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From the 5/7/2021 release of VAERS data:

Found 188,897 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

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VAERS ID: 1276511 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:2021-04-23
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041AZ1A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 antibody test, Therapy non-responder
SMQs:, Lack of efficacy/effect (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Blood pressure high; Non-smoker; Social alcohol drinker; Unspecified disorder of thyroid
Preexisting Conditions: Comments: The patient had no known allergies and did not had drug abuse or illicit drug use.
Allergies:
Diagnostic Lab Data: Test Name: SARS-CoV-2 antibody test; Result Unstructured Data: Negative antibody test
CDC Split Type: USJNJFOC20210452504

Write-up: SUSPECTED IMMUNOLOGICAL VACCINE FAILURE; This spontaneous report received from a consumer concerned a 65 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included high blood pressure, thyroid, alcohol use (occasional wine), and non-smoker, and other pre-existing medical conditions included the patient had no known allergies and did not had drug abuse or illicit drug use. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration not reported, batch number: 041AZ1A or 041A21A, expiry: Unknown) frequency one total, dose was not reported, administered on 09-APR-2021 in right deltoid for prophylactic vaccination. No concomitant medications were reported. The consumer reported that on unspecified date, the patient experienced suspected immunological vaccine failure and reported that antibody test called Sars-cov2-spikeAK was given to the patient by her primary care physician which came back negative for antibodies. The consumer also reported that the patient did not had any other side effects. Laboratory data included: Sars-cov-2 antibody test (NR: not provided) Negative antibody test. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of suspected immunological vaccine failure was not reported. This report was serious (Other Medically Important Condition). The suspected product quality complaint has been confirmed to be voided based on the PQC evaluation/investigation performed.; Sender''s Comments: V0: 20210452504-Covid-19 vaccine ad26.cov2.s-Suspected Immunological Vaccine Failure. This event is considered not related. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1276519 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Maryland  
Vaccinated:0000-00-00
Onset:2021-04-23
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Computerised tomogram thorax, Platelet count, Pulmonary embolism, SARS-CoV-2 test
SMQs:, Embolic and thrombotic events, venous (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: MESALAMINE; AZATHIOPRINE; DICYCLOMINE [DICYCLOVERINE]; MULTIVITAMINS [VITAMINS NOS]
Current Illness: Crohn''s disease; Drug allergy (Remicade allergy)
Preexisting Conditions: Comments: The patent was on multi vitamins
Allergies:
Diagnostic Lab Data: Test Date: 20210423; Test Name: CT pulmonary angiogram; Result Unstructured Data: Central and peripheral pulmonary emboli in the right lower lobe; Test Date: 20210423; Test Name: COVID-19 virus test; Result Unstructured Data: negative; Test Date: 20210423; Test Name: Platelet count; Result Unstructured Data: 252 k/mcL
CDC Split Type: USJNJFOC20210453021

Write-up: PULMONARY EMBOLISM/RIGHT SIDED MID BACK PAIN; This spontaneous report received from a health care professional concerned a 64 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included Crohn''s disease. The patient was previously treated with infliximab for Crohn''s disease. The patient experienced drug allergy when treated with infliximab (Remicade). The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 042A21A, expiry: unknown) dose was not reported, 1 total administered on 31-MAR-2021 to left arm for prophylactic vaccination. Concomitant medications included vitamins nos, azathioprine, dicycloverine, and mesalazine for drug used for unknown indication. On 22-APR-2021 by evening, the patient experienced right-sided mid-back pain and shortness of breath and was presented to ED (emergency department) on 23-APR-2021. The patient''s pain was sharp and worsened with coughing and deep inspiration; she felt that she was taking shallow breaths. Upon ED (emergency department) presentation, there was no shortness of breath, chest pain, dizziness, fevers, dysuria, or abdominal pain. The patient had reproducible pain on her right mid-back area. There was some mild diffuse tenderness in her abdomen, but it was reported that she always had a tender abdomen due to Crohn''s disease. The patient had no peritoneal signs and had no recent travel history. On 23-APR-2021, the CTA (Computed tomography angiography) of chest was done with and without contrast and found out central and peripheral pulmonary emboli in the right lower lobe. The patient had no CT (computerized tomography) evidence of right heart strain. The patient''s ground glass opacities within the right lower lobe was somewhat band like in appearance and concerned for early pulmonary infarcts. It was reported that this might also relate to sub segmental atelectasis or less likely an inflammatory/infectious process. The patient had also small right pleural effusion; no acute inflammatory process in the abdomen or pelvis. On 23-APR-2021, the patient''s platelet count was 252 k/mcL and was tested negative for covid test. The patient was diagnosed with pulmonary embolism; she consulted hematology/oncology specialist and recommended with initiation of argatroban for treatment of pulmonary embolism. The patient was admitted to inpatient on 23-APR-2021. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of pulmonary embolism/right sided mid back pain was not reported. This report was serious (Hospitalization Caused / Prolonged).; Sender''s Comments: V0;-covid-19 vaccine ad26.cov2.s-Pulmonary Embolism. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


VAERS ID: 1276549 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-04-23
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Blood fibrinogen, Blood homocysteine, Blood immunoglobulin G, Blood immunoglobulin M, Cerebral venous thrombosis, Computerised tomogram, Fibrin D dimer increased, Headache, Immunology test, Jugular vein thrombosis, Mesenteric vein thrombosis, Platelet count, Portal vein thrombosis, Protein C deficiency, Protein S deficiency, SARS-CoV-2 test negative, Splenic vein thrombosis, Thrombocytopenia, Transaminases
SMQs:, Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Ischaemic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Congenital, familial and genetic disorders (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Overweight
Preexisting Conditions: Medical History/Concurrent Conditions: Fatty liver; Comments: The patient had family history significant for a DVT/anticoagulant treatment in her mother, and a history of unspecified blood clots in her maternal grandmother. The patient was on no medications, including no estrogen containing pharmaceutical products or supplements. She has never been exposed to heparin. The patient had no history of COVID-19.
Allergies:
Diagnostic Lab Data: Test Date: 202104; Test Name: ELISA; Result Unstructured Data: Positive; patient had a diagnosis of VITT; Test Date: 202104; Test Name: Platelet count; Result Unstructured Data: 17,000; Test Date: 202104; Test Name: IgM; Result Unstructured Data: against the SARS-COVID-2 nucleocapsid protein-positive; Test Date: 202104; Test Name: IgG; Result Unstructured Data: against the SARS-COVID-2 nucleocapsid protein-positive; Test Date: 202104; Test Name: Transaminases; Result Unstructured Data: Elevated; Test Date: 20210423; Test Name: CT scan; Result Unstructured Data: See relevant lab tests/data; Test Date: 20210423; Test Name: Platelet count; Result Unstructured Data: 22000; Test Date: 20210423; Test Name: COVID-19 virus test negative; Result Unstructured Data: Negative; Test Date: 20210429; Test Name: Platelet count; Result Unstructured Data: 138,000; Test Name: Protein S deficiency; Result Unstructured Data: negative; Test Name: Protein C deficiency; Result Unstructured Data: Negative; Test Name: Homocysteine level; Result Unstructured Data: Negative; Test Name: Fibrinogen; Result Unstructured Data: 103 (low); Test Name: Fibrin D dimer high; Result Unstructured Data: $g12.8 (high); Test Name: CT scan; Result Unstructured Data: Revealed resolution of the sigmoid sinus vein thrombosis; Comments: the internal jugular thrombosis persisted
CDC Split Type: USJNJFOC20210454429

Write-up: LEFT SIGMOID SINUS VEIN THROMBOSIS; PORTAL VEIN THROMBOSIS; SPLENIC VEIN THROMBOSIS; SUPERIOR MESENTERIC VEIN THROMBOSIS; LEFT INTERNAL JUGULAR VEIN THROMBOSIS; THROMBOCYTOPENIA; ABDOMINAL PAIN; HEADACHE; This spontaneous report was received from a physician and concerned a 58-year-old white female. Initial information was received on 27-APR-2021, with additional information obtained via telephone follow up from the physician on 29-APR-2021. The patient''s specific height and weight were not reported. The patient''s past medical history included fatty liver, and the patient was overweight. Family history was significant for a deep venous thrombosis treated with anticoagulants in the patient''s mother, and a history of unspecified blood clots in her maternal grandmother. The patient was on no medications, including no estrogen containing pharmaceutical products or supplements. She has never been exposed to heparin. The patient had no history of COVID-19 infection. The patient received COVID-19 VACCINE AD26.COV2.S (suspension for injection, route of administration not reported, batch number not reported) on 12-APR-2021. The batch number has been requested. No concomitant medications were reported. On 18-APR-2021, 6 days after receiving vaccine, the patient developed a headache. On 23-APR-2021, 11 days after receiving vaccine, the patient presented to the hospital with complaints of headache and abdominal pain. COVID test in the emergency room was negative. On 23-APR-2021, imaging of the head and abdomen revealed: left sigmoid sinus vein thrombosis, portal vein thrombosis, splenic vein thrombosis, superior mesenteric vein thrombosis, left internal jugular vein thrombosis. The patient also had thrombocytopenia, with platelet count on presentation 22,000 (units not provided). D-dimer was elevated at $g12.8 (units not provided), Fibrinogen was low at 103 (units not provided), HIT antibody test by ELISA was positive, and physicians made the diagnosis of Vaccine-induced Thrombotic Thrombocytopenia (VITT). The patient was hospitalized in the intensive care unit. Treatment medications included argatroban, steroids and IVIG. Following treatment, the platelet count remained low, with a nadir of 17,000. On 27-Apr-2021, she underwent thrombectomy and thrombolysis of the intra-abdominal clots. This was performed due to the potential for portal hypertension in the future, given the extent of the thromboses. Repeat CT venogram of the head on an unknown date, revealed resolution of the sigmoid sinus vein thrombosis; the internal jugular thrombosis persisted. The patient has steadily improved since the thrombectomy. Abdominal pain and headache are improving. Platelet count has steadily risen, to 138,000 on 29- Apr-2021. Her transaminases were slightly elevated on admission and have not worsened, and she appears to have no organ dysfunction. A dialysis catheter had been placed in the event she would require plasmapheresis, but this was never used. Additional laboratory data included: IgG and IgM antibodies against the SARS-COVID-2 nucleocapsid protein positive; Protein C deficiency negative; Protein S deficiency negative; Homocysteine level (NR: not provided) negative. Serotonin release assay, anticardiolipin panel and Factor V Leiden tests were pending. The plan was to transition the patient to an oral anticoagulant and remove the dialysis catheter on 30-APR-2021, with a possible discharge on 01-MAY-2021. The patient had not recovered from left sigmoid sinus vein thrombosis, portal vein thrombosis, splenic vein thrombosis, superior mesenteric vein thrombosis, and left internal jugular vein thrombosis, and was recovering from left sigmoid sinus vein thrombosis, thrombocytopenia, headache and abdominal pain. This report was serious (Hospitalization Caused / Prolonged, and Life Threatening). Additional information was received from physician on 29-APR-2021. The following information was updated and incorporated into the case narrative: patient history, disease course, events, outcome, lab data, concomitant drugs.; Sender''s Comments: V0: This spontaneous report concerns a 58-year-old female patient who experienced left sigmoid sinus vein thrombosis, portal vein thrombosis, splenic vein thrombosis, superior mesenteric vein thrombosis, left internal jugular vein thrombosis, thrombocytopenia, headache and abdominal pain, 11 days after receiving COVID-19 VACCINE AD26.COV2.S. The patient is overweight and there is a family history of clots in her mother and maternal grandmother. Imaging of the head and abdomen revealed multiple sites of thrombus formation, platelet count was 22,000, D-dimer was elevated at $g12.8 (units not provided), Fibrinogen was low at 103 (units not provided), and HIT antibody test by ELISA was positive. Physicians made the diagnosis of Vaccine-induced Thrombotic Thrombocytopenia (VITT). The patient was treated with argatroban, IVIG, and steroids. Platelet counts remained low and she underwent thrombectomy of the intra-abdominal thrombi. Following thrombectomy the platelet counts rose and abdominal pain began to improve. Lab data included a positive test for IgG and IgM antibodies against the SARS-COVID-2 nucleocapsid protein. Based on the evolving knowledge of Thrombosis with Thrombocytopenia Syndrome (TTS, per definition from Brighton Collaboration), the low platelet count and temporal relationship to vaccination, we consider the events to have a plausible relationship with vaccination.


