fever between 98?101.5 over the past five days; stomach hypersensitive to salty or oily foods. Increased bronchial congestion.


VAERS ID: 1519496 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O45B21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthma, Blood pressure increased, Blood test normal, Chest X-ray normal, Condition aggravated, Dyspnoea, Electrocardiogram normal, Hypersensitivity, Palpitations, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Asthma
Allergies: None
Diagnostic Lab Data: Test done were chest x-rays, ekg, COVID test and bloodwork. Everything was normal. ER visit was 7/30/2021
CDC Split Type:

Write-up: Elevated blood pressure, felt like her heart was raising, and shortness of breath. Patient went to ER and was treated with a breathing treatment and inhaler. ER visit was 7/30/2021. Diagnosed with allergic reaction resulting in acute asthmatic bronchitis.


VAERS ID: 1519510 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-19
Onset:2021-07-29
   Days after vaccination:101
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin
Current Illness:
Preexisting Conditions: None
Allergies: Rofecoxib
Diagnostic Lab Data: SARS-Cov-2 PCR test
CDC Split Type:

Write-up: Pt was fully vaccinated with both doses of the Moderna vaccine, on 3/22/21 and 4/19/21. Pt developed a mild infection with COVID around 7/29/21, but was not ill enough to be hospitalized.


VAERS ID: 1519515 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

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

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

Write-up: Patient called the pharmacy Saturday morning and spoke to pharmacist states her lips began to swell ~30 minutes after receiving the Pfizer Covid 19 vaccine. She was already at home and it wasn''t too severe, she took some Benadryl. The swelling subsided and on Saturday she experienced swelling around her eyes. Pharmacist recommended to continue Benadryl and seek medical attention if it persisted or became worse. Called patient on 8-2 she reports doing much better swelling is down and has appointment with physician on Tuesday.


VAERS ID: 1519526 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-12
Onset:2021-07-29
   Days after vaccination:108
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / 2 RA / IM

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

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

Write-up: Pt received both doses of the Moderna COVID-19 vaccine, on 3/15/2021 and 4/12/2021. He developed minor symptoms of COVID-19 and tested positive via PCR test on 7/29/2021. He did not need to be hospitalized.


VAERS ID: 1519559 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Muscle spasms
SMQs:, Dystonia (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states that after receiving the 1st dose of Phizer 07/29/2021, started experiencing headaches Intense with muscle spasms in the left hand and left side of the face. Subsided after a week''s time.


VAERS ID: 1519570 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Computerised tomogram head, Dizziness, Hemiparesis, Lethargy, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Cymbalta, Portia birth control
Current Illness: none
Preexisting Conditions: none
Allergies: augmentin, dilaudid
Diagnostic Lab Data: blood tests, ct scan, mrs has been ordered
CDC Split Type:

Write-up: stroke like symptoms, dizziness, visual disturbance, left side weekness, lethargic


VAERS ID: 1519612 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pyrexia, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: dicyclomine (BENTYL) 10 MG capsule levonorgestrel (MIRENA) 20 MCG/24HR IUD(Expired) tretinoin (RETIN-A) 0.05 % cream
Current Illness: NA
Preexisting Conditions: NA
Allergies: NKDA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Patient calling for Acute IUD Check, COVID-19 Vaccine, and VAGINAL BLEEDING Symptoms started 7/29/21. Symptoms include: Constant Moderate vaginal bleeding. Patient Has not attempted treatment at home.. Pertinent negatives include: No abdominal pain. No breathing difficulty. No injury. No symptoms of allergic reaction. Pertinent Medical History: Patient received the second dose of the Pfizer COVID vaccine and later that day started having moderate vaginal bleeding. She has not had a period in 5 years due to mirena IUD. She does report she had a fever in the first 24 hours after the vaccine but has been afebrile since. She also is not having any abdominal pain or cramping. Patient wanted to report the vaginal bleeding as it occurred after her 2nd covid shot and she wondered if that was related. She had to change tampon every 2-3 hours initially but has slowed down some No chest pain or SOB No lightheadedness or dizziness. Patient will call office tomorrow with progess Patient has IUDin place and has not had a period in 5 years..


