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

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



Case Details (Reverse Sorted by Onset Date)

This is page 179 out of 3,232

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VAERS ID: 1366873 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-01-28
Onset:2021-05-03
   Days after vaccination:95
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Basophil count, Lymphocyte count, Lymphoma, Monocyte count, Neutrophil count, Neutrophil percentage, White blood cell count
SMQs:, Malignant lymphomas (narrow), Haematological malignant tumours (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: Medical History/Concurrent Conditions: COVID-19 (Patient''s antibody response was noted as ''robust'' and it did not require any hospitalization at the time.)
Allergies:
Diagnostic Lab Data: Test Date: 20210503; Test Name: Basophils; Test Result: Inconclusive ; Result Unstructured Data: basophils: 0; Test Date: 20210503; Test Name: Lymphocytes; Test Result: Inconclusive ; Result Unstructured Data: lymphocytes: 55.0; Test Date: 20210503; Test Name: Monocytes; Test Result: Inconclusive ; Result Unstructured Data: monocytes 4.0; Test Date: 20210503; Test Name: Total Neutrophil Level; Test Result: Inconclusive ; Result Unstructured Data: Total Neutrophil Level: 7.44; Test Date: 20210503; Test Name: Differential: Neutrophils; Test Result: Inconclusive ; Result Unstructured Data: Differential: Neutrophils 36.0; Test Date: 20210503; Test Name: WBC; Test Result: Inconclusive ; Result Unstructured Data: WBC 12.6
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: Possible Lymphoma Diagnosis; This spontaneous case was reported by an other health care professional and describes the occurrence of LYMPHOMA (Possible Lymphoma Diagnosis) in a 42-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 029L20A) for COVID-19 vaccination. The patient''s past medical history included COVID-19 (Patient''s antibody response was noted as ''robust'' and it did not require any hospitalization at the time.) in March 2021. On 28-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 03-May-2021, the patient experienced LYMPHOMA (Possible Lymphoma Diagnosis) (seriousness criterion medically significant). At the time of the report, LYMPHOMA (Possible Lymphoma Diagnosis) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 03-May-2021, Basophil count (0.01-0.07): 0 (Inconclusive) basophils: 0. On 03-May-2021, Lymphocyte count (17.0-48): 55.0 (Inconclusive) lymphocytes: 55.0. On 03-May-2021, Monocyte count (6-13): 4.0 (Inconclusive) monocytes 4.0. On 03-May-2021, Neutrophil count (0.99-3.2): 7.44 (Inconclusive) Total Neutrophil Level: 7.44. On 03-May-2021, Neutrophil percentage (38-73): 36 (Inconclusive) Differential: Neutrophils 36.0. On 03-May-2021, White blood cell count (3.6-9.9): 12.6 (Inconclusive) WBC 12.6. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Treatment information not reported. No concomitant medications reported. Additional diagnostic results: On 03-May-2021, Markers: CD5 positive/dim, CD19 positive/mod, CD20 positive/dim, CD23 positive/dim, CD38 positive/dim, CD45 positive/bright, HLA-BR positive/mod, S-Lambda positive/dim. Evidence of Monoclonal B cell population CD5+CD23+B-CLL phenotype. As of 19-MAY-2021, the patient has not been officially diagnosed with Lymphoma, but it is suspected. Company comment: Very limited information regarding this event has been provided at this time. Further follow up is not possible.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further follow up is not possible.


VAERS ID: 1367216 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-22
Onset:2021-05-03
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EV10161 / 2 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Blood fibrinogen, Blood fibrinogen increased, Body temperature, C-reactive protein, COVID-19, Cardiac resynchronisation therapy, Chest pain, Chills, Computerised tomogram, Fibrin D dimer, Fibrin D dimer increased, Fluid wave test, Headache, Hot flush, Hyperhidrosis, Paraesthesia, Pneumonia, Polymerase chain reaction, Pyrexia, SARS-CoV-2 test, TRPV4 gene mutation, Vaccination failure
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Lack of efficacy/effect (narrow), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Congenital, familial and genetic disorders (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Non-smoker
Allergies:
Diagnostic Lab Data: Test Date: 20210517; Test Name: Fibrinogen; Result Unstructured Data: Test Result:879; Test Name: Body temperature; Result Unstructured Data: Test Result:99; Comments: low-grade fever; Test Name: CRT; Result Unstructured Data: Test Result:Unknown result; Test Date: 20210507; Test Name: CT scan; Result Unstructured Data: Test Result:no blood clots, no kidneys stones or anything like; Test Name: CPR; Result Unstructured Data: Test Result:Unknown result; Test Date: 20210507; Test Name: Dimer test; Result Unstructured Data: Test Result:high levels with mainly blood clot; Test Name: Fluid test; Result Unstructured Data: Test Result:Unknown result; Test Name: PRC; Result Unstructured Data: Test Result:Unknown result; Test Date: 20210507; Test Name: COVID antigen test; Test Result: Positive ; Test Name: TRP; Result Unstructured Data: Test Result:Unknown result
CDC Split Type: USPFIZER INC2021564322

Write-up: Headache; hurt right below my chest and in stomach; skin became extremely prickly; Low grade fever like 99; Dimer test showed kind of high levels with mainly blood clot; some fiber or Fibrogen which was for thickening of blood/ supposed to be between 400 and 420, his was 879; have COVID, it was positive COVID antigen test; have COVID, it was positive COVID antigen test; felt pressure in his back almost like pneumonia; Chills; sweat; Hot flashes; Stomach was cramping/ hurt right below my chest and in stomach; This is a spontaneous report from a contactable consumer (patient). A 49-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) via unspecified route on right shoulder single dose for COVID-19 immunization; second dose with lot number: EV10161 on 22Apr2021, first dose with lot number: EP7533 on 01Apr2021, at 49-year-old. Medical history and concomitant medication were not reported. The patient was non-smoker, non-drinker. The patient had a little headache with the second shot but 2 weeks later on 03May2021 started having chills every night and would sweat. He was having chills and hot flashes and stomach was cramping and when inhaled like taking a deep breath, felt pressure in his back almost like pneumonia like lungs were filling with fluid or clotting. On the 07May2021, he took a little flu medication Theraflu over the counter (treatment) thinking that''d clear it up. Every time he took a deep breath, it''d just hurt right below my chest and in stomach and skin became extremely prickly. He''d have like a low-grade fever like 99. This was 2 weeks after the second shot, so he went to the ER on 07May2021 and was given a COVID test, a fluid test and lab work trying and figure what he was having. One of his blood test - Dimer test showed kind of high levels with mainly blood clot so they gave him a CT scan, scan showed no blood clots, no kidneys stones or anything like that should had any sweating. ER doctor gave him an antibiotic (ciprofloxacin) for infection like diverticulitis or diverticulosis. The doctor said the patient did not have a stomach infection, his tests showing such high levels for clots so the doctor did more lab work a PRC, CRT, TRP or CPR, a CRT lab work and some fiber or Fibrogen which was for thickening of blood. Those numbers are supposed to be between 400 and 420, his was 879 today (17May2021). The patient did have COVID, it was positive COVID antigen test, I got those results today (17May2021). Outcome of the events was unknown.


VAERS ID: 1367341 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Hypoaesthesia, Influenza like illness, Nausea, Pyrexia, SARS-CoV-2 antibody test
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data: Test Name: Antibody test; Test Result: Negative
CDC Split Type: USPFIZER INC2021593451