VAERS ID: 1276553 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-04-23
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Antibody test, Therapy non-responder
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210423; Test Name: Antibody test; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20210454496

Write-up: SUSPECTED IMMUNOLOGICAL VACCINE FAILURE; This spontaneous report received from a patient concerned a 43 year old female. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 042A21A, and expiry: UNKNOWN) dose was not reported, administered on 03-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 23-APR-2021, the subject experienced suspected immunological vaccine failure. Laboratory data included: Antibody test (NR: not provided) Negative. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of suspected immunological vaccine failure was not reported. This report was non-serious.


VAERS ID: 1276589 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-04-23
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, COVID-19, Decreased appetite, Diarrhoea, Epistaxis, Fatigue, Headache, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ESTRADIOL; SYNTHROID; ADVIL [IBUPROFEN]; ZYRTEC [CETIRIZINE HYDROCHLORIDE]; SINGULAIR; PREVACID; BABY ASPIRIN; PSEUDOEPHEDRINE; GUAIFENESIN; XOLAIR; FLOVENT; HYDROXYZINE
Current Illness: Aspirin-exacerbated respiratory disease; Asthma
Preexisting Conditions: Comments: Patient have allergies.
Allergies:
Diagnostic Lab Data: Test Name: Body temperature; Result Unstructured Data: over 100 deg; Test Name: COVID-19; Result Unstructured Data: Negative
CDC Split Type: USJNJFOC20210456339

Write-up: NOSE BLEED; LOSS OF APPETITE; DIARRHEA; LOW GRADE FEVER; HEADACHE; EXTREME FATIGUE; This spontaneous report received from a patient concerned a 58 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included asthma, and samter''s triad disease, and other pre-existing medical conditions included patient have allergies . The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805031, and expiry: UNKNOWN) dose was not reported, administered on 10-MAR-2021 for prophylactic vaccination. Concomitant medications included acetylsalicylic acid, cetirizine hydrochloride, estradiol, fluticasone propionate, guaifenesin, hydroxyzine, ibuprofen, lansoprazole, levothyroxine sodium, montelukast sodium, omalizumab, and pseudoephedrine. From 20-MAR-2021 the subject experienced a low grade fever, extreme fatigue, diarrhea, headache, and nose bleed till 29-MAR-2021. On 23-APR-2021, the subject again experienced nose bleed, loss of appetite, diarrhea and low grade fever ,her fever reduced to a low grade on 27-APR-2021. On 23-APR-2021, the subject experienced headache, extreme fatigue. Laboratory data (dates unspecified) included: Body temperature (NR: not provided) over 100 degree, and COVID-19 (NR: not provided) Negative (units unspecified). Treatment medications (dates unspecified) included: paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from low grade fever, diarrhea, headache, extreme fatigue, nose bleed, and loss of appetite. This report was non-serious.


VAERS ID: 1276726 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-01
Onset:2021-04-23
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blindness unilateral
SMQs:, Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Loss of vision in left eye; This spontaneous case was reported by a consumer and describes the occurrence of BLINDNESS UNILATERAL (Loss of vision in left eye) in a 74-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In April 2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 23-Apr-2021, the patient experienced BLINDNESS UNILATERAL (Loss of vision in left eye) (seriousness criterion medically significant). At the time of the report, BLINDNESS UNILATERAL (Loss of vision in left eye) had not resolved. Not Provided On 23-Apr-2021 (2 weeks after receiving the second dose), patient had loss of vision in the left eye. Concomitant product use was not provided by the reporter. No treatment was received by the patient. The patient received both scheduled doses of mRNA-1273 prior to the events; therefore, action taken with the mRNA-1273 in response to the events was not applicable. Company comment: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded


VAERS ID: 1276772 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-04-02
Onset:2021-04-23
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Ear discomfort, Fatigue, Haemorrhage urinary tract, Headache, Hypobarism, Influenza like illness, Nausea, Tinnitus
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: METOPROLOL
Current Illness:
Preexisting Conditions: Comments: No patient medical history reported.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: blood in her urine with clots; felt bad like the flu; went to sleep and woke up dizzy; buzzing in her ears; she feels with altitude sickness; Plugged ears; tiredness; nausea; headache; This spontaneous case was reported by a consumer and describes the occurrence of HAEMORRHAGE URINARY TRACT (blood in her urine with clots) in a 56-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No patient medical history reported. Concomitant products included METOPROLOL for an unknown indication. On 02-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 23-Apr-2021, the patient experienced HAEMORRHAGE URINARY TRACT (blood in her urine with clots) (seriousness criterion medically significant), INFLUENZA LIKE ILLNESS (felt bad like the flu), DIZZINESS (went to sleep and woke up dizzy), TINNITUS (buzzing in her ears), HYPOBARISM (she feels with altitude sickness), EAR DISCOMFORT (Plugged ears), FATIGUE (tiredness), NAUSEA (nausea) and HEADACHE (headache). At the time of the report, HAEMORRHAGE URINARY TRACT (blood in her urine with clots), INFLUENZA LIKE ILLNESS (felt bad like the flu), DIZZINESS (went to sleep and woke up dizzy), TINNITUS (buzzing in her ears), HYPOBARISM (she feels with altitude sickness), EAR DISCOMFORT (Plugged ears), FATIGUE (tiredness), NAUSEA (nausea) and HEADACHE (headache) outcome was unknown. Additional concomitant medications included reflux medication when needed and asthma medication when needed. This case concerns a 56-year-old female with a serious unexpected event of hemorrhage urinary tract, and nonserious unexpected Influenza like illness, dizziness, tinnitus, ear discomfort, hypobarism, and expected headache, fatigue, nausea. Hemorrhage urinary tract latency 22 days after first dose mRNA-1273. Event outcomes unknown. Based on current available information and temporal association between use of the product and the start date of the event, a causal relationship cannot be excluded. This case was linked to US-MODERNATX, INC.-MOD-2021-090443, US-MODERNATX, INC.-MOD-2021-090371 (E2B Linked Report).; Sender''s Comments: This case concerns a 56-year-old female with a serious unexpected event of hemorrhage urinary tract, and nonserious unexpected Influenza like illness, dizziness, tinnitus, ear discomfort, hypobarism, and expected headache, fatigue, nausea. Hemorrhage urinary tract latency 22 days after first dose mRNA-1273. Event outcomes unknown. Based on current available information and temporal association between use of the product and the start date of the event, a causal relationship cannot be excluded. US-MODERNATX, INC.-MOD-2021-090443:Dose 1 US-MODERNATX, INC.-MOD-2021-090371:Son''s case


VAERS ID: 1276779 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-25
Onset:2021-04-23
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Decreased appetite, Influenza like illness, Mental impairment, Myalgia, Nausea, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: inability to think straight; stomach ache; loss of appetite; weakness; achy feet and hands; feeling like she had the flu; nausea; fever; muscle ache; This spontaneous case was reported by a consumer and describes the occurrence of MENTAL IMPAIRMENT (inability to think straight) in a 52-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 027B21A and 001B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 25-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 22-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 23-Apr-2021, the patient experienced MENTAL IMPAIRMENT (inability to think straight) (seriousness criterion intervention required), ABDOMINAL PAIN UPPER (stomach ache), DECREASED APPETITE (loss of appetite), ASTHENIA (weakness), PAIN (achy feet and hands), INFLUENZA LIKE ILLNESS (feeling like she had the flu), NAUSEA (nausea) and PYREXIA (fever). On an unknown date, the patient experienced MYALGIA (muscle ache). On 25-Apr-2021, PYREXIA (fever) had resolved. At the time of the report, MENTAL IMPAIRMENT (inability to think straight), ABDOMINAL PAIN UPPER (stomach ache), DECREASED APPETITE (loss of appetite), ASTHENIA (weakness), PAIN (achy feet and hands), INFLUENZA LIKE ILLNESS (feeling like she had the flu), NAUSEA (nausea) and MYALGIA (muscle ache) outcome was unknown. Company Comment: Based on the information provided which includes a strong temporal association between the use of mRNA-1273 vaccine and onset of the reported events, a causal relationship cannot be excluded. Nausea, fever and myalgia are consistent with the product safety profile. This case was linked to MOD-2021-090510 (Patient Link).; Sender''s Comments: Based on the information provided which includes a strong temporal association between the use of mRNA-1273 vaccine and onset of the reported events, a causal relationship cannot be excluded. Nausea, fever and myalgia are consistent with the product safety profile


VAERS ID: 1276781 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-23
Onset:2021-04-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Passed out for a little bit; This spontaneous case was reported by a consumer and describes the occurrence of LOSS OF CONSCIOUSNESS (Passed out for a little bit) in a 24-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 017C21A) for COVID-19 vaccination. No Medical History information was reported. On 23-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Apr-2021, the patient experienced LOSS OF CONSCIOUSNESS (Passed out for a little bit) (seriousness criterion medically significant). At the time of the report, LOSS OF CONSCIOUSNESS (Passed out for a little bit) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant medication information was not provided. Patient passed out for a little bit after his shot. After he came to, he felt thirsty and got some food. No treatment information was provided. Company comment: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.