VAERS ID: 1519634 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-23
Onset:2021-07-29
   Days after vaccination:128
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anosmia, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Taste and smell disorders (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: In the last 48 hours, have you had a fever* OR symptoms that are unrelated to a preexisting illness?: New muscle aches, New loss of smell


VAERS ID: 1519635 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-24
Onset:2021-07-29
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, Oropharyngeal pain
SMQs:, Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Immune-mediated/autoimmune disorders (broad)

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

Write-up: In the past 14 days are any of the following symptoms new to you and not related to an existing health condition?: New sore throat, New loss of smell, New change or loss of taste sensation


VAERS ID: 1519636 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-06
Onset:2021-07-29
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 LA / IM

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

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

Write-up: COVID Positive PCR


VAERS ID: 1519652 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

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

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

Write-up: Patient stood for a few minutes after receiving vaccine while his sister was receiving hers. He began "blacking out" as he described later, but it initially looked as if he may have a seizure. The patient had a blank stare and then started leaning. I let him go to the floor slowly and the mother came in the room and attended him until he regained awareness/consciousness.


VAERS ID: 1519655 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-06
Onset:2021-07-29
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Cough, Dyspnoea, Exposure to SARS-CoV-2, Malaise, Rhinorrhoea, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), COVID-19 (narrow)

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

Write-up: Pt was exposed to Covid on Monday from a close coworker. On Thursday, pt was not feeling well and began having a dry cough and shortness of breath. She had a negative Covid test on Thursday and was put on Prednisone. Pt has taken 3 pills. Pt has SOB that got worse since Thursday. Pt also is having central chest tightness. SOB is worse while lying flat. She also has a little clear drainage coming out of her nose.


VAERS ID: 1519679 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Injection site reaction, Rash papular
SMQs:, Anaphylactic reaction (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: Estradiol - Metoprolol - Synthroid - Advair/Diskus - Omeprazole - Baby Aspirin - Zyrtec - Calcium - Vitamin C - Naproxen - Placquenil
Current Illness: N/A
Preexisting Conditions: Asthma - Hypothyroidism - High Blood Pressure - Inflammatory Arthritic Auto Immune Disease - Lymphedemea - Lipedema
Allergies: Morphine - Lisinopril - Ketamine
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 1) Extreme tightness in chest but did not affect breathing. This lasted 2 days. 2) Raised rash a 1/2 inch below injection site & the rash is 2"x2.5" in size & still present as of 8/2/2021.


VAERS ID: 1519730 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066A21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: carvedilol, doxepin, fenofibrate, gabapentin
Current Illness: N/A
Preexisting Conditions: pinched nerve in neck; hypertension, hyperlipidemia (high trigycerides), nightmares
Allergies: Lortab (itchy)
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Redness and swelling at the injection site (started off the size of a golf ball diameter, but has increased to the size of a baseball diameter, stretching from one side of arm to the other side); Hot to the touch initially but only warm to the touch now; No itching originally, but some slight itching now; It is less red now


VAERS ID: 1519757 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

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

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

Write-up: Patient received Janssen shot in March and should not have received first dose of Pfizer vaccine. No adverse side effects were reported by patient - but at this time, second dose is not needed and will not be completed.


VAERS ID: 1519805 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: California  
Vaccinated:2021-01-19
Onset:2021-07-29
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Cough, Exposure to SARS-CoV-2, Impaired work ability, Nasal congestion, Pain
SMQs:, Anaphylactic reaction (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: Sx, bodyache, nasal congestion, cough since 7/29. Forced scheduled for test 7/30. Vaccinated. Roommate is Pos. The last day worked was on 7/28.


VAERS ID: 1519842 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 3 UN / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Third dose of vaccine administered, no reported ill effect to patient discovered upon documentation after vaccination was administered.