Write-up: He had flu like symptoms; Severe diarrhea; Low grade fever; Nauseous; He got dizzy and his hands fell asleep; He got dizzy and his hands fell asleep; This is a spontaneous report from a contactable consumer (patient). A 65-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Batch/Lot Number: ER8736), first dose via an unspecified route of administration, administered in left arm on 03May2021 (at the age of 65-year-old,) as a single dose for Covid-19 immunisation. The patient''s medical history, family history and concomitant medications were reported as none. The patient did not experience any adverse event prior Covid vaccination. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccination. On 03May2021, it was reported that 5 min after the vaccine dose around 13:30 to 14:00 in the afternoon the patient''s hands fell asleep, and the fire department had to walk him around for a bit. Six or seven days later after Covid vaccination on 09May2021, the patient was dizzy (time unknown), and, in the afternoon, he felt nauseous and experienced diarrhea and flu like symptoms, on the same day in the evening he also had low grade fever. The patient did not visit emergency room for events. The patient did not received treatment for dizzy and flu like symptoms. Therapeutic measures were taken, because of diarrhea he took Imodium (a week before he visited physician office) and Tylenol for low grade fever. Treatment for nauseous was not reported. No investigation assessment was reported. No relevant tests were performed. The patient underwent lab tests and procedures which included Sars-Cov-2 antibody test: result was negative. The reporter did not specify event seriousness. No product quality complaint was reported. The patient visited the physician office after it was over to get doctors opinion. Everything went away and the patient did not know if it was a reaction or food poisoning and the doctor said it was a reaction to Covid vaccine. The patient reported that he was supposed to get second dose of vaccine and he would like to know that if he should get second dose or not because he recorded an Adverse event with DSU on 24May2021. The reporter also mentioned that since his second dose was on 24May2021 (reported as today), would it screw things up if he did not get the second dose on the date of report 24May2021 (today). The patient states that his provider says that his side effects are from vaccine and he would be putting him on medication for side effects. The patient also queried that would it screw things up if he waits for a week or so before going back to get the second dose. The patient dug through when he got back on 24May2021 (today), he was curious if it is advisable to go back after the reactions. Attempted was made to explain to the patient that ?we'' would not be able to tell him whether or not to go back for his second dose and that we suggest he reach out to primary care provider for more information. The patient wanted to know if it is advisable to get the second dose or hold off and that''s his biggest worry. The has a second question, the second dose date is supposed to be on 24May2021 (today) will it screw things up if he waits a week or so before going back to get the second dose. The outcome of the event hands fell asleep was reported as recovered on 03May2021, events diarrhea and low-grade fever was recovered on 10May2021, events flu like symptoms and nauseous was recovered on 11May2021 and event dizzy was recovered on 12May2021. No follow-up attempts are needed. No further information is expected.


VAERS ID: 1367714 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-30
Onset:2021-05-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cough, Dyspnoea, Fatigue, Nausea, Retching
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: He reports getting the first Pfizer shot on 4/30/21. Starting on 5/1/21, he reports feeling fatigue, SOB and cough. These symptoms worsened over the subsequent two days until today when he felt that the cough was so frequent and severe that he couldn''t breathe. No fevers/chills/vomitting. He has felt nauseous and has dry heaved multiple times, mostly in the context of coughing fits. Pt was advised to go to ED for evaluation.


VAERS ID: 1367806 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-12
Onset:2021-05-03
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Deafness unilateral, Tinnitus
SMQs:, Hearing impairment (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: Patient called call center only to report side effects from 1st dose Pfizer vaccine on 4/12. Pt denied emergency symptoms at time of call. Only wanted to report what happened after first dose, per advisement from PCP. 4/12 pt received 1st dose Pfizer vacc 4/21 evening pt experienced intense tinnitus. 4/22 pt states she experienced complete hearing loss in one ear. Received medical attention from PCP @outside insitutation. Per PCP pt was told not to receive 2nd dose of Pfizer vaccine. Pt is on 2 week steroid treatment, still reports complete hearing loss in one ear."


VAERS ID: 1368023 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-01
Onset:2021-05-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Ageusia, Body temperature increased, Cough, Fatigue, Pain, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: patient called health system call center. pt c/o generalized body pain,feling tired started 5/1/2021(saturday) midnight after she got ist dose covid vaccine on 05/01 morning time. Pt denies emergency sx at this time. Noted temp 100.7F stated by pt. Also c/o slight dry cough,runny nose,sore throat and loss of taste. Scheduled earliest available UC MD telephone appt for further consult and evaluation. told pt to go to nearest ED/call 911 if any medical emergency arises,pt verbalized understanding.


VAERS ID: 1368207 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-26
Onset:2021-05-03
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Pain in extremity
SMQs:, Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: left inner arm pain and weakness continuing sine 1 week after injection


VAERS ID: 1368528 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-27
Onset:2021-05-03
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Ataxia, Balance disorder, CSF glucose increased, CSF protein increased, Dizziness, Lumbar puncture abnormal, Magnetic resonance imaging spinal normal, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine 5 mg daily
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: NKDA
Diagnostic Lab Data: MRI lumbar spine: no demyelinating lesions or stenosis Spinal tap: high protein, high glucose
CDC Split Type:

Write-up: Dizziness, lightheadedness, imbalance, ataxia Nausea, vomiting Hospitalized for extensive work-up, Possible diagnoses Guillain-Barre variant (Miller Fisher)


VAERS ID: 1368750 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-28
Onset:2021-05-03
   Days after vaccination:95
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 2 LA / IM

Administered by: Pharmacy       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DOCUSATE SOD 100MG 1 CAP BID; NAMENDA 5MG 1 TAB DAILY; EXELON 1.5MG 1 CAP BID; PRN MEDICATIONS: MILK OF MAGN SUS 1200/15 GIVE 30ML PO AT HS PRN IF NO BM THAT DAY.
Current Illness: NONE REPORTED
Preexisting Conditions: NONE REPORTED
Allergies: NONE REPORTED
Diagnostic Lab Data:
CDC Split Type:

Write-up: VACCINE INFECTION BREAKTHROUGH


VAERS ID: 1368891 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Mobility decreased, Pain, Pain in extremity
SMQs:, Parkinson-like events (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: generic synthroid at times fish oil
Current Illness: n/a
Preexisting Conditions: hypothyroidism
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: SEVERE pain in the arm. Not where the vaccine was given but farther down. For 2 days couldn''t even move my arm. It is now nearly a month later-and I still have a sore arm. It doesn''t always hurt now-seems to be cyclical. After about 3 or 4 days I could move it-but with pain. No rash, feeling fatigued.


VAERS ID: 1368908 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Malaise, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: Patient said he lost feeling in his fingers. Can''t sense hot vs cold, etc. Also, said he lost strength in arm/hand and drops things frequently. He said he got pretty sick the next day, but that the doctor attributed this to possibly having COVID previously.


VAERS ID: 1369068 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-28
Onset:2021-05-03
   Days after vaccination:95
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 2 LA / IM

Administered by: Pharmacy       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? No
Previous Vaccinations:
Other Medications: HYDROSKIN 1% CREAM/ALOE APPLY PRN; BAZA CLEANSE 2%; CALCIUM/MAG/ZINC TAB 1 TAB DAILY; CELEXA 20MG 1 TAB DAILY; COENZYME Q10 30MG 1 TAB DAILY; DOCUSATE SOD 100MG 1 TAB DAILY; FISH OIL 500MG 1 CAP DAILY; FLORAJEN3 1 CAP DAILY; FLONASE 1 SPRAY
Current Illness: NONE REPORTED
Preexisting Conditions: NONE REPORTED
Allergies: AMOXICILLIN, COMPAZINE, SULFADIAZINE, CIPROFLOXACIN
Diagnostic Lab Data:
CDC Split Type: CR outbreak #23427, CC ou

Write-up: COVID INFECTION POST VACCINE


VAERS ID: 1369076 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-28
Onset:2021-05-03
   Days after vaccination:95
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 2 LA / IM

Administered by: Pharmacy       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ASA 325MG 1 TAB Q AM; CALCIUM/D3 600-400 1 TAB BID WITH MEALS; FEROSUL 325MG 1 TAB BID WITH MEALS; PROZAC 10MG 1 CAP DAILY; FLONASE 2 SPRAYS EACH NOSTRIL DAILY; BONIVA 150MG 1 TAB Q MONTH ON SAME DATE WITH FULL GLASS WATER; ZESTERIL 10MG 1
Current Illness: NONE REPORTED
Preexisting Conditions: NONE REPORTED
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type: CR outbreak #23427, CC ou

Write-up: COVID INFECTION POST VACCINATION


VAERS ID: 1370682 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-23
Onset:2021-05-03
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Pain in extremity, Pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021593479