VAERS ID: 1281058 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Maryland  
Vaccinated:0000-00-00
Onset:2021-04-23
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 antibody test, Therapy non-responder
SMQs:, Lack of efficacy/effect (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Drug allergy (rash all over body); Food allergy (sick with vomiting); Non-smoker
Preexisting Conditions: Comments: No drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data: Test Name: SARS-CoV-2 IgG antibody test; Result Unstructured Data: No detectable antibodies.
CDC Split Type: USJNJFOC20210459180

Write-up: Confirmed Immunological Vaccine Failure; This spontaneous report received from a patient concerned a 66 year old male. The patient is healthy otherwise, concurrent conditions included green pepper allergy, prednisone allergy, non alcoholic, and non smoker, and other pre-existing medical conditions included no drug abuse or illicit drug usage. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805022, expiry: 25-MAY-2021) dose was not reported, frequency one total administered in left arm on 04-MAR-2021 for prophylactic vaccination. No concomitant medications were reported. On unspecified date, the patient underwent lab test include SARS-CoV-2 IgG antibody test which showed no detectable antibodies which considered as confirmed immunological vaccine failure and lack of efficacy. Patient''s doctor recommended that to took another covid-19 vaccine (Moderna) since the antibody patient came out low and the doctor stated that it did not work. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of confirmed immunological vaccine failure was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0:202104591580-Covid-19 vaccine ad26.cov2.s-Confirmed Immunological vaccine Failure .These events are considered not related. The events has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event than the drug. Specifically: SPECIAL SITUATIONS.


VAERS ID: 1281584 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-07
Onset:2021-04-23
   Days after vaccination:16
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: Other       Purchased by: ?
Symptoms: Injected limb mobility decreased, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (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: Centrum vitamin, aspirin (Excedrine migraine), Budesonide.
Current Illness: None.
Preexisting Conditions: Microscopic colitis.
Allergies: Almonds, bananas.
Diagnostic Lab Data: As above.
CDC Split Type:

Write-up: WAS TOLD THAT IT WAS THE ONE AND DONE AND IT WAS THE JANSSEN VACCINE, BUT LOT # IS MODERNA: He got the vaccine, had no reactions at all for 2 weeks. Then on Friday, 4/23/21 he woke up early with pain in his left arm near the area of the injection and the back of his arm and to his shoulder like he was hit with a bat. It did not move the next day and went to his PCP on Tuesday and referenced Ortho and could not find any doctor and his pain was getting worse. He went to the ER on Wednesday, had a bad experience. Went back on Friday 4/30/21 and nothing was done for his shoulder and needs to see somebody regarding his arm. The arm is painful and painful to move in all directions. They did not do anything for him in the ER, actually made it worse. The ER said that they could not do an MRI as he needed a referral from an orthopedist for that. They wanted to check him for his heart, and they would not listen to him.


VAERS ID: 1281599 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-07
Onset:2021-04-23
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 AR / SYR

Administered by: Work       Purchased by: ?
Symptoms: Catheterisation cardiac abnormal, Chest pain, Coronary artery dissection, Intracardiac thrombus, Myocardial infarction, Myocardial necrosis marker increased, Pain in extremity, Troponin increased
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Cardiac panel with increased enzymes included troponin increases. Heart Catheter test came back showing blood clot as well as coronary spontaneous arterial dissection.
CDC Split Type:

Write-up: Culminated in myocardial infarction. Chest pains started next day and leg pains. By April 23, I had severe chest pains and had to see medical at work. On April 30, 2021 was at emergency department for heart attack symptoms. Was transferred for myocardial infarction. Test results show myocardial infarction, coronary spontaneous arterial dissection, and blood clot.


VAERS ID: 1281880 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-10
Onset:2021-04-23
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time shortened, Alanine aminotransferase normal, Albumin globulin ratio normal, Angiogram pulmonary abnormal, Anion gap decreased, Aspartate aminotransferase normal, Basophil count decreased, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin increased, Blood calcium decreased, Blood chloride increased, Blood cholesterol normal, Blood creatinine normal, Blood fibrinogen increased, Blood glucose normal, Blood magnesium normal, Blood potassium normal, Blood sodium normal, Blood thyroid stimulating hormone decreased, Blood triglycerides increased, Blood urea normal, Brain natriuretic peptide normal, Carbon dioxide normal, Catheter directed thrombolysis, Chest pain, Deep vein thrombosis, Dyspnoea, Dyspnoea exertional, Eosinophil count normal, Eosinophil percentage, Full blood count, Globulins decreased, Glomerular filtration rate normal, Granulocyte percentage, Haematocrit normal, Haemoglobin normal, High density lipoprotein decreased, Hyperglycaemia, Imaging procedure abnormal, Immature granulocyte count increased, International normalised ratio normal, Limb discomfort, Low density lipoprotein normal, Lung infiltration, Lymphocyte count normal, Lymphocyte percentage decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin increased, Mean cell volume increased, Mean platelet volume normal, Metabolic function test, Monocyte count increased, Monocyte percentage, Neutrophil count increased, Neutrophil percentage increased, Pain in extremity, Peripheral swelling, Platelet count normal, Pleural effusion, Pleuritic pain, Protein total decreased, Prothrombin time normal, Pulmonary artery thrombosis, Pulmonary embolism, Pulmonary infarction, Red blood cell count normal, Red cell distribution width increased, Scan with contrast abnormal, Subclavian vein thrombosis, Tachycardia, Troponin I, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Dyslipidaemia (narrow), Haematopoietic leukopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (narrow), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Lipodystrophy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (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: Cholecalciferol 5000 unit capsule 1 by mouth daily Ibuprofen 200 mg tablets. Take 2 tablets by mouth twice daily as needed Multivitamin - 1 tablet daily
Current Illness: None
Preexisting Conditions: Hyperlipidemia, Hypertension, DJD
Allergies: none
Diagnostic Lab Data: 4/25/2021 12:18 WBC: 12.35 (H) RBC: 5.22 Total Hemoglobin: 17.1 (H) Hematocrit: 50.4 (H) MCV: 96.6 (H) MCH: 32.8 MCHC: 33.9 RDW-CV: 15.6 (H) Platelet Count: 198 MPV: 10.0 Absolute Neutrophils: 9.74 (H) Absolute Lymphocytes: 1.36 Absolute Monocytes: 0.86 (H) Absolute Eosinophils: 0.25 Absolute Basophils: 0.00 Absolute Immature Granulocytes: 0.1000 (H) % Neutrophils: 78.9 % Lymphocytes: 11 % Monocytes: 7 % Eosinophils: 2 % Basophils: 0 % Immature Granulocytes: 0.8 4/25/2021 12:15 Prothrombin Time: 12.3 INR: 1.06 PTT: 39.3 (H) 4/25/2021 20:38 PTT: 35.1 (H) Fibrinogen: 553 (H) 4/25/2021 12:18 Na: 140 K: 4.2 Chloride: 103 Carbon dioxide: 28 Anion Gap: 9 Glucose: 148 (H) BUN: 12 Creatinine: 1.09 Estimated GFR: $g60 Calcium: 9.9 Troponin I, High Sensitivity: 5 4/25/2021 16:05 B-TYPE NATRIURETIC PEPTIDE: 8.4 4/26/2021 01:07 Na: 137 K: 4.1 Chloride: 107 Carbon dioxide: 24 Anion Gap: 6 Glucose: 110 BUN: 15 Creatinine: 1.02 Albumin: 3.7 Albumin/Globulin Ratio: 1.7 Total Protein: 5.9 Estimated GFR: $g60 Calcium: 8.4 (L) Magnesium: 1.3 (L) ALK PHOS: 120 (H) ALT (SGPT) (REF): 11 AST (SGOT) (REF): <20 Bilirubin Total (Calculated): 2.1 (H) Globulin: 2.2 Cholesterol: 163 HDL Cholesterol: 36 (L) LDL, Calculated: 94 Triglycerides: 163 (H) TSH: 1.44 CT Angio Chest w Contrast 4/25/2021 1. Pulmonary arterial thromboembolism. Thromboemboli in the lower lobes. Low clot burden. Lingular left lower lobe infiltrate compatible with infarct. Trace left pleural effusion.
CDC Split Type:

Write-up: 4/25/2021 - He was apparently well until 2 days prior to admission when he developed spontaneous left calf pain and swelling. He denies any associated trauma, recent travel and immobility. He is not taking any new prescription, including steroids. One day prior to admission, he started experiencing left-sided pleuritic chest pain up to 9/10 in intensity and exertional shortness of breath. He denies any fevers, hemoptysis, sputum production, diaphoresis, nausea, vomiting, abdominal pain, dizziness or lightheadedness. The pain was persistent throughout the day. Today, his chest pain persisted and his shortness of breath had progressed. He also noted left arm swelling with mild discomfort. He felt that his left leg swelling and pain had improved today. Nevertheless, given persistent symptoms, he decided to come to the emergency room for further evaluation management. In the emergency room, his initial blood pressure was 218/104 with mild tachycardia of 99, normal oxygen saturation and no fevers. CBC showed a white count of 12.35, hematocrit of 50.4 and normal platelet count 198. INR was normal at 1.06. BMP showed mild hyperglycemia at 148. Troponin was 5 and BNP was 8. Imaging studies show extensive left upper extremity DVTs that involved the left subclavian vein, left lower extremity DVTs and bilateral lower lobe pulmonary emboli. 4/30/2021 Presumed unprovoked extensive DVT of the left upper extremity and left lower extremity. However, he did recently receive Johnson & Johnson Covid vaccine. Now status post catheter directed thrombolysis to the left upper extremity.