VAERS ID: 1519869 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Pain, SARS-CoV-2 test
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 54 moderna jume 30
Other Medications: Ibuprofen
Current Illness: Body pain, headache, chills
Preexisting Conditions: Asthma
Allergies: Peanut, mosquito bite, dust, mold
Diagnostic Lab Data: Covid test
CDC Split Type:

Write-up: Chills, headache, body pain


VAERS ID: 1519903 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-26
Onset:2021-07-29
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 AR / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Facial paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Symptoms began appearing on 7/26/21, where the left side of her face wouldn''t move.


VAERS ID: 1519916 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-07-27
Onset:2021-07-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Gait disturbance, Gait inability, Motor dysfunction, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: LANTUS, GAPAPENTIN, TRAMADOL
Current Illness: DIABETES
Preexisting Conditions: DIABETES, INSULIN DEPENDENT WITH PERIPHERAL NEUROPATHY
Allergies: NONE
Diagnostic Lab Data: Unsure what tests they have done at the ER. . Also do not know physician names- .
CDC Split Type:

Write-up: Patient had vaccine on Tuesday afternoon. Wednesday woke up with sore arm and leg but able to work. Thursday and Friday it was steadily getting worse. Saturday, patient went to a festival. He wanted to see granddaughter in parade and also for his business. It was an extremely hot day but patient drank water. He was very weak and wife had to help him walk to the site for the parade and auction. The patient''s wife put out on social media his complications and a nurse responded that they needed to go to the ER. Later that evening patient was unable to hold drink in his hand. Patient decided to wait until Sunday and see if he felt better. Sunday he woke up and could not walk. They went to ER and were admitted. His wife did not know the physicians that were seeing him in the hospital.


VAERS ID: 1519978 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2020-12-21
Onset:2021-07-29
   Days after vaccination:220
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, General physical health deterioration, 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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Humira, Allegra, Flonase, Synthroid, Lisinopril, Meloxicam, Stahist
Current Illness:
Preexisting Conditions: Hypertension, Psoriatic arthritis, hypothyroidism
Allergies: Compazine
Diagnostic Lab Data: Patient tested positive at an urgent care on 7/29 - test was repeated in the ED of Hospital and was again positive
CDC Split Type:

Write-up: After becoming fully vaccinated in January 2021, patient was admitted to Hospital after clinically worsening when 4 days prior tested positive for COVID-19 at an urgent care thinking it was sinus infection


VAERS ID: 1519994 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-12
Onset:2021-07-29
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 RA / IM

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: CONTRACTED COVID-19 POST VACCINATION


VAERS ID: 1520048 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-26
Onset:2021-07-29
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Ear discomfort, Fatigue, Hypoacusis
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: DMSA
Current Illness:
Preexisting Conditions: Chronic EBV complications
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Off and on since Thursday, a feeling of ?clogging? in ears, accompanied by muffled noise, as though water in ear. Seems worse after sleep. Also some fatigue.


VAERS ID: 1520056 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Please be advised that we had an individual come and was administered what we were led to believe was his 1st dose of Pfizer Vaccine on 7/30/2021. On his intake form and during his verbal questioner prior to the injection, he advised that he had not received a COVID-19 Vaccine. While inputting his data he prepopulated in the system and under vaccinations we identified that he actually did in fact receive a previous Pfizer dose 1 on 12/22/2020 and a Dose 2 on 01/08/2021. I contacted and they advised to follow-up with the patient to check on his/her wellbeing and assess for any adverse events and/or reactions. This is considered an administration error, due to 3rd doses not being authorized, a report to VAERS will need to be submitted. I contacted the patient and he advised that the information we found was incorrect, he advised that he had scheduled but never received the vaccine, and that he would contact the healthcare facility.


VAERS ID: 1520083 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-25
Onset:2021-07-29
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Hypoaesthesia, Limb discomfort, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (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: Yaz
Current Illness: N/a
Preexisting Conditions: N/A
Allergies: N/a
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: 7-29 bilateral facial paresthesia (numb face from cheeks down and heaviness in cheeks). Contacted urgent care. PA prescribed prednisone. 7-30 some numbness in arms. 7-31 facial paresthesia has subsided some but still present. Numbness and heaviness in arms causing discomfort and some numbness in legs and feet. 8-1 and 8-2 numbness in face, arms and legs.


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