Write-up: a red blotchy look to his skin that almost looked like welts; arm hurt a little bit/little soreness around his arm; rash and redness; slight rash like hives around his shoulder; hives underneath the skin that was a itchy feeling; rash and redness; This is spontaneous report from contactable consumer (patient, self-reported). A 50-year-old male patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: solution for injection, Lot number: EW0170) via an unspecified route of administration on 23Apr2021 at single dose for covid-19 immunization at hospital. The patient''s medical history and concomitant medications were not reported. The patient previously took first dose of BNT62B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: solution for injection, Lot number EK8737) for on 02Apr2021 via an unspecified route of administration at single dose for COVID-19 immunization. On 03May2021, the patient experienced a red, blotchy, hive type of reaction and had a rash type of redness, the patient clarified it was more like hives underneath the skin that was a itchy feeling then it kind of went away. The patient stated he has been monitoring himself since he was reluctant to even take the vaccine. The patient had little soreness around his arm and then noticed a slight rash like hives around his shoulder and that was basically it. The patient had rash and redness around the shoulder. He had redness on his neck while on the phone with the agent and it was very random. He noted that there was not anything on his face or his privates and it looks like a reaction of some sort. The patient enquired this something that can happen, will he be dealing with its long term and was this an indication that something could be going wrong. It was strange that he was experiencing symptoms so long after the vaccine noting it has been four weeks after the second shot. The patient stated that he did not have any real significant reaction other than his arm hurt a little bit. On 15May2021, the rash and redness came back where he felt itchy, and it had a red blotchy look to his skin that almost looked like welts and then might be like half hour or 25 minutes it would disappear and come back to a different part of his body like his neck or chest. The patient stated that they came back on 15May2021 with a vengeance and the events are sporadic with no set schedule. The patient had itching on his shoulder, back, chest, sometimes his stomach noting all over his body. The reporter seriousness for itchy and it had a red blotchy look to his skin that almost looked like welts was unspecified. The patient stated his doctors were asking if he had any chills or fevers associated with this and he was like no. The patient stated he would be disingenuous if he said he was not alarmed and reluctant to take the vaccine. The patient stated now he has taken it and it has weeks later and he would think a reaction like this would have happened sooner. The patient stated he was just reaching out to see if this sounds like, was this normal or common or should he be alarmed. The patient stated he would rather talk to someone and get a general feeling of what he was describing if this sounded like something that they have heard of and was not totally abnormal as related to side effects that have been seen. It would quench the alarm in his spirt that has him like hey maybe he needs to go to the emergency room. The outcome of the events was unknown. Information on Lot/Batch number was available. Additional information has been requested.


VAERS ID: 1371156 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-18
Onset:2021-05-03
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0614 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Menstruation delayed, Pregnancy test negative
SMQs:, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pregnancy tests taken after 2 and 3 weeks of scheduled period date, both negative results. Still waiting to be seen by a doctor.
CDC Split Type:

Write-up: Disruption of menstrual cycle. Period was regular after first dose of the vaccine. After receiving the second shot, I still have not gotten my period. Currently 4 weeks late and on day 65 of my cycle, which is usually consistent every 28-30 days. All tests taken confirm that I am not pregnant.


VAERS ID: 1371303 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-04-24
Onset:2021-05-03
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Blood pressure increased, Chest pain, Computerised tomogram thorax abnormal, Condition aggravated, Dizziness, Heart rate increased, Pulmonary embolism
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lescol - 80mg. Olmesartan - 40mg. Levothyroxine - 75mcg. Bupropion - 450mg. Cialis - 5mg. Saw Palmetto
Current Illness: None
Preexisting Conditions: High Blood Pressure. Depression
Allergies: None
Diagnostic Lab Data: CT scan on 5/19/2021. Admitted to Hospital on 5/19/2021 for treatment
CDC Split Type:

Write-up: Confirmed pulmonary embolism in 3 locations. Prescribed Xaralto. Symptoms include Chest pain, rapid heart rate, increased blood pressure, dizzy, light headed feeling


VAERS ID: 1371526 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain, Adnexa uteri pain, Chills, Diarrhoea, Dizziness, Haemorrhage, Hypoaesthesia, Immediate post-injection reaction, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: Immediate abdominal cramping. Bleeding, bloating, numb legs, ovarian pain, nausea, diarrhea, vomit, dizziness, chills.


VAERS ID: 1371595 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-23
Onset:2021-05-03
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Depression, Headache, Pain
SMQs:, Depression (excl suicide and self injury) (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: citalapram, lithium, carbamezapan, lamictal, fish oil, N-A-C, multivitamins/mineral, probiotics, prevagen
Current Illness: none... I"m a very healthy person
Preexisting Conditions: depression
Allergies: penicillan
Diagnostic Lab Data: none... might be a good idea though... will ask my doc
CDC Split Type:

Write-up: Depression and anxiety, body aches, headache - it happened 9 days after my second shot... so I was surprised, had not expected it and worried I''d gotten covid before my second shot had built immunity. The depression was most troublesome though since it had not been reported as a potential side effect and because I have a history of depression,.. and I have such a concern about losing my ability to function due to depression. The body symtpoms have gone, but I''ve had some recurring periods of depression. I''m confident my depression is related to inflammation (any kind of infection sets it off), so the thought of a "cytokine storm" with covid, would have certainly killed me (through suicide if not respiratory illness). Knowing what to expect is 2/3 the battle, so I hope you can figure out what the broader pattern is, how long it lasts, and is there anything we can do about it. For myself, I increased my fish oil to 6 grams (pure EPA) and NAC to 6 grams as well, plus additional Tumeric... all things that help with inflammation (not motrin tho, it can make it worse). Best of luck to you. Do let me know if you need further information.


VAERS ID: 1371988 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-30
Onset:2021-05-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abortion spontaneous, Ultrasound scan, Uterine dilation and curettage
SMQs:, 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: Pre-natal Vitamin
Current Illness: No known
Preexisting Conditions: Psoraisis
Allergies: No known
Diagnostic Lab Data: Medically managed miscarriage and subsequent D&C procedure
CDC Split Type:

Write-up: Loss of pregnancy. I received my first dose at approximately 4 weeks pregnant on 3/30. I had a positive home pregnancy test the following day on 3/31. On 4.29, I had my first confirmation ultrasound where a heartbeat was found, but the fetus was not measuring as expected. On 4.30, I received my 2nd dose of the Moderna vaccine. A follow-up ultrasound was done on 4.12, at that time, no heartbeat was indicated and the fetus had stopped developing shortly after receiving the 2nd does on 4.30. This was my first pregnancy.


VAERS ID: 1374001 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2021-05-03
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Seafood allergy
Preexisting Conditions: Comments: The patient had no known drug allergies.
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: Allergy test; Result Unstructured Data: Allergic to tomatoes, peanuts, pecans, and grass
CDC Split Type: USJNJFOC20210606283

Write-up: HIVES; This spontaneous report received from a patient concerned a 49 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included allergic to seashells. The patient had no known drug allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose was not reported, administered on 03-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 2021, Laboratory data included: Allergy test (NR: not provided) Allergic to tomatoes, peanuts, pecans, and grass. On 03-MAY-2021, the subject experienced hives. Treatment medications (dates unspecified) included: diphenhydramine hydrochloride. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of hives was not reported. This report was non-serious.


VAERS ID: 1280980 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Confusional state, Fall, Gait disturbance, Head injury, Nausea
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: Individual was standing approximately 5 minutes after receiving his Janssen COVID-19 vaccination (LOT: 201A21A), and had a witnessed fall from standing first onto his buttocks, and then to the back of his head, witnessed by Dr. The patient had no loss of consciousness, but was slight altered and had sensation of nausea. He requested use of the restroom as a result of the sensation of nausea and was escorted to the restroom, where the patient had some trouble ambulating and had a small bowel movement. He returned to normal mentation, was escorted from the restroom to our treatment area where his vital signs were within normal limits. He was monitored for approximately


VAERS ID: 1288853 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea, Paraesthesia, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: paresthesia on the left side of the face, diarrhea, fever for 3 days


VAERS ID: 1291534 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-05-03
Onset:2021-05-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 21C10-05 / UNK LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Injection site pain, Pain, Pyrexia, Somnolence, Thirst
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Fever Body pain somnolence thirst headache pain in the left arm(where took the vaccine)


VAERS ID: 1279517 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-28
Onset:2021-05-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Computerised tomogram head, Full blood count, Metabolic function test, Neurological symptom, Plasminogen activator inhibitor, Troponin, Venogram
SMQs:, Haemorrhage laboratory terms (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Adderall, Zyrtec, ferrous sulfate
Current Illness: microcytic anemia
Preexisting Conditions: microcytic anemia, dysfunctional uterine bleeding
Allergies: Avocado, penicillin
Diagnostic Lab Data: head CT, CT angio head/neck, CT venogram (all on 5/01/2021) bloodwork: CMP, CBCD, troponin (5/01/2021)
CDC Split Type:

Write-up: presented with stroke symptoms, received tPA


VAERS ID: 1279636 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (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: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Additional Details: Patient had a syncope event shortly after receiving Janssen Covid vaccine. Patient put feet up and laid back for additional 10 minutes after initial 15 minute observation. BP and Pulse were not significant (176/79 and 79). Patient recovered after 25 minutes and went home.


VAERS ID: 1279640 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Flushing, Hyperhidrosis, Syncope, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (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: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Shakiness-Mild, Additional Details: he fell


VAERS ID: 1279671 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 RA / IM

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

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

Write-up: The patient was given the vaccine even though she was only 16 years at the time of administration.


VAERS ID: 1279674 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-01
Onset:2021-05-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Pruritus, Pyrexia, Somnolence
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Fever, chills, aches, headache, groggy, itchy ears


VAERS ID: 1279723 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: unk
Allergies: unk
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt was 17 years old and received Moderna Vaccine . No reaction.