VAERS ID: 1281910 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-07
Onset:2021-04-23
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Atypical pneumonia, COVID-19, Chest X-ray abnormal, Cough, Dyspnoea, Hypoxia, Lung opacity, Productive cough, Pyrexia, SARS-CoV-2 test positive, Sinus congestion
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Mucinex
Current Illness: None
Preexisting Conditions: Exercise induced asthma
Allergies: NKA
Diagnostic Lab Data: CTA of chest was negative for PE on 4/26 but showed extensive groundglass opacities throughout both lungs are nonspecific, but would be consistent with a provided history of COVID-19 infection.
CDC Split Type:

Write-up: Emergency room with symptoms of cough, fever, phlegm and sinus congestion since 4/14. He had an outpatient COVID test positive on 4/16. His fevers reoccurred so his PCP obtained a CXR showing atypical pnuemonia, started him on azithromcyin and solumedrol on 4/22. He presents today with worsening shortness of breath, now hypoxic on day 9 of his infection. He got the Johnson & Johnson vaccine on 4/7.


VAERS ID: 1282084 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-03-13
Onset:2021-04-23
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray, Cough, Dyspnoea, Fatigue, SARS-CoV-2 test negative, Sinus operation, Sleep disorder, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxitine, Metformin, Adderall, Levothyroxine, Premarin, Estradiol, Alprazolam, Promethazine, Albuterol Inhaler, Ibuprofen, Pepto Bismol, OTC Allergy Meds, Multivitamin, Fiber Gummies, Butabitol, BREZTRI Inhaler Prednisone
Current Illness: Migraines, Seasonal Allergies
Preexisting Conditions: Asthma, Depression, Anxiety, Panic Disorder, PTSD, Bulimia, Metabolic Disorder, Obesity, PCOS, Pre-Diabetic, ADHD
Allergies: Adhesive tape, Codeine Sensitive
Diagnostic Lab Data: Appt with DR. on 4/30/2021. Advised by After Hours Nurse Line to proceed to ER at 2:00am Sunday, May 2nd, 2021. Covid Text PCR (Negative), Chest XRay, Solumedrol given via IV push, Albuterol Breathing Treatment, Lab Panels drawn, elevated Eosinophils.
CDC Split Type:

Write-up: Increased difficulty breathing, wheezing on inhale, high pitched crowing sounds on inhale and exhale, shortness of breath, fatigue, constant cough, drainage down back of throat, pulse O2 Sat variations, inability to sleep due to wheezing, cough


VAERS ID: 1282175 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-11
Onset:2021-04-23
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205821A / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Anosmia
SMQs:, Taste and smell disorders (narrow), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Vaccine administered 4/11/21. Patient developed loss of smell 4/23/21. Has improved since that time but has not completely resolved.


VAERS ID: 1284721 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-03-25
Onset:2021-04-23
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Thrombosis, Ultrasound scan
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Test Date: 20210424; Test Name: Ultrasound; Result Unstructured Data: Ultrasound of left arm was done and determined a blood clot in that arm.
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Superficial blood clot; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of THROMBOSIS (Superficial blood clot) in a 58-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 014C21A and 018B21A) for COVID-19 vaccination. No Medical History information was reported. On 25-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 22-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 23-Apr-2021, the patient experienced THROMBOSIS (Superficial blood clot) (seriousness criterion medically significant). At the time of the report, THROMBOSIS (Superficial blood clot) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 24-Apr-2021, Ultrasound scan: abnormal (abnormal) Ultrasound of left arm was done and determined a blood clot in that arm.. Patient went to the emergency room on 24 Apr 2021, approximately 7 pm. The patient was a healthy individual and used to do bike ride 11 miles per day with average speed 16mph. He did bike ride the evening of his second covid shot. No relevant concomitant medications were reported. Treatment information included anti-inflammatory medicine. Action taken with mRNA-1273 in response to the events was not applicable. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Most recent FOLLOW-UP information incorporated above includes: On 26-Apr-2021: Additional information was received on 26 Apr 2021. Added lab data and treatment; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1284723 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-03-19
Onset:2021-04-23
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A2L1A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Decreased appetite, Fatigue, Headache, Nausea, Presyncope, Pyrexia, Urinary retention
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: PROZAC
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: he couldn''t pee; low appetite; he thought he may pass out; Chills; severe headache every time he got up; feel sick to his stomach but never vomited; low grade fever; tired; This spontaneous case was reported by a consumer and describes the occurrence of URINARY RETENTION (he couldn''t pee) in a 67-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 037A21B and 030A2L1A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included COVID-19 in December 2020. Concomitant products included FLUOXETINE HYDROCHLORIDE (PROZAC) for an unknown indication. On 19-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 23-Apr-2021, the patient experienced URINARY RETENTION (he couldn''t pee) (seriousness criterion medically significant), DECREASED APPETITE (low appetite), PRESYNCOPE (he thought he may pass out), CHILLS (Chills), HEADACHE (severe headache every time he got up), NAUSEA (feel sick to his stomach but never vomited), PYREXIA (low grade fever) and FATIGUE (tired). On 23-Apr-2021, DECREASED APPETITE (low appetite) had resolved. On 25-Apr-2021, URINARY RETENTION (he couldn''t pee), PRESYNCOPE (he thought he may pass out), CHILLS (Chills), HEADACHE (severe headache every time he got up), NAUSEA (feel sick to his stomach but never vomited), PYREXIA (low grade fever) and FATIGUE (tired) had resolved. The reporter stated, the patient had similar side effect from what he had from the 1st dose. Additional concomitant medications included Blood pressure pills, Cholesterol pills and maybe back pain pill. Treatment medication included Tylenol. Based on the information provided which includes a strong temporal association between the use of mRNA-1273 vaccine and onset of the reported events, a causal relationship cannot be excluded. Chills, headache, pyrexia, fatigue and nausea are consistent with the product safety profile. Most recent FOLLOW-UP information incorporated above includes: On 26-Apr-2021: An additional document received on 26 Apr 2021 has information Upgraded case to serious, updated suspect product details, concomitant medication, treatment medication and event details.; Sender''s Comments: Based on the information provided which includes a strong temporal association between the use of mRNA-1273 vaccine and onset of the reported events, a causal relationship cannot be excluded. Chills, headache, pyrexia, fatigue and nausea are consistent with the product safety profile.


VAERS ID: 1285497 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-12
Onset:2021-04-23
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Computerised tomogram abnormal, Cough, Lymphadenopathy, Mass, Night sweats, Pyrexia, X-ray abnormal
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations:
Other Medications: Arm our Thyroid, levothyroxine, Testosterone cypionate, anastrazole, Pregablin
Current Illness: Non
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: X- ray, CT Scan
CDC Split Type:

Write-up: Night sweats, fever, cough, chills, swollen lymph nodes, mass located on lymph node


VAERS ID: 1285576 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-08
Onset:2021-04-23
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Pulmonary thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ALodipine 10mg daily Pravastatin 80 mg, daily Eliquis 5 mg daily Lisinopril 10 mg, daily Metoprolol 25 mg twice a day
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Lots of testing
CDC Split Type:

Write-up: Shot on 3/8/21 & on 4/23/21 had pain in chest. MWH tested & NOT heart UT LUNGS that a clot in each.


VAERS ID: 1287955 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Ohio  
Vaccinated:0000-00-00
Onset:2021-04-23
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Fatigue
SMQs:

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: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210502944

Write-up: LEG FATIGUE/FATIGUE ELSEWHERE; This spontaneous report received from a patient concerned a 55 year old male. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808978, expiry: UNKNOWN) dose was not reported, administered on 07-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 23-APR-2021, the subject experienced leg fatigue/fatigue elsewhere. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from leg fatigue/fatigue elsewhere. This report was non-serious.