VAERS ID: 1279735 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Cold sweat, Dizziness, Fatigue, Feeling cold, Hyperhidrosis, Hypotension, Vital signs measurement
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad), 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: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: BP and EMS vitals (unknown)
CDC Split Type:

Write-up: Patient started filling dizzy about 10 minutes after vaccine. He felt weak and tired and also started sweating profusely. Skin was cold and clammy to the touch. I checked his BP and it was 89/53. I called 911 as precautionary and ems arrived within 5 minutes. Patient had stopped sweating by then and was able to stand and walk with EMS to another area of the store to be evaluated further and monitored.


VAERS ID: 1279901 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 1 RA / IM

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

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

Write-up: Patient is 17 and 9 months. He does not turn 18 until august but accidentally received the first dose of the moderna vacine today 5/2/21. (Pt date of birth 8/18/2003). No adverse events have been reported to me so far.


VAERS ID: 1279951 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Condition aggravated, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: claritin, singular
Current Illness: Seasonal Allergies
Preexisting Conditions: fainting after injections
Allergies: NKDA
Diagnostic Lab Data: see above
CDC Split Type:

Write-up: Patient; writer was called by family member, patient observed sitting in chair with episode of unresponsiveness. No head trauma, No SOB, No respiratory distress. Paramedic notified. Patient had episode of fainting lasting about 30secs then returned to baseline mental status post covid vaccination. MD notified. Family member present stated that she history of fainting. Patient discharged home, in stable condition.


VAERS ID: 1279957 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: claritin, singular
Current Illness: Seasonal Allergies
Preexisting Conditions: fainting after injections
Allergies: NKDA
Diagnostic Lab Data: see above
CDC Split Type:

Write-up: writer was called by family member, patient observed sitting in chair with episode of unresponsiveness. No head trauma, No SOB, No respiratory distress. Paramedic notified. Patient had episode of fainting lasting about 30secs then returned to baseline mental status post covid vaccination. MD notified. Family member present stated that she history of fainting. Patient discharged home, in stable condition.


VAERS ID: 1279964 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient states he faints every time he is in contact with a needle.
Other Medications: Unavailable
Current Illness:
Preexisting Conditions: Unavailable
Allergies: Unavailable
Diagnostic Lab Data: unavailable
CDC Split Type:

Write-up: The patient came in to get his COVID vaccine. The vaccine was administered with no abnormalities. The patient went to sit in the waiting area and fell off his chair. Pharmacy staff rushed to him to find him on the floor conscious and speaking stating he was okay. The patient was assisted to stand and get on a chair. At that point Orange Juice and Water were provided to the patient and the pharmacist sat next to him for ten minutes. Next, the patient was instructed to stay for five more minutes to make sure he was okay. The patient stated this happens to him every time he gets a vaccine and it isn''t out of the ordinary at all. Patient also stated he did not eat or drink much all day besides a bag of chips and on top of that was doing strenuous work in the heat all day and this could have contributed to his collapse.


VAERS ID: 1279968 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Eye movement disorder, 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), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Ocular motility disorders (narrow), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient received the vaccine and waited in the room while the parent received the vaccine. The patient then walked to sit in the waiting area, lost vision while walking, sat down, eyes began to roll, and the patient passed out momentarily (less than a minute). Was moved to an area to lie down and remained there for approximately 15 minutes.


VAERS ID: 1279995 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Pfizer not FDA approved for a 15 year old. No symptoms reported.


VAERS ID: 1279997 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: birth control, medication for depression, unable to recall name
Current Illness:
Preexisting Conditions: depression
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: client complained of dizziness and nausea after receiving 1st Pfizer Covid Vaccine. At 1000 client reported to EMTs feeling light headed and nauseous. Per client had not had any breakfast or hydrated today. EMT gave client water and crackers. Per client no allergy to any of the ingredients. First vitals: blood pressure 130/70, pulse 80, oxygen 98%. Client''s parent here, states client takes medication for depression, unable to recall name and birth control. Vitals at 1010: blood pressure 110/70, pulse 80, oxygen 98%. Per client still nauseous, light headedness improving. 1015 vitals: blood pressure 110/70, pulse 79, oxygen 97%. Mild nausea, light headed resolved. Vitals at 1020: blood pressure 108/70, pulse 78, oxygen 98%. Per client all symptoms resolved. Client given ER precautions and advised to consult with provider prior to second dose. Parent driving client home. Client left facility with steady gait at 1022.


VAERS ID: 1280009 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-01
Onset:2021-05-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

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

Write-up: Patient''s neighbor called pharmacy sunday 5/2 at 4:30 pm stating he is experiencing fever, chills, nausea/vomiting. Advised for him to drink fluids to keep hydrated when able, take Tylenol. Patient does not have a regular doctor, advised to go to ER if symptoms continue to worsen.


VAERS ID: 1280018 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient fainted for a moment and felt down while standing. Patient was conscious right after falling, was able to talk and did not feel any symptoms other than sweetness which could have caused by wearing hat that he was wearing. EMS took patient.


VAERS ID: 1280138 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-01
Onset:2021-05-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Epistaxis, Fatigue, Headache, Muscle spasms, Pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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: Ibuprofen 400mg x 1 dose
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Spontaneous nose bleed approximately 24 hours after the injection. Lasted for approximately 30 mins and resolved with pressure. Other expected side effects he has are fatigue, muscle cramps, body aches, headache.


VAERS ID: 1280159 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Cough, Dyspnoea, Hyperventilation, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)

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

Write-up: At 11:40am on 5-2-21, patient went into anaphylaxis approximately 10 minutes after receiving vaccine. Patient''s breathing was labored and patient indicated that her throat was constricted. 0.3mg of epinephrine was administered IM via EpiPen into left thigh at 11:45am. Patient breathing improved, began coughing and deep breathing noted. HR stable at 55 BPM: BP machine was registering BP at $g200/100 but machine constricted her arm so numbers were unclear. Patient remained conscious and responded to verbal commands until EMS arrived and took over care at approximately at 11:50am. EMS ordered another dose of epinephrine at approximately 12:05pm. Albuterol administered at 11:50am. Pt transported to Clinic in Hospital via EMS


VAERS ID: 1280177 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Pyrexia, Rash, Vision blurred
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient said she was feeling dizzy, vision was blurry, sweeting. Was able to breath, asked for water which was given to her. She had some rash on the face, provided diphenhydramine liquid 50mg. She was feeling feverish, took tylenol.


VAERS ID: 1280215 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Eye movement disorder, Flushing, Hyperhidrosis, Loss of consciousness, Pallor, Posture abnormal, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (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: Unknown
Current Illness: Pneumonia (hospitalized previously) but had been out of the hospital for 3 weeks
Preexisting Conditions: Esophageal cancer survivor (2004)
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient was administered the Johnson and Johnson Janssen COVID-19 vaccine. Shortly after, a few seconds, the patient stated he felt flushed and head started to fall back. Staff member cradled his head and called another staff member over. Staff member called 9-1-1. Patient went unconscious and his eyes rolled back for approximately 30 seconds. When aware, we (staff members) transferred patient from the chair to the floor where staff member supported his back and fanned him due to his profuse sweating. Staff member continued talking to him when he became unconscious again, this time gasping for air and turning pale. We kept saying his name until he came to again and was somewhat aware of his surroundings. He fainted one last time. After this time, he sat up on his own and seemed to be very coherent. The EMS arrived shortly after and took over. They said they would take him out to check him out but he seemed to be doing better. An EMS personnel let us know the patient did tell him that he has fainted from vaccines before. However, he did not disclose this to us on the PQCF form or when asked verbally.


VAERS ID: 1280216 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 OT / IM

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

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

Write-up: Lightheadedness. Evaluated by EMS-Cleared


VAERS ID: 1280253 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-01
Onset:2021-05-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Fatigue, Rhinorrhoea
SMQs:, Retroperitoneal fibrosis (broad)

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

Write-up: Back pain, tiredness and runny nose. No treatment.


VAERS ID: 1280277 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Condition aggravated, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: none
Allergies: No known allergies
Diagnostic Lab Data: 12:08pm: BP 152/82 , Pulse 70, RRR, clear auscultation, BS = 100mg/dl. 12:20pm: 119/73 12:22 107/74.
CDC Split Type:

Write-up: Patient passed out with associated convulsions within 2 minutes of vaccine being administered. No previous Hx of this post vaccination but did occur once after donating blood. Patient was lowered to flat position on floor.


VAERS ID: 1280370 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Headache
SMQs:

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

Write-up: headache; no additional symptoms


VAERS ID: 1280412 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, 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), 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: Autism
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was sitting down and said he felt dizzy, guardian with him stated that he passed out briefly and then just said he felt dizzy. He wanted to get some air so him, myself, and his mom went outside and waited for the paramedics to arrive . Once outside, patient said he felt better but a little dizzy. Paramedics came to make sure he was okay, he went to the hospital after that,


VAERS ID: 1280438 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure measurement, Dizziness, Hyperhidrosis, Malaise, Pallor, Respiratory rate decreased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 5 minutes after receiving the vaccine patient approached the pharmacy and said he wasn''t feeling well. I asked him if he would like some water and he accepted. He returned to the chair in front of the pharmacy and sipped on the water. He looked like he was pale and breathing more slowly. I went out front to check on him and his breathing appeared labored, he was sweating profusely and he said he felt lightheaded and his hands were tingling. I told him to relax and take some breaths. His hands were very shaky and I took him BP (94/61 and HR 54). At this point I had my technician call 911. Between the time the paramedics arrived he went unresponsive for approx 20-30 seconds. I yelled his name and slapped his leg. No response. I checked for a pulse and if he was breathing. He did have a pulse and was breathing. After coming to the paramedics arrived and took him to the hospital for evalution.


VAERS ID: 1280443 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-01
Onset:2021-05-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Cold sweat, Fatigue, Irritability, Nausea
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (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: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Since this morning she has been very cranky and nauseous and she it has had been having abdominal pain and weakness but extreme amounts of fatigue and she thought she had a fever but every time I felt her head her head was really cold now she is sleeping and my son has the similar issue and my son has autism


VAERS ID: 1280450 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Public       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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5 second seizure activity.


VAERS ID: 1280492 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, 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? 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: latex (rash), NKFA, NKEA
Diagnostic Lab Data: vaccinated @11:10am in left deltoid (1st dose), symptoms began @11:13am (felt tired), LOC @11:15am (lasted ~10seconds), pt was driven home by parents @11:55 Denies: HA, CP, SOB, respiratory distress, vision changes, hearing changes, hives, itchiness, erythema, bruising, swelling, paresthesia, numbness/tingling, confusion, sensitivity to light or sound, dizziness/lightheaded PMH: none, denies history of prior syncope (including after vaccines, blood draws, needles) Meds: none Allergies: Latex (rash), NKFA, NKEA @11:17am (lying down): BP: 73/40, HR: 52, SPO2: 100% RA @11:23am (lying down): BP: 74/50, HR: 60, SPO2: 100% RA @11:27am (sitting): BP: 107/68, HR: 68, SPO2: 100%RA Cardiac: normal S1S2, rate rhythm Lungs: clear to auscultation b/l, no respiratory distress, no wheezing, no rales Neuro: PERRLA, no nystagmus, radial and PT pulses 2+ b/l, strenght 5+ b/l, no focal deficits, no head/facial/ neck pain, no C-spine tenderness, full ROM neck
CDC Split Type:

Write-up: 16 y/o female with NO PMH and no h/o similar prior experiences/syncope c/o "feeling tired" ~3 min after receiving the 1st dose of pfizer vaccine. Pt LOC, "gently" falling onto the floor, landing on her face ~5 min after receiving the vaccine. Pt reported feeling tired before LOC, not associated with any other symptoms (dizziness, changes in vision/hearing). LOC lasted ~10 seconds, pt immediately returned to baseline. She was sat up with the help of her mother and nurse and the clinical lead was notified. Pt was laid down on a cot, VS were taken, ice was applied to her pressure points. Pt reported complete resolution of symptoms within ~5 min. Pt was progressively moved from lying down to sitting to standing. Pt denies eating or drinking anything today and was given fluids and snacks. Pt was monitored for a total duration of 45 min. Pt was driven home by parents. Pt was advised to eat and hydrate today and for the next dose. Pt and parents were advised to call PCP / 911 if symptoms return/persist/worsen or if pt develops concussive symptoms. Pt was instructed to inform the nurse that she fainted ater 1st dose and to prophylactically lay down prior to receiving prior to second dose vaccination.


VAERS ID: 1280571 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Nervousness, 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), Vestibular disorders (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient was vaccinated and said that she feels dizzy, nervous. The patient sat on the chair ,passed out and had a seizure.


VAERS ID: 1280576 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Chills, Dizziness, Dyspnoea, Paraesthesia
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Duloxetine 30mg, celecoxib 100mg, dicyclomine 20mg, Nucynta 50mg, sertraline 50mg,
Current Illness:
Preexisting Conditions: Depression, anxiety, chronic pain
Allergies: morphine, ketorolac, meperidine, latex
Diagnostic Lab Data: Epipen administered
CDC Split Type:

Write-up: Anaphylaxis. Patient experienced shortness of breath, tingling in hands and arms, cold chills, and feeling faint.


VAERS ID: 1280661 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-01
Onset:2021-05-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Slight fever 100.3F One fainting episode


VAERS ID: 1280662 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, 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:
CDC Split Type:

Write-up: PALE, LOST OF CONSCIOUSNESS X5 SECONDS. CODE GREEN CALLED, DIAPHORETIC, BP 116/80, HR 78, GLUCOSE 83, ALSO C/O DIZZINESS. IV ON LEFT ANTCUBITAL WITH NS, TRANSPORTED TO HOSPITAL.


VAERS ID: 1280705 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Head injury, Immediate post-injection reaction, Nausea, Paraesthesia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: Within about 5 minutes of receiving her first Pfizer Covid19 vaccine, the patient passed out and hit her head on the floor. She regained consciousness quickly (within seconds) after I got to her. She stated she had felt nauseas and tingly before fainting. She has not experienced this before with other vaccines. Ambulance was dispatched due to her hitting her head. Parents and paramedics determined she was ok to go home.


VAERS ID: 1280776 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-01
Onset:2021-05-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Computerised tomogram normal, Electroencephalogram normal, Headache, Laboratory test normal, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: 2 OTC ibuprofen (Advil) taken approx 4 PM on day of vaccine
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa drugs, ingredient in cough syrup beginning with C (name unknown- no reaction since around age five)
Diagnostic Lab Data: May 2nd; EEG during ambulance ride, CT scan and urine test/labs at hospital showed no abnormalities.
CDC Split Type:

Write-up: Woke up at 6:30 AM on May 2 with chills and moderate-severe headache, took 2 Ibuprofen at 7:00 AM. Took nap and then stood to speak to my mother, followed by a severe headache for a few seconds and then a seizure lasting less than 1 minute. Hospital released and recommended follow up with PCP for referral to neurologist. No further events as of May 2nd at 9:15 PM


VAERS ID: 1280779 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-05-01
Onset:2021-05-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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: Bupropion 150 mg daily Desvenlafaxine 100 mg daily Montelukast 10 mg daily Certirizine 10 mg daily Albuterol Inhaler taken as needed (was taken day of vaccination) Flaxseed oil supplement taken every other day Calcium supplement taken every
Current Illness: N/A
Preexisting Conditions: Depression Anxiety Asthma Psoriasis
Allergies: Coconut Animal Dander Pollens Dust mites
Diagnostic Lab Data:
CDC Split Type:

Write-up: I received the COVID 19 vaccine at approximately 5pm May 1, 2021. At approximately 1 am, May 2nd, I woke up shaking uncontrollably. I had a fever at the time. The shaking happened in episodes, and these episodes lasted 5-10 minutes, about a minute or 2 apart for about 30 minutes. I was still able to get up once during the shaking, and I was fully conscious. The shaking made my heart race, and I was very sore and had a hard time sleeping after the shaking finished.


VAERS ID: 1280794 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Head injury, Immediate post-injection reaction, Syncope, Tension, Tremor, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Penicillin
Diagnostic Lab Data: Pfizer Covid19 vaccination dose #1
CDC Split Type:

Write-up: Patient came into the immunization room for his shot along with his mom. He did state he hated needles, but was in good spirits. He got the shot, I filled out his card, and directed him and his mom to sit in the waiting area for 15 mins in case of dizziness or a reaction. They were walking out of the room to the waiting area and he almost immediately fainted. He fell and possibly hit his head on the chair/ floor when he went down. (This was maybe 2 mins post-injection). He almost looked like he was going to have a seizure (arms were tensed up, his eyes were not focused, was starting to shake) but then he suddenly came-to. He seemed to be pretty coherent after he woke back up but 911 was called since he was bleeding


VAERS ID: 1280879 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Heart rate increased, Hypotonia, Loss of consciousness, Mydriasis, Seizure, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Patient states about 2 years ago, he fainted after receiving the Typhoid vaccine.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was administered the Janssen COVID vaccine at 403 pm. I returned back to the pharmacy to prep his partner''s vaccine and when I came back at 405 pm, he was loopy with his head swaying. He wasn''t responding to verbal communication by his spouse and me nor through touch as I shook his shoulder. He then lost consciousness and so I lifted his head to check for breathing and pulse which he had. I asked my technician to call 911, and asked my other tech to help me transition him to the floor so we can raise his legs to provide blood flow to his head. Mid-transition, he had a seizure. We brought him completely to the floor and just as I was about to turn him to his side, he regained consciousness. Pupils were dilated, breathing normal, pulse elevated. He also was able to speak immediately and confirmed feeling "okay". I then had my technician remain outside with him laying on the ground as I returned back inside the pharmacy to call management and my technician was still on the phone with EMS. Paramedics and management arrived within 10 minutes upon which patient was then taken to the hospital. Wife followed and we rescheduled her vaccine.