VAERS ID: 1288106 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-03-24
Onset:2021-04-23
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Angina pectoris, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: VERAPAMIL; LABETALOL; VITAMIN D 2000
Current Illness: Hypertension
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: myocardial infarction with 100% vessel occlusion; Chest pain; This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDIAL INFARCTION (myocardial infarction with 100% vessel occlusion) and ANGINA PECTORIS (Chest pain) in a 79-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 031B21A and 038A21A) for COVID-19 vaccination. Concurrent medical conditions included Hypertension. Concomitant products included VERAPAMIL, LABETALOL and CALCIUM CARBONATE, COLECALCIFEROL (VITAMIN D 2000) for an unknown indication. On 24-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 20-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 23-Apr-2021, the patient experienced ANGINA PECTORIS (Chest pain) (seriousness criterion hospitalization). On 24-Apr-2021, the patient experienced MYOCARDIAL INFARCTION (myocardial infarction with 100% vessel occlusion) (seriousness criterion hospitalization). On 26-Apr-2021, MYOCARDIAL INFARCTION (myocardial infarction with 100% vessel occlusion) had resolved. At the time of the report, ANGINA PECTORIS (Chest pain) outcome was unknown. The patient had an urgent coronary intervention and was discharged from the ER on 26Apr2021. He was informed about an additional 80% occlusion which will require stenting in a future. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) was not applicable. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1288129 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-26
Onset:2021-04-23
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 2 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Fatigue, Loss of consciousness, Taste disorder
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Passed out; Felt dizzy; Nasty taste in mouth; was feeling tired; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of LOSS OF CONSCIOUSNESS (Passed out) in a 68-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 038A21A and 037B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 26-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 23-Apr-2021, the patient experienced TASTE DISORDER (Nasty taste in mouth) and FATIGUE (was feeling tired). On 26-Apr-2021, the patient experienced LOSS OF CONSCIOUSNESS (Passed out) (seriousness criterion medically significant) and DIZZINESS (Felt dizzy). At the time of the report, LOSS OF CONSCIOUSNESS (Passed out), DIZZINESS (Felt dizzy), TASTE DISORDER (Nasty taste in mouth) and FATIGUE (was feeling tired) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications were reported. The patient had acetaminophen for the events. Action taken with mRNA-1273 in response to the drug was not applicable. Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Further information has been requested. This case was linked.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Further information has been requested Dose 1 case


VAERS ID: 1288657 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Oregon  
Vaccinated:0000-00-00
Onset:2021-04-23
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 antibody test, Therapy non-responder
SMQs:, Lack of efficacy/effect (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ALLOPURINOL; ATORVASTATIN; TAMSULOSIN; VITAMINS NOS; MAGNESIUM
Current Illness: Alcohol use (occasionally 2-3 drinks a week); Gout; Hypercholesterolemia; Non-smoker
Preexisting Conditions: Comments: Patient had No known allergies and was not allergic to any medication. Patient had no drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data: Test Date: 20210423; Test Name: SARS-CoV-2 IgG antibody test; Result Unstructured Data: negative; Test Date: 20210424; Test Name: SARS-CoV-2 IgM antibody test; Result Unstructured Data: negative; Test Date: 20210424; Test Name: SARS-CoV-2 IgG antibody test; Result Unstructured Data: negative
CDC Split Type: USJNJFOC20210504060

Write-up: SUSPECTED IMMUNOLOGICAL VACCINE FAILURE; This spontaneous report received from a patient concerned a 61 year old male. Initial information was processed along with additional information received on 03-MAY-2021. The patient''s height, and weight were not reported. The patient''s concurrent conditions included non smoker, alcohol use occasionally 2-3 drinks a week, gout, and hypercholesterolemia, and other pre-existing medical conditions included patient had no known allergies and was not allergic to any medication. patient had no drug abuse or illicit drug usage. The patient was not pregnant at the time of reporting. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808978, expiry: unknown) frequency 1 total, dose was not reported, administered on 02-APR-2021 to left arm for prophylactic vaccination. Concomitant medications included allopurinol for gout, atorvastatin for hypercholesterolemia, magnesium, Tamsulosin, and vitamins nos. On 23-APR-2021, the patient experienced suspected immunological vaccine failure. Patient did not experience any side effects. Three weeks later (23-APR-2021) after the vaccination, patient decided to get the antibody test, they found no antibody and he did a regular blood test on 24-APR-2021 and still they did not find antibodies. On the day of vaccination, he did not take any Tylenol or Advil and he did not develop any side effects. On 23-APR-2021, Laboratory data included: SARS-CoV-2 IgG antibody test (NR: not provided) negative. On 24-APR-2021, Laboratory data included: SARS-CoV-2 IgG antibody test (NR: not provided) negative, and SARS-CoV-2 IgM antibody test (NR: not provided) negative. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of suspected immunological vaccine failure was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0:20210504060-Covid-19 vaccine ad26.cov2.s-suspected immunological vaccination failure. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


VAERS ID: 1294090 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-14
Onset:2021-04-23
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood potassium, Dizziness, Hypokalaemia, Peripheral swelling, Polyuria, Vertigo
SMQs:, Cardiac failure (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (narrow), Tubulointerstitial diseases (broad), Hypokalaemia (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: ASPIRIN [ACETYLSALICYLIC ACID]; VITAMIN D3; ACETAMINOPHEN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210423; Test Name: Potassium; Result Unstructured Data: diagnosed with hypokalemia
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: dizzy spells; swollen feet; frequent urination; vertigo/room was spinning around me; hypokalemia; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of HYPOKALAEMIA (hypokalemia) in a 61-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 038B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concomitant products included ASPIRIN [ACETYLSALICYLIC ACID], COLECALCIFEROL (VITAMIN D3) and PARACETAMOL (ACETAMINOPHEN) for an unknown indication. On 14-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Apr-2021, the patient experienced HYPOKALAEMIA (hypokalemia) (seriousness criterion medically significant) and VERTIGO (vertigo/room was spinning around me). On an unknown date, the patient experienced DIZZINESS (dizzy spells), PERIPHERAL SWELLING (swollen feet) and POLYURIA (frequent urination). At the time of the report, HYPOKALAEMIA (hypokalemia), DIZZINESS (dizzy spells), PERIPHERAL SWELLING (swollen feet), POLYURIA (frequent urination) and VERTIGO (vertigo/room was spinning around me) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 23-Apr-2021, Blood potassium: 2.6 (Low) diagnosed with hypokalemia. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Treatment for the event hypokalemia included 2 intravenous bag of potassium chloride. Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1294192 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-03-09
Onset:2021-04-23
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Retinal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Retinal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin 1000mg [twice per day] Blood sugars Lisinopril-HCTZ 20-12.5 MG [twice per day] Blood pressure Metoprolol 50mg [1 once per day] Blood pressure Lamotrigine 25mg [4 twice a day} Seizures Potassium CL ER 10 MEQ [twice per day] Seizur
Current Illness:
Preexisting Conditions: Hemochromatosis Dilated cardiomyopathy secondary to hemochromatosis Type 2 diabetes mellitus without complication Partial symptomatic epilepsy with complex partial seizures, not intractable, without status epilepticus Seizure Onychomycosis Pharyngoesophageal dysphagia
Allergies: Amlodipine, Codeine, Penicillin
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Hemorrhages of the left eye retina.


VAERS ID: 1228898 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-12
Onset:2021-04-22
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Blood test abnormal, Dehydration, Diarrhoea, Dyspnoea, Gait inability, Lymphocyte count increased, Red blood cell count increased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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: Fentanyl patch, Tylenol #3, Lisinopril, Seroquel, Amitripylline, Furosemide, Humalog Mix 75/25, Cyclobenzaprine, Pravastatin,
Current Illness: None
Preexisting Conditions: Diabetes, blood pressure, cholesterol, chronic pain
Allergies: NKA
Diagnostic Lab Data: Patient states that bloodwork revealed high T-cell and RBC counts.
CDC Split Type:

Write-up: On 4/14/2021 patient woke up with stomach cramps and diarrhea. states he could not walk, and had no energy from dehydration. patient states he had SOB. Patient has emergency alert system, so he pressed the button and an ambulance took him to the ER.


VAERS ID: 1240228 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-04-19
Onset:2021-04-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 04213211 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site rash, Rash papular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 50 mg
Current Illness: No
Preexisting Conditions: None
Allergies: Latex
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Raised rash appeared at injection site


VAERS ID: 1240237 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Famotidine 20 MG
Current Illness: None
Preexisting Conditions: IBS
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Diarrhea after the second dose. No reaction from first dose


VAERS ID: 1240251 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Injection site pain, Muscle fatigue
SMQs:, Rhabdomyolysis/myopathy (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Fatigue
Other Medications: Buspar
Current Illness: A cold one week prior
Preexisting Conditions: Orthostatic hypotension
Allergies: Lactose sensitivity, allergic to Cipro
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore injection site, muscle fatigue, tired, diarrhea


VAERS ID: 1240486 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-20
Onset:2021-04-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Dyspnoea, Fatigue
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (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: Lexapro, prenatal, Buspirone
Current Illness: Miscarriage
Preexisting Conditions: PE, EOE, GERD, PMDD, PCOS, DDD, obesity
Allergies: Corn, soy, peanuts, watermelon Clindamyocin, Wellbutrin, Abilify, morphine, diladid, xarelto
Diagnostic Lab Data:
CDC Split Type:

Write-up: I am having extreme shortness of breath and sharp chest and right shoulder pains. I also feel congested and really exhausted.


VAERS ID: 1240497 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-17
Onset:2021-04-22
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Skin mass
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: I felt an nodule on my left collarbone its was moving while I moved my neck , It is not painful and pea sized I didn?t get it checked by a doctor yet


VAERS ID: 1240705 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: School       Purchased by: ?
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Vomiting approx 18 hours after 2nd dose. Did not eat anything unusual or different and drank plenty of water and gatorade


VAERS ID: 1241106 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Headache, Nausea, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Tylenol extra strength
Current Illness:
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills, nausea, headache, and arm soreness. Teeth chattering from chills.


VAERS ID: 1241114 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Feeling cold, Feeling hot, Headache, Hyperhidrosis, Neck pain, Paranasal sinus discomfort
SMQs:, Neuroleptic malignant syndrome (broad), Arthritis (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: Lamotrogine, Preponanol, turmeric, vitamin C, fish oil, apple cider vinegar
Current Illness: N/A
Preexisting Conditions: Bipolar I disorder
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Around 6:30 pmI began feeling chills and incredibly tired. I became sore all over and began shaking uncontrollably because of the chills. I went to sleep around 7pm and woke up 20 minutes laterwith the worst fever I ever had. I was extremely hot but when I lifted the covers I would immediately get cold. I got out of bed around 3am because I was very thirsty and completly stuffed up in my head and sinuses. I used vicks sinex and drank water and tea. I was very cold when i got out of bed. I went back to bed and woke up every 30 mins or so very hot and chilly when I lifted the covers. I finally got out of bed at 6am. At that point I had sweated through two shirts, my sheets and comforter. When i got out of bed I was no longer chilly. I had a mild headache, sinus pressure and soreness throughout my neck and shoulders. Throughout the day (April 21, 2021) I would get chills and then get hot. I continued to havce sinus pressure and a mild headache. I went to bed around 8:30pm and woke up at 3:00am. when I woke up I had sweated through half my shirt. At the time of writing (April 22, 2021 @ 6:08am) I feel slight sinus pressure, no headache and get chills and hot from time to time.