VAERS ID: 1280926 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Headache, Pain, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

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

Write-up: Ascending Body Aches, headaches, chills, mild audible expiratory wheezing 6hrs, Albuterol Inhaler for wheezing, 600mg, Motrin, 500mg Tylenol.


VAERS ID: 1280927 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-01
Onset:2021-05-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: sertraline 25mg (1x daily) finasteride 1mg (1x daily) testosterone cyp .25ml*200mg/ml (1x weekly) tretinoin .025% cream (1x daily) multivitamin (1x daily) 500mg omega-3 fish oil (1x daily) melatonin 5mg (as needed)
Current Illness: none
Preexisting Conditions: crohn''s disease, ulcerative colitis
Allergies: penicillin minocyclines benzoyl peroxide unknown red dye
Diagnostic Lab Data: none
CDC Split Type:

Write-up: fatigue (11:30 AM May 1 to 2:00 PM May 2nd) fever and chills, full body pain, dizziness (2:00 AM May 2nd to 2:00PM May 2nd) no treatment (slept, stayed in bed until symptoms stopped)


VAERS ID: 1280928 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-29
Onset:2021-05-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Neuralgia, Pain in extremity
SMQs:, Peripheral neuropathy (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: Venlafaxine, B vitamin complex
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nerve pain in one toe: left foot "pointer" toe


VAERS ID: 1280930 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D 2000 IUs
Current Illness:
Preexisting Conditions: PCOS
Allergies: Penicillin
Diagnostic Lab Data: Dermatology appointment on 4/29
CDC Split Type:

Write-up: After shot one on 4/11 I developed an allergic reaction skin rash on both arms and the thighs of both legs. I saw the doctor on 4/29 and was prescribed a steroid cream to help my body get rid of the rash. After my vaccine on 5/2, the rash flared hours after injection and became more prevalent and itchier.


VAERS ID: 1280933 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-01
Onset:2021-05-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anal haemorrhage, Chest pain, Diarrhoea, Discomfort, Dizziness, Dysgeusia, Erythema, Fatigue, Headache, Injection site streaking, Intermenstrual bleeding, Malaise, Maternal exposure during breast feeding, Nausea, Pain in extremity, Paranasal sinus hypersecretion, Postpartum haemorrhage, Rash macular, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Gastrointestinal haemorrhage (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Neonatal exposures via breast milk (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: 5/1/2021 Drainage and weird taste in back of mouth 11:30a Slight redness left thigh warm to touch 12:30-1:15p Fatigue 12:30-current Nausea 12:30-current Headache 3:15-current Diarrhea 4:30-current Sore arm 8p-current General malaise, especially if standing up 9:30p-current Face pressure 11:30p-11:35p 5/2/2021 Shakes 5a-7a Chest pains 8a-current, intermittently Anal bleeding 2p, every bowel movement since, bright reed blood in toilet and on paper Lightheaded and faint called EMS Blood pressure 155/94 3p, they suggested to follow up with my PCP in AM Anal bleeding 5:30p Red streak R arm near injection site 6:15p-6:45p Red dots on L knee 6:15p-current (not itchy) Started period/spotting 1st one since conceiving last year. I am 12 weeks postpartum and exclusively breastfeeding. (light brown not heavy) 9:30p (with prior two children J did not start my period until babies were about one year old and weaning from breastfeeding)


VAERS ID: 1280940 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Feeling hot, Hyperhidrosis, Hypoaesthesia, Immediate post-injection reaction, Nausea, Pain in extremity, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (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? No
Previous Vaccinations:
Other Medications: Lamictal, Keppra, Zoloft, mini pill, prenatal vitamin
Current Illness:
Preexisting Conditions: Epilepsy (complex partial)
Allergies: Oxcarbazepine medication
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediately after receiving the vaccine, I became severely nauseated, light headed, sweaty, warm and dizzy. My hands became tingly/numb as well as my legs. This lasted about a half hour where I felt I could faint at any moment. My arm is currently sore 7 hours later and I am fatigued.


VAERS ID: 1280955 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Fall, Headache, Hyperhidrosis, Loss of consciousness, 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), Glaucoma (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Psoriasis cream (unknown name)
Current Illness:
Preexisting Conditions: psoriasis
Allergies: none listed
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was working in the traffic area of the parking lot. The patient was exiting the area after the 15 min observation period. She reported no symptoms or complications prior to leaving the area and no usual behavior was noted at this time. Patient was accompanied by her husband and son. Near the parking lot the patient was witnessed losing consciousness and falling to the ground. Patient immediately assisted the patient and also called for assistance. I was notified immediately and myself, the paramedics on sight, and NP responded to the patient incident. The patient was diaphoretic and had abnormal vital signs that were repeated multiple times. The set I obtained were 117 heart rate, 99% oxygen on room air, 167/94, 225/112, both taken lying down. Patient complained of severe headache, blurry vision, tinnitus, and dizziness over the past 2 days prior to days. Patient reports having only one medical condition, psoriasis, and takes a cream for it, but also reports she has not seen a doctor in "many years". No stroke symptoms were observed.


VAERS ID: 1280960 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-01
Onset:2021-05-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

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

Write-up: During the night after my second shot a small ball appeared in my neck (clavicular lymphadenopathy) on the left side


VAERS ID: 1280985 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Fatigue and minor pain at site.


VAERS ID: 1280986 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-30
Onset:2021-05-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Chills, Decreased appetite, Echocardiogram, Electrocardiogram, Full blood count, Metabolic function test, Pyrexia, Troponin
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: EKG, CXR, CBC, BMP, trop x 2, POC echo
CDC Split Type:

Write-up: Fever/chills, decreased appetite. ED visit for chest pain day 3 post vaccination


VAERS ID: 1281091 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-01
Onset:2021-05-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood sodium decreased, Dehydration, Electrocardiogram, Exposure during pregnancy, Full blood count normal, Heart rate increased, Lymphocyte count decreased, Mean cell haemoglobin concentration increased, Mean platelet volume decreased, Metabolic function test, Nausea, Neutrophil count increased, Vomiting
SMQs:, Acute pancreatitis (broad), Haematopoietic leukopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Chronic kidney disease (broad), Myelodysplastic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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: Levothyroxine, prenatal vitamins, baby aspirin, vitamin D, Omega-3
Current Illness: None
Preexisting Conditions: Hashimoto''s thyroiditis Asthma
Allergies: None
Diagnostic Lab Data: BASIC META- all normal except low sodium (135 mmol/L) 5/2/2020 CBC and differential- all normal except high MCHC (36.8 g/dL), low MPV (8.9 fl), high absolute neuts (8.94 K/uL), low absolute lymphs (0.57 K/uL)
CDC Split Type:

Write-up: 21 weeks pregnant, due September 8, 2020. Started vomiting at 4am on 5/2/2020. Vomited about once an hour until 4pm 5/2/2020. Heart rate started racing and felt very dehydrated so went to the ER. Got IV fluids and an EKG. Nausea remained that evening but began to ease on 5/3/2020.


VAERS ID: 1281095 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Medium, Additional Details: ems was called but patient refused


VAERS ID: 1281231 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Flushing, Hyperhidrosis, Seizure, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (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:
CDC Split Type:

Write-up: Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Mild, Systemic: Seizure-Medium, Systemic: Vomiting-Mild


VAERS ID: 1281233 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-12
Onset:2021-05-02
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Oral herpes
SMQs:, Oropharyngeal infections (narrow), Opportunistic infections (broad)

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

Write-up: Cold sore developing on bottom lip


VAERS ID: 1281248 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Headache, Hyperhidrosis, Injection site pain, Paraesthesia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (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: Site: Pain at Injection Site-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Headache-Mild, Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: Tingling at site of injection. Patient was seated after receiving the vaccine and suddenly collasped. Patient maintained consciousness throughout the episode and her symptoms have improved.


VAERS ID: 1281255 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Flushing, Hyperhidrosis, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (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: Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed/Sweating-Mild, Systemic: Weakness-Mild, Additional Details: FOLLOWED UP WITH PATIENT AT 6:30P ON 05/02/2021. DAD SAID PATIENT IS DOING OK NOW. HE EATS AND TALK NORMALLY.