VAERS ID: 1241117 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-14
Onset:2021-04-22
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Dizziness, Headache, Injection site rash, Injection site swelling, Lethargy, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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: Vitamin d, b-complex
Current Illness: Extreme headache, dizziness, fatigue, pain at injection site, and then an achey pain deep in armpit (lymph?) and finally a large itchy swelling (looks like the ?COVID arm?).
Preexisting Conditions: I have had high blood pressure in the past.
Allergies: Pennicilins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within minutes of injection developed sore arm. Next day I had an extreme headache, dizziness, lethargy. About four or five days later I developed a pain in my left armpit and wasn?t sure if it was my lymph nodes or a scapular muscle. I woke up a weeke later with a large swollen rash at the injection site, about 2? in diameter.


VAERS ID: 1241680 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Nausea, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Generic brand of benicar for HTN. No other medications reported.
Current Illness: none reported
Preexisting Conditions: Hypertension
Allergies: None reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client states that 5 minutes post vaccination he began to feel swelling of the throat, dizziness and nausea. Observation area leads alerted by nurse and MD notified. Client evaluated by observation leads and given Benadryl 50 mg/1ml. Symptoms improved and client released by Dr.


VAERS ID: 1241696 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Hypertension, Limb discomfort, Nervousness, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Hypertension (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: None
Current Illness:
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: 55 y/o female, with no past medical history, who presents with Right arm tingling post vaccination. Patient states that this is her first dose in the two-dose series. Patient denies previous vaccination reactions. Patient received her vaccination to the Right arm. Patient states that she also feels anxious and nervous. Patient denies sore throat, difficulty swallowing, chest pain or difficulty breathing. NP and Paramedics at patient side. Patient provided with a bottle of water and legs were elevated. Within 3 minutes patient stated that tingling resolved. Patient noted to be hypertensive (172/104) with all other vital signs normal. Patient denies medical history of hypertension. Patient moved to the partitioned off area and placed on cot. Patient vitals monitored every 5 mins for 1 hour. Patient became normotensive and stated that symptoms had resolved. Patient discharged home in stable condition.


VAERS ID: 1241705 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cataplexy, Fear of injection, 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: NA
Current Illness:
Preexisting Conditions:
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT SEEMED TO BE AFRAID OF NEEDLE HE CLOSED HIS EYES AND LOOKED AWAY WHILE PRIMARY NURSE DID INJECTION AFTER INJECTION HE STATED "I FEEL SOMETHING" HIS BODY THEN WENT LIMP SECONDARY NURSE WAS BY HIS SIDE ALREADY HELP HIM UP AND CODE GREEN WAS CALLED. PT WAS TRANSFERED TO SUPINE POSITION CONSCIOUS AT THIS POINT WHEN LAYED DOWN. VSS WITH EMT. PT WAS MONITORED X30 MIN WAS COHERENT, WHEELED TO CAR PARTNER DROVE HIM HOME, REFUSED HOSPITAL.


VAERS ID: 1241927 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-01
Onset:2021-04-22
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Injection site streaking
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (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: None reported
Current Illness: None
Preexisting Conditions: None
Allergies: None reported
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Had red streaks on left arm day after immunization - no pain and did go away


VAERS ID: 1242136 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-08
Onset:2021-04-22
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Fatigue, Nausea, Pain, Rash, Retching, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: advil
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: initial side effects chills, achy, fatigue lasting approximately 48 hours. 4/8-4/10/2021 startled awake from sleep with feeling of vomit in throat that was gagging me that I was able to swallow back down. the nauseous wasn''t going away so went to bathroom and vomited around 12am Thursday 4/22/2021 for about 15 minutes, woke up with rash on my face and neck


VAERS ID: 1242227 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site rash, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: The patient had a localized rash near the injection site. The patient was told to monitor the rash and report to the ED if symptoms continue or worsen.


VAERS ID: 1242861 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-11
Onset:2021-04-22
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Groin pain, Menstruation irregular, Muscle tightness
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dystonia (broad), Accidents and injuries (narrow), Osteonecrosis (broad), Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: allegra, ashwaganda, l-theanine, fish oil, calcium, magnesium, vitamin d, vitamin c
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Started having a period after not having one for 4 months. Tightness, slight pain in groin on right side. 3 small bruises in a line on right leg.


VAERS ID: 1243087 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-01
Onset:2021-04-22
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram cerebral abnormal, Cerebral haemorrhage, Cerebral venous thrombosis, Computerised tomogram, Intensive care
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: B12, Ibuprofen, Loratadine, Raloxifene, D3
Current Illness:
Preexisting Conditions: osteoarthritis
Allergies: Amplicillin, cephalexin, clindamycin
Diagnostic Lab Data: 4/21 CT, CTA brain with above.
CDC Split Type:

Write-up: Cortical sinus thrombosis with intracerebral hemorrhage, seizures. Admitted to ICU.


VAERS ID: 1243751 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-10
Onset:2021-04-22
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Deep vein thrombosis, Erythema, Peripheral swelling, Ultrasound Doppler abnormal, Venous thrombosis limb
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
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: Aspirin, Codeine, Sulfa
Diagnostic Lab Data: Venous doppler ultrasound on 4/22/21
CDC Split Type:

Write-up: DVT to left arm, pt came to appt reporting left arm redness and swelling. Sent to hospital for venous doppler ultrasound that confirmed DVT to site. Pt started on blood thinners at this time.


VAERS ID: 1243967 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DULOXETINE GABAPENTIN PROPANOLOL ATORVASTATIN LEVOTHYROXINE MELOXICAM FLUTICASONE PROPIANATE DOXYCYCLINE MONOHYDRATE TRAZODONE VITAMIN D3
Current Illness: NONE
Preexisting Conditions: CHRONIC BIPOLAR DISORDER NEUROTIC EXCORIATION HYPERTRIGLYCERIMIA HYPERTENSION TACHYCARDIA MALINGERING DEGENERATIVE DISC DISEASE LOW BACK PAIN
Allergies: PROZAC - RASH
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT. WAS GIVEN JANSSEN VACCINE 3/19/21 AND GIVEN MODERNA VACCINE TODAY.


VAERS ID: 1244983 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-13
Onset:2021-04-22
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bone pain, Pain, Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Osteonecrosis (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: ?Metaxolone (800mg 2x daily), ?Tramadol HLC ER (100mg 2x daily), ?Topiramate (50mg, 2x daily), ?Cymbalta (60mg 1x), ?Omeprazole (20mg 2x daily), ?Estradiol (1mg 1x), ?Naproxen (500mg 2x daily), ?Multivitamin, OTC (1x), ?Vit D, OTC
Current Illness: None
Preexisting Conditions: Severe B12 deficiency, Peripheral Polyneuropathy caused by B12 deficiency, Fibromyalgia, Traumatic Encephalopathy caused by B12 deficiency, Chronic Fatigue Syndrome, Insomnia, Circadian Rhythm Sleep Disorder, Heat Intolerance, Silent Migraines, Psoriasis, IBS, Lumbar Facet Joint Arthopathy (degenerative joint disease L5-S), pre-Osteoporosis (Osteopenia) in back & hips.
Allergies: ?All Tricyclic (TCA) antidepressants (extreme agitation, nervousness, restlessness, & anger, hostility, irritability, loss of balance, mood swings with anxiety & depression, emotionally flat, suicidal thoughts, blurred vision) ?Fentanyl patches (hallucinations); ?Baclofen (full body rashes); ?Marijuana/THC (tetanic seizures) ?Low Tolerance to: ?erythromycin, ?codeine, ?certain adhesive bandages
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Experienced blood clots in my nose every night for about 10 nights after receiving vaccine injection. Didn''t think anything of it until I mentioned it to my mom who received her vaccine at the same time & place from the SAME BOTTLE and she too was waking with bloody clots in her nose. I experienced a reoccurrence for 4 days in mid April. I wouldn''t have said anything but friends nagged us after the J&J blood clotting issue. (We both also experienced severe piercing & throbbing pain in the bone beneath the injection for about 14 days.) I mentioned both events to my GP on 3/26/21


VAERS ID: 1245230 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-09
Onset:2021-04-22
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Condition aggravated, Cor pulmonale, Deep vein thrombosis, Embolism venous, Myocardial strain, Platelet count normal, Pulmonary embolism
SMQs:, Cardiac failure (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Pulmonary hypertension (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: Acetaminophen PRN, aripiprazole 1mg qday, buproprion XL 150mg qday, duloxetine 60mg qday, Flonase nasal 2 sp qday, ibuprofen PRN, naproxen PRN, propranolol LA 160mg qday
Current Illness:
Preexisting Conditions: 1. H/o R PE, provoked 2014 after transcontinental flight, s/p Warfarin x 6 months, reportedly negative hypercoagulable panel; with strong family history of venous thrombosis in mother and sister (+ hypercoagulable state, specific type unrecalled to patient) 2. OSA with morbid obesity, nocturnal hypoxemia; on CPAP 3. Asthma, mild intermittent 4. Hypertension 5. Depression, Panic disorder, IBS 6. Allergic rhinitis 7. Intermittent migraine headaches 8. Endometriosis, Ovarian cyst
Allergies: Codeine
Diagnostic Lab Data: Plt 280 (4/22/21)
CDC Split Type:

Write-up: Patient received J&J COVID vaccine on 4/9/21 at pharmacy . Today (4/22/21), patient is admitted to our facility with VTE, submassive, unprovoked, with bilateral high-burden PE and LLE DVT, and right heart strain / acute cor pulmonale; in patient with H/o R PE, provoked 2014 after transcontinental flight, s/p Warfarin x 6 months, reportedly negative hypercoagulable panel; with strong family history of venous thrombosis in mother and sister. Heparin drip started, plan to start DOAC tomorrow. Anticipate hospital admission for at least 2 nights.


VAERS ID: 1245252 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-20
Onset:2021-04-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site rash, Injection site warmth, 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Ehlers Danlos Syndrome
Allergies: Sulfur drugs Ceclor Cefzil Demeral Lasix Tamiflu
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash on uper left arm that is hot to the touch, itchy, and painful


VAERS ID: 1245258 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 LA / IM

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

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

Write-up: AT THE BEGINNING OF THE APPOINTMENT FOR THE COVID VACCINE, I VERIFIED WITH THE PATIENT IF THIS WAS HIS SECOND PFIZER VACCINE PRIOR TO GIVING THE SHOT AND HE AGREED. ACCORDING TO HIM, HE HAD GOTTEN HIS FIRST DOSE SOMEWHERE ELSE. AFTER GIVING THE VACCINE, I WENT OVER HIS CDC COVID VACCINATION RECORD CARD THAT WE HAD FILLED OUT FOR HIM AND THAT''S WHEN HE PULLED OUT OF HIS WALLET ANOTHER CDC VACCINATION RECORD CARD AND I REALIZED THAT HE HAD GOTTEN HIS FIRST DOSE ON 3/23/21 AND IT WAS MODERNA VACCINE NOT PFIZER. I EXPLAINED TO THE PATIENT THAT HE SHOULD''VE GOTTEN THE MODERNA VACCINE AS HIS SECOND DOSE NOT THE PFIZER AND THAT''S WHEN HE REALIZED HE''D SIGNED UP FOR THE WRONG VACCINATION. I CALMED HIM DOWN AND TOLD HIM I''D FOLLOW UP WITH HIM IN 24 HOURS TO LET HIM KNOW WHAT HE NEEDS TO DO. I REACHED OUT TO MY COORDINATOR TO GET GUIDANCE AND SHE TOLD ME TO TELL THE PATIENT THAT AS LONG AS HE RECEIVED 2 MRNA COMPONENT VACCINES ON TIME, THAT THAT WOULD COMPLETE THE 2 DOSE SERIES AND THAT THERE WAS NO NEED TO RESTART THE SERIES OR GIVE THE PATIENT AN ADDITIONAL MODERNA OR PFIZER VACCINE. I COUNSELED THE PATIENT ON POSSIBLE SIDE EFFECTS FROM THE PFIZER VACCINE AND TOLD HIM THAT SINCE HE''D GOTTEN 2 MRNA COMPONENTS SERIES THAT HIS VACCINATION SERIES IS CONSIDERED COMPLETE.


VAERS ID: 1245259 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Dysphagia, Nausea, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: HTN
Preexisting Conditions: new onset HTN
Allergies: Possible (childhood) allergy to Sulfa
Diagnostic Lab Data: Vitals
CDC Split Type:

Write-up: 42 y.o. female AAO x4, CC nausea and difficulty swallowing. Pt. had first dose of Moderna COVID 19 Vaccine Lot 007C21A. Pt. was sent to 30 min lot for hx of allergies (unk. type, childhood). Post vaccination approx. 15 min pt. signaled for assistance. Pt. advised that she had some slight nausea, dizziness and slight difficulty swallowing, although she attributed difficulty with swallowing to the nausea. During interaction with pt., she advised that she felt increase of swelling swelling in her throat. Pt. had recent hx of HTN and vitals were as follows: BP 178/132 (wrist cuff), pulse 95, RR 16. Pt. administered 25 mg of Benadryl which relieved the discomfort in throat within 10 min. Pt. second set of vitals was 182/115, P 100 R 16 unlabored. Pt. talked to personal MD and advised for them to go to urgent care. Pt. refused further tx/ hospital transport and was released to go direct to urgent care with husband per MD.


VAERS ID: 1245261 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamotrigine 200 mg/ day (100 day/ 100night) Phentemine 30mg Camrese 1/day Seroquel 50mg/night
Current Illness:
Preexisting Conditions: Bipolar disorder
Allergies:
Diagnostic Lab Data: Blood screen, blood sugar. All normal.
CDC Split Type:

Write-up: 10 minutes after having shot administered, I had severe hypertension/ faint and dizziness. My BP is usually 120/87. My BP went as high as 180/110 and did not go down until 5 hours later. I was recommended to go to the ER by ambulance and instead had a friend take me. After blood screening, the doctor stated it was adverse effect from vaccine. They treated with saline, benedryl and Ativan and was sent home. I will continue to monitor and notate any other symptoms


VAERS ID: 1245266 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anaphylactic reaction, Anxiety, Dysphagia, Dyspnoea, Emotional distress, Nausea, Pallor, Presyncope, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown language barrier
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unk but to a "pill" per translator
Diagnostic Lab Data: VItals
CDC Split Type:

Write-up: OS 42 Y.o. Female AAox4, anaphylactic reaction. translator was used. Pt complained of extreme difficulty breathing, swollen tongue, difficulty swallowing. Pt was out side of vehicle pacing back and forth in distress. Prior to epi admin pt. Was having near syncope also. Pt. Appeared pale in color and distressed, pacing back and forth with anxious look on her face. Pt pulse rate also was approx 110 prior to administration, and strong. RR was approximately 20. Bp 186/92 post administration. Tx. Pt was examined and verbal interview conducted through interpreter. EMS summonsed. Pt advised tongue was starting to swell significantly, and increase in SOB, nausea and. Near syncope. Pt administered 0.3 mg epinephrine through autoinjector to r thigh @ 1128. Pt advised after approx 6 min post injection that tongue swelling was decreasing and she was able to breath again and was not having near syncopal episodes. Pt care transfers to hospital with a non-emergent transfer to hospital.


VAERS ID: 1245273 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-19
Onset:2021-04-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid; fluoxetine; losartan
Current Illness: None
Preexisting Conditions: Eczema
Allergies: Allergy to unknown antibiotics given during surgery
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Red rash, itchy, very warm arm surrounding injection site. Spread out approximately 4 inches.


VAERS ID: 1245276 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 RA / IM

Administered by: Public       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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa and Cipro
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pounding headache that started around Noon. I took a nap around 2:30pm and woke up around 5:30pm. After waking up, there was some residual discomfort, but I applied a topical analgesic (Tiger Balm) and the symptoms resolved.


VAERS ID: 1245283 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site pain, 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: Allopurinol, Losarton, B12 complex, C, Magnesium, zinc, D3, K2 MK7, boron
Current Illness: none
Preexisting Conditions: obesity, gout
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: body aches, fatigue, sore injection site


VAERS ID: 1245286 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, 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), Accidents and injuries (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown, not reported
Current Illness: Unknown, not reported
Preexisting Conditions: Unknown, not reported
Allergies: None
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient received the vaccine in the vaccination room and was instructed to wait 15 minutes to monitor for a reaction. The pharmacist returned to the pharmacy and shortly after was notified by another customer that someone had fallen down. The pharmacist arrived at the aisle to find the person laying on floor unconscious. The patient quickly regained consciousness and had no breathing or swelling. He was assisted to a chair and was responsive to questions. A few minutes later, he lost consciousness again and emergency services were contacted. He was taken to the hospital.


VAERS ID: 1245289 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-19
Onset:2021-04-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Itchy rashy skin, bumps, hives


VAERS ID: 1245296 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-15
Onset:2021-04-22
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Injection site rash, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

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

Write-up: Red, swollen and itchy rash around injection known as covid arm started today - 1 week after injection


VAERS ID: 1245301 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-12
Onset:2021-04-22
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Mild URI for 2-3 days a couple weeks prior
Preexisting Conditions: None
Allergies: No known food or drug allergy. Suspect food allergy as cause of urticaria
Diagnostic Lab Data: Non
CDC Split Type:

Write-up: Urticaria starting morning of April 22nd, 10 days post 1st Pfizer shot in left arm. Worse in left forearm, but also on right forearm, chest, back, and neck. Suspect new food allergy or possibly recent viral illness.


VAERS ID: 1245302 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Burning sensation, Chest pain, Head discomfort, Headache
SMQs:, Peripheral neuropathy (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Client received 2nd dose COVID vaccine @ 12:00pm, complained of feeling burning sensation in chest and lower back, with pressure in head @ 12:02pm. Client placed in chair, vital signs stable. Burning sensation in chest and lower back resolved at 12:09pm, head pressure lessened. Client left for home @ 12:34pm, with headache, advised to follow up with primary care if symptoms not resolved at home or worsen.


VAERS ID: 1245308 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site vesicles
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: Levothyroxine (137mcg) Liothyronine sod (5 mcg)
Current Illness: N/a
Preexisting Conditions: Pcos
Allergies: Penicillin
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: I have a dime sized blister about 1.5 inches from the injection site. The blister is yellow and fluid filled. I noticed it today, but it could have appeared sooner.


VAERS ID: 1245309 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-01
Onset:2021-04-22
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 1 LA / IM

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

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

Write-up: Patient was vaccinated on 04/01/2021. Patient is 15 years old and was not supposed to be vaccinated on that day, she should have been refused. It is unknown as to what occurred on that day that patient was vaccinated even though she is 15 years old. It was not brought to the attention of the site lead or charge nurse on 04/01/21. Patient returned to the site on 04/22/2021 for second dose. Vaccinating nurse and scribe asked the patient and looked at her date of birth which states she is 15 years old. It was brought to the attention of the charge nurse and site lead that the patient had been incorrectly vaccinated 3 weeks ago. Patient was not given second dose and educated that she may not receive it until she is 16 years old. Patient and mother understood and left site without incident.


VAERS ID: 1245310 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Cardiac disorder, Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Heart and chest pain, started about 8-9 hours after injection. Going to sleep, so I cannot continue to monitor until morning.


VAERS ID: 1245320 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Chest discomfort, Crying, Fatigue, Fear, Immediate post-injection reaction, Pain in extremity, Panic attack, Paranoia, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Yaz
Current Illness: None
Preexisting Conditions: Diagnosed General Anxiety Disorder, PTSD, and Major Depressive Disorder
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Upon onset of other typical effects (sore/swollen arm, fever, fatigue) experience instantaneous and intense panic attack, which included tightness in the chest, feeling of fear and danger, sobbing, and paranoia. I had no anxiety surrounding the receiving of the vaccine nor anxiety about potential side effects. I was standing still and upright at the time of the attack and it lasted appx 30-40 min, subsiding to feelings of heightened anxiety through the remainder of the night. While anxiety and panic attacks have occurred in the past, it is not on a regular basis, nor has either occurred in over 6 months.