VAERS ID: 1281263 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (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: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Additional Details: 911 was called when patient fainted. She was conscious when they arrived. They evaluated her at the store and did not take her to the ER


VAERS ID: 1281265 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)


VAERS ID: 1281271 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

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

Write-up: Error: Improper Storage (temperature)


VAERS ID: 1281274 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Pharmacy       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadness-Mild


VAERS ID: 1281323 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-01
Onset:2021-05-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Pyrexia, Sensitive skin
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair Loratadine Pro-air Flovent Vitamin D Iron suoplement
Current Illness:
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 100.7 fever, sensitive skin


VAERS ID: 1281328 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-01
Onset:2021-05-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: Focalin 15mg
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, left arm soreness, head ache and tiredness


VAERS ID: 1281706 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-29
Onset:2021-05-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute myocardial infarction, Chest pain, Dyspnoea, Hyperhidrosis, Malaise, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Men''s multivitamin, denies other supplements. High blood pressure (never on meds)
Current Illness:
Preexisting Conditions: PMH: -Endoscopy/colonoscopy in Jan 2021 for thinning of walls in stomach; on acid suppression -dairy intolerance; yeast intolerance -Chronic nausea -high blood pressure: never on meds Family Hx: - grandfather and all 6 of his brothers died from heart attack - no known heart attacks prior to 50 - mom had blood clot
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received his 2nd dose of the COVID vaccine (pfizer) on 4/29/21. The next day he developed a fever of 103 F which lasted about 36 hours. He felt achy and generalize malaise and felt sweaty in the evening on 5/1. Presented to ED on 5/2 with chest pain and shortness of breath. Patient given nitro x3, asa, and heparin gtt and transferred for ongoing management of NSTEMI. Family history of CAD; grandfather and all 6 of his brothers died from heart attack


VAERS ID: 1281806 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-30
Onset:2021-05-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Telemisartan HCTZ, Meloxican, zyrtec, Vitamin C
Current Illness: N/A
Preexisting Conditions: Hypertension
Allergies: Penecillen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph nodes in armpit and chest of the injection arm. feels like edema to the touch and tender when arm is in a lowered position.


VAERS ID: 1281886 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-30
Onset:2021-05-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site rash
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 200mg Nature Made Prenatal Multi + DHA daily vitamin
Current Illness: none
Preexisting Conditions: scoliosis, arthritis (degenerative disk disease)
Allergies: neosporin with pain relief (specifically the pain relief part)
Diagnostic Lab Data:
CDC Split Type:

Write-up: red rash surrounding injection site, painful when touched


VAERS ID: 1281929 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-24
Onset:2021-05-02
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Atrial fibrillation, Compression fracture, Cough, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Cardiomyopathy (broad)

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

Write-up: Admitted with intractable back pain (known compression fracture). Per ED note, patient found to have cough and labored breathing. New onset A fib


VAERS ID: 1282037 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-01
Onset:2021-05-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: I had a 102?F fever from 9am to around 6pm (9 hours). Along with that the normal headache and muscle pain. After 6pm, everything went back to normal and I?ve felt fine


VAERS ID: 1282075 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills
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: Ibuprofen
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: No immediate side effects - approximately 9 hours after injection when trying to sleep got cold chills for 2-3 hours.


VAERS ID: 1282128 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-29
Onset:2021-05-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Myopericarditis secondary to Pfizer vaccine


VAERS ID: 1282202 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-04-08
Onset:2021-05-02
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Chest discomfort, Chronic sinusitis, Echocardiogram abnormal, Electrocardiogram ST segment elevation, Inflammatory marker increased, Myocarditis, Red blood cell sedimentation rate increased, Systolic dysfunction, Troponin increased, White blood cell count increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Found to be Rhino/enterovirus positive at time of admission, though asymptomatic from it
Preexisting Conditions: Recurrent chronic sinusitis
Allergies: Augmentin
Diagnostic Lab Data: Troponin 5/3: 12.7 5/2 labs: WBC 10.4K, initial troponin 6.17, and elevated inflammatory markers with CRP 80.6mg/L and ESR 26mm/hr. EKG: diffuse ST segment elevation ECHO: Mild to moderately decreased left ventricular systolic function
CDC Split Type:

Write-up: Received dose #1 on 4/8/21 and dose #2 on 4/30/21. On 5/1 evening developed chest pain and tightness. He told his family about the chest pain the following day, on 5/2, which prompted his Mom to take him to an ED. In ED on 5/2 and found to have ST elevation, elevated troponins and elevated inflammatory markers. ECHO with mildly decreased systolic function. Picture consistent with perimyocarditis. Admitted to Hospital 5/3 AM. Currently clinically stable but admitted for close monitoring.


VAERS ID: 1282370 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Loss of consciousness, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (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: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: patient passed out due to anxiety-Mild, Systemic: Flushed / Sweating-Mild


VAERS ID: 1282424 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-01
Onset:2021-05-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 48 hour: 102 fever body aches muscle soreness headache


VAERS ID: 1282465 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pt told the pharmacist he always faints when vaccinated
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had fainted, pharmacist used ammonia salt to wake pt up and pharmacist had called 911. Patient was fine when he left.


VAERS ID: 1282512 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-04-30
Onset:2021-05-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Angiogram, C-reactive protein increased, Electrocardiogram normal, Intensive care, Myocarditis, Pyrexia, Red blood cell sedimentation rate normal, SARS-CoV-2 test negative, Troponin increased
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: troponin 11.93 on 5/3/21 EKG with diffuse ST elevation on 5/3/2021 Prepped for CT angiogram ESR 10 CRP 3.25 respiratory viral swab (including Sars cov2) negative
CDC Split Type:

Write-up: Patient with initial low grade fever which resolved but then developed 3 days after shot developed acute myopericarditis with elevated troponins requiring intensive care unit and therapy.


VAERS ID: 1282545 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-10
Onset:2021-05-02
   Days after vaccination:81
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Alanine aminotransferase normal, Albumin globulin ratio normal, Aphasia, Aspartate aminotransferase increased, Back pain, Blood albumin decreased, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium decreased, Blood chloride normal, Blood creatine phosphokinase MB normal, Blood creatine phosphokinase normal, Blood creatinine increased, Blood glucose increased, Blood lactic acid increased, Blood potassium normal, Blood sodium normal, Blood urea increased, Brain natriuretic peptide increased, Bundle branch block left, CD4 lymphocytes increased, Carbon dioxide normal, Catheter management, Culture urine negative, Differential white blood cell count, Dyspnoea, Electrocardiogram abnormal, Endotracheal intubation, Eosinophil count increased, Eosinophil count normal, Fibrin D dimer normal, Full blood count, Glomerular filtration rate decreased, Haematocrit normal, Haemoglobin normal, Lymphocyte count normal, Lymphocyte morphology abnormal, Malaise, Mean cell haemoglobin concentration decreased, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume normal, Metabolic function test, Monocyte count decreased, Monocyte count increased, Musculoskeletal pain, Neutrophil count increased, Neutrophil percentage, Nitrite urine absent, Nucleated red cells, Pain, Pain in extremity, Platelet count normal, Protein total normal, Red blood cell count normal, Red blood cell morphology normal, Red blood cells urine negative, Red cell distribution width increased, Respiratory distress, Sinus tachycardia, Specific gravity urine normal, Troponin I normal, Unresponsive to stimuli, Urine analysis normal, Urobilinogen urine decreased, White blood cell count increased, White blood cells urine positive, pH urine normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic leukopenia (narrow), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Malignant lymphomas (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Tendinopathies and ligament disorders (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? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Current Outpatient Medications: ? acetaminophen (TYLENOL) 500 MG tablet, Take 500 mg by mouth every 6 hours as needed for Pain, Disp: , Rfl: ? albuterol (PROAIR HFA) 108 (90 Base) MCG/ACT inhaler, Inhale 2 puffs by mouth every 4 hours a
Current Illness:
Preexisting Conditions:
Allergies: Allergen Reactions ? Ceftin [Cefuroxime] Other/Unknown (See Comments) ? Cephalosporins Other/Unknown (See Comments) ? Floxin I.V. In Dextrose 5% [Ofloxacin] Other/Unknown (See Comments) ? Lorazepam Other/Unknown (See Comments) ? Seroquel [Quetiapine] Other/Unknown (See Comments) ? Topamax [Topiramate] Other/Unknown (See Comments) ? Tuberculin Tests Other/Unknown (See Comments) ? Venlafaxine Other/Unknown (See Comments)
Diagnostic Lab Data: CBC W AUTO DIFF Collection Time: 05/02/21 5:13 AM Result Value Ref Range White Blood Cell Count 27.1 (HH) 4.3 - 10.5 THOUS/uL Red Blood Cell Count 4.08 3.93 - 5.07 MIL/uL Hemoglobin 11.9 11.8 - 14.8 GM/DL Hematocrit 38.7 35.6 - 45.0 % Mean Corpuscular Volume 94.9 83.5 - 95.9 FL Mean Corpuscular Hemoglobin 29.2 27.4 - 32.0 PG Mean Corpuscular Hemoglobin Conc 30.7 (L) 31.5 - 34.7 G/DL Rdwcv 14.3 (H) 11.8 - 14.2 % Rdwsd 48.4 (H) 37.2 - 47.8 FL Platelet Count 340 167 - 402 THOUS/uL Mean Platelet Volume 11.5 8.8 - 12.0 FL Nucleated Red Blood Cells 0.3 (H) 0.0 /100 WBC''S Abs NRBC 0.1 (H) 0.0 THOUS/uL Differential Type AUTO Lymphs 20.4 - 48.6 % 22.0 CORRECTED ON 05/02 AT 0531: PREVIOUSLY REPORTED AS 22.3 Monocytes (L) 5.0 - 11.5 % 4.0 CORRECTED ON 05/02 AT 0531: PREVIOUSLY REPORTED AS 3.8 Eos 1.0 - 5.4 % 2.0 CORRECTED ON 05/02 AT 0531: PREVIOUSLY REPORTED AS 0.7 Neutrophils Absolute Count (H) 1.7 - 8.3 THOUS/uL 19.3 CORRECTED ON 05/02 AT 0531: PREVIOUSLY REPORTED AS 19.2 Lymphocytes Absolute Count (H) 0.8 - 5.3 THOUS/uL 6.2 CORRECTED ON 05/02 AT 0531: PREVIOUSLY REPORTED AS 6.1 Monocytes Absolute Count (H) 0.1 - 1.0 THOUS/uL 1.1 CORRECTED ON 05/02 AT 0531: PREVIOUSLY REPORTED AS 1.0 Eosinophils Absolute Count (H) 0.0 - 0.3 THOUS/uL 0.5 CORRECTED ON 05/02 AT 0531: PREVIOUSLY REPORTED AS 0.2 Seg 71.0 39.9 - 72.2 % Atyp/Reactive Lymph 1.0 (H) 0 % RBC Morphology NORMAL NORMAL Platelet Estimate ADEQUATE ADEQUATE COMPREHENSIVE METABOLIC PANEL Collection Time: 05/02/21 5:13 AM Result Value Ref Range Glucose 198 (H) 65 - 100 MG/DL Blood Urea Nitrogen 62 (H) 7 - 18 MG/DL Creatinine 1.5 (H) 0.5 - 1.0 MG/DL Sodium 141 136 - 145 MMOL/L Potassium 5.1 3.5 - 5.1 MMOL/L Chloride 106 98 - 107 MMOL/L Co2 30 21 - 32 MMOL/L Calcium 7.5 (L) 8.5 - 10.1 MG/DL Protein Total 6.5 6.4 - 8.2 G/DL Albumin 3.1 (L) 3.4 - 5.0 G/DL A/G Ratio 0.9 0.8 - 2.0 Alkaline Phosphatase 111 46 - 116 U/L Alt (SGPT) 52 14 - 59 U/L AST(SGOT) 40 (H) 15 - 37 U/L Bilirubin, Total 0.4 0.2 - 1.0 MG/DL GFR Comment IF PATIENT IS AFRICAN AMERICAN, MULTIPLY RESULT BY 1.16 Est GFR 34 (L) $g90 ML/MIN/1.73sq.m TROPONIN Collection Time: 05/02/21 5:13 AM Result Value Ref Range Troponin I 0.02 0.00 - 0.06 ng/mL D-DIMER,QUANTITATIVE Collection Time: 05/02/21 5:13 AM Result Value Ref Range D-Dimer 207 0 - 400 NG/ML FEU CKMB Collection Time: 05/02/21 5:13 AM Result Value Ref Range Creatine Kinase-MB 1.5 0.0 - 3.6 NG/ML CK (CPK) CREATINE PHOSPHOKINASE Collection Time: 05/02/21 5:13 AM Result Value Ref Range Creatine Kinase Total 118 26 - 192 U/L LACTIC ACID, SERUM Collection Time: 05/02/21 5:14 AM Result Value Ref Range Lactate 2.6 (H) 0.4 - 2.0 MMOL/L BRAIN NATRIURETIC PEPTIDE (BNP) Collection Time: 05/02/21 5:14 AM Result Value Ref Range B-Type Natriuretic Peptide 259 (H) 0 - 100 PG/ML URINALYSIS WITH REFLEX TO CULTURE, IF INDICATED Collection Time: 05/02/21 5:39 AM Result Value Ref Range Glucose UA NEGATIVE NEGATIVE MG/DL Protein UA 2+ (A) NEGATIVE MG/DL Bilirubin UA NEGATIVE NEGATIVE Urobilinogen UA 0.2 0.2 - 1.0 MG/DL pH UA 5.5 5.0 - 8.0 Blood UA NEGATIVE NEGATIVE Ketones UA NEGATIVE NEGATIVE MG/DL Nitrite UA NEGATIVE NEGATIVE Leukocyte Esterase UA NEGATIVE NEGATIVE UR Appearance CLEAR CLEAR Specific Gravity UA 1.015 1.000 - 1.030 Color YELLOW YELLOW Site CATH INDWELLING Comment, Urine Culture NOT INDICATED RBC Urine 0 to 5 <3 /HPF WBC Urine 0 to 5 <5 /HPF Bacteria RARE (A) NONE /HPF Amorphous Sediment SCATTERED /HPF Old charts were reviewed per EPIC EMR. Pertinent details are summarized above. All laboratory, radiologic, and EKG studies that were performed in the Emergency Department were a necessary part of the evaluation needed to exclude unstable or emergent medical conditions. ED Course as of May 02 0622 Sun May 02, 2021 0450 EKG Report Date: 5/2/21 Time: 4:48:38 Previous EKG available for comparison: No The EKG showed a sinus tachycardia with a ventricular rate of 114 bpm. PR interval normal at 174 ms. QRS duration normal at 114 ms. QT and QTC intervals are within normal range. R axis is leftward at -43 degrees consistent with left anterior fascicular block. There is T-wave inversion in leads 1 and aVL consistent with possible lateral ischemia. No comparison available. There is no voltage criteria for left ventricular hypertrophy.
CDC Split Type:

Write-up: 5/2/21 er hpi: 74 y.o. female who presents to the Emergency Department by EMS. EMS was called to the patient''s home at an assisted living facility with a complaint of shortness of breath. When EMS initially arrived the patient was able to talk and tell them that she was feeling poorly and then shortly after this, she started having a lot of trouble breathing and essentially became unresponsive. EMS started bagging the patient and back to her all the way here. When she got here she was obviously in respiratory distress. Once IV access was established, the patient was intubated using RSI. Not much history other than this is available because the patient was unable to speak before she was intubated due to her shortness of breath. transferred to higher level of care 4/30/21 ER HPI: 74 y.o. female who presents with severe lumbar back pain that radiates into her right buttock and right posterior thigh. She rates it a 7 to 8/10. The pain has improved since its onset last evening. She denies any numbness tingling or muscle weakness. She further denies injury or incontinence. Patient does have a history of low back pain though none as severe as this. dc''d home


VAERS ID: 1282764 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-01
Onset:2021-05-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / 2 - / SYR

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

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

Write-up: Swollen lips


VAERS ID: 1282790 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-02
Onset:2021-05-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A2 / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Blood pressure increased, Diarrhoea, Dizziness, Dyspnoea, Fatigue, Headache, Nausea, Pallor, Rash
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid 50mg Gianvi
Current Illness: None
Preexisting Conditions: Hashimoto''s Disease
Allergies: Milk Codeine Contrast dye
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea, diarrhea, headache, rash on chest, shortness of breath, loss of color in face, dizziness, light-headed, extreme fatigue (could not drive home from site), elevated blood pressure


VAERS ID: 1282816 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-06
Onset:2021-05-02
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None reported
Preexisting Conditions: congestive heart failure, hypertension, diabetes type 2, atrial fibrillation, history of sustained ventricular tachycardia, thrombocytopenia
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed presumptive Guillain-Barr? syndrome after receiving the J&J vaccine outside of a hospital.


VAERS ID: 1282854 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-01
Onset:2021-05-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Oesophageal pain, Pyrexia, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Rash and welts from head to thighs, severe headache, esophageal pain, fever of 101.


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