VAERS ID: 1245323 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Washington  
Vaccinated:1921-04-22
Onset:2021-04-22
   Days after vaccination:36525
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Hypoaesthesia oral, Swelling
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Had swelling of that and numbness in lips and stomach started hurting and only took 10 mins after shot.Then the people admitted ephi into my leg..03mg.And then fire department got called and got 50 cc of liqard benadryl into me and iv and it was off to the hospital and got some prednisone and and was in hospital for 8 hrs


VAERS ID: 1245326 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site pruritus, Injection site swelling, Injection site warmth, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: DTap, 2015, age 33, hives (90% of body) Rhogam, 2016, age 34, mild hives (shot administered AFTER taking antihistamine)
Other Medications: Zoloft, 50mg Prenatal vitamin Vitamin D Probiotic
Current Illness: None
Preexisting Conditions: None
Allergies: Hives after a tetanus shot and after a Rhogam shot
Diagnostic Lab Data: None so far
CDC Split Type:

Write-up: Approx. 24 hours after 2nd shot, a very large swollen lump appeared at injection site. It is more than 3? in diameter, very hot to the touch, and very itchy. A rash has also appeared around the edges of the soles of my feet.


VAERS ID: 1245331 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Citalopram, Wellbutrin, Vitamin C, Vitamin D, Zyrtec, Multivitamin & Probiotic
Current Illness:
Preexisting Conditions: Vitamin D Deficiency
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: EXTREME NAUSEA AND SEVERE FATIGUE AS WELL AS SHAKINESS


VAERS ID: 1245332 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-15
Onset:2021-04-22
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Headache, Heart rate increased, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: Flush and feverish (low grade), racing heart. Headache onset at say 6 and continuing.


VAERS ID: 1245336 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamictal prestiq ambien
Current Illness: None
Preexisting Conditions: No
Allergies: Sulfa, mycin based meds, Cephalexin
Diagnostic Lab Data: No test because you can see the hives all over me
CDC Split Type:

Write-up: Severe allergic reaction with hives that started on my face and moved down to my neck and body also with a cough. Went to Er bc my face felt like it was on fire and they gave me meds and a steroid shot and I know have to take steroids for 3 days along with Benadryl every 6 hours as well.


VAERS ID: 1245349 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Full blood count normal, Metabolic function test, Nausea, Seizure, Vomiting
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Keppra, mult
Current Illness:
Preexisting Conditions: chromosome abnormality seizures
Allergies: augmentin
Diagnostic Lab Data: CBC, CMP, Keppra level (4/23/21)
CDC Split Type:

Write-up: pt began having n/v in the evening and then seizures at night. pt does have seizure history but does not usually have breakthrough seizures.


VAERS ID: 1245351 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: This resident is a new resident to the facility, admitted on 03/09/2021 according to the patient chat. Staff member are not aware the patient already received 2 doses of Pfizer ( on 01/19 and 02/09) at the facility she previously lived in. Staff filled out the consent and answered "No" to the question she has ever received COVID vaccine. I have no way of knowing or verifying with the patient because she is nonverbal. So, I gave her a dose of Moderna. I only found out after getting an insurance reject and looked up immunization registry.


VAERS ID: 1245494 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Dysgeusia
SMQs:, Taste and smell disorders (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: no
Current Illness: no
Preexisting Conditions: no
Allergies: kiwi
Diagnostic Lab Data:
CDC Split Type:

Write-up: metallic taste


VAERS ID: 1245497 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Hypoaesthesia, Pain, Pain in jaw
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Osteonecrosis (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: Birth control SSRI Synthroid
Current Illness: None
Preexisting Conditions: Celiac Hypothyroid
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Jaw pain and numbness on left side under ear Body aches Chills


VAERS ID: 1245620 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-15
Onset:2021-04-22
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, Chest discomfort, Fatigue, Haemoptysis, Influenza like illness, Malaise, Pain
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Norco, Fentanyl, Keppra, low-dose aspirin, Carbamazepine , daily vitamin, Lyrica, Benadryl, Omeprazole
Current Illness: Fibromyalgia, Bipolar, Back pain
Preexisting Conditions: Fibromyalgia, Bipolar, Back pain
Allergies: Blue cheese, generic Lamictal
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever up to 102.6, body aches, extreme fatigue, coughing up blood (bright red), chest tightness, general malaise -Feels like the flu


VAERS ID: 1245630 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Headache, Nasopharyngitis, Nausea, Sleep disorder, Somnolence
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: I got the 1st shot of Covid Vaccine in the morning, during the evening symptoms have started: nausea, drowsiness, head pain, fatigue, classic cold symptoms, could not sleep through the night.


VAERS ID: 1245963 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: Inflamed lymph nodes under arms to breast, fever, nausea, diarrhea, extreme muscle pain


VAERS ID: 1245970 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Peripheral swelling, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Red, swollen arm where vaccination was given. Arm is also hot.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red, swollen injection arm that?s also hot to the touch. Noticed it the day after I received The injection. So far it?s lasted 2 days.


VAERS ID: 1245979 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-20
Onset:2021-04-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Stellara Zoloft Vitamin D Prenatal supplements
Current Illness:
Preexisting Conditions: Crohn''s Disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: - Swollen injection site over 2 inches and growing, warm to the touch - Doctor prescribed an antibiotic - Outcome to be determined


VAERS ID: 1245980 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Injection site pain, 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), 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-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Additional Details: Patient recieved the vaccine (sitting) and was instructed to sit for 15 minutes post vaccination.After about 5 minutes, patient stated that he was feeling light headed. Patient was seated when he fainted and was out for about 12-15 seconds. Patient came back and was able to speak with us.We provided him some water and called the EMT''s. EMT''s looked after patient/checked vitals and everything was okay. Patient states he has a fear of needles. Called patient a few hours after the incident to check


VAERS ID: 1245983 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Hyperhidrosis, Syncope, Tremor, Unresponsive to stimuli, Visual impairment
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), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Mild, Systemic: Shakiness-Mild, Systemic: Visual Changes/Disturbances-Mild


VAERS ID: 1245986 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Nausea, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? 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: Allergic: Rash (specify: facial area, extremeties)-Medium, Systemic: Allergic: Rash Generalized-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Nausea-Medium, Additional Details: sweating


VAERS ID: 1246091 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (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), Accidents and injuries (narrow), Cardiomyopathy (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? 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-Medium, Systemic: Seizure-Mild, Additional Details: Pt fell face flat on her face within 5 minutes of her injection and scratched her left cheekbone. Look like she was having a seizure but she was already conscious when we flipped her over. She felt fatigue from working a night shift yesterday, and a morning shift today. She ate a couple hours before the appointment. FS associate, monitored her for an extra 15 minutes before she walked home. I followed up with her at 4:40pm and 7:30pm on 4/22. Recommended that she report this to her PCP.


VAERS ID: 1246094 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Dizziness, Dyspnoea, Tremor, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (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: Allergic: Difficulty Breathing-Mild, Systemic: Abdominal Pain-Mild, Systemic: Dizziness / Lightheadedness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Shakiness-Mild.


VAERS ID: 1246099 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Asthenia, Cold sweat, Communication disorder, Confusional state, Dizziness, Fall, Flushing, Hyperhidrosis, Hypersensitivity, Hyperventilation, Hypotension, Immediate post-injection reaction, Panic reaction, Respiration abnormal, Respiratory rate decreased, Syncope, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Dementia (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Allergic: Anaphylaxis-Medium, Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hyperventilation-Medium, Systemic: Hypotension-Medium, Systemic: Shakiness-Medium, Systemic: Weakness-Medium, Additional Details: immediately after first dose pt head started to lower, eyes closed, slid down in chair. respiratory rate decreased for several seconds then panic breathing occured thereafter. pt was sweating profusely and skin was cold and clammy. could not verbally respond for 30-45 seconds. after a minute pt could talk and answer question. blood pressure was taken 3 different times 5 minutes apart 75/43, 87/46, 93/52. Pt was feeling fine a half hour later and was called 4 hours later to follow up.


VAERS ID: 1246113 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Back pain, Chills, Decreased appetite, Feeling cold, Feeling hot
SMQs:, Retroperitoneal fibrosis (broad), Guillain-Barre 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: Zyrtec, Lo-Ovral
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lower back aches, Hot/cold/chills, no energy, no appetite


VAERS ID: 1246121 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Hot flush, Hyperhidrosis, Hypertension, Hypoacusis, Injection site pain, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypertension (narrow), Cardiomyopathy (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: Confusion-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypertension-Mild, Additional Details: Patient reported that he had difficulty hearing. Patient sat in the chair and then lost conciousness. He was laid down on the ground, vitals were checked, and water was given. Noted high blood pressure. Patient regained conciousness within 3-5 minutes. Vitals were rechecked and returned to normal.


VAERS ID: 1246122 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia oral, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre 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: Systemic: Dizziness / Lightheadness-Mild, Systemic: Numbness (specify: facial area, extremities)-Mild, Systemic: Tingling (specify: facial area, extemities)-Mild, Additional Details: Patient reported feeling numbness spread over the left side of her face and the back of the head. After waiting 45 minutes, patient reported feeling tingling in the left side of the face.


VAERS ID: 1246135 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Vermont  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Neck pain
SMQs:, Arthritis (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: Joint Pain-Medium, Additional Details: neck pain


VAERS ID: 1246159 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Axillary pain, Fatigue, Headache, Pain, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid 125 mcg Prenatal vitamins 6000 d3
Current Illness: None
Preexisting Conditions: Hypothyroidism (thyroid removed due to papillary thyroid cancer, which hasn?t returned).
Allergies: Sulfa and ceclor drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue, body aches, soreness in right arm, soreness in armpit, headache,


VAERS ID: 1246197 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Flushing, Oral discomfort, Paraesthesia oral
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (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: Zyrtec
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: edible seeds, melon, adult protein in chicken, celebrex
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Complained of lips burning, flushing, tingling to lips. 50 mg Oral Benadryl given. Symptoms dissipating Taken home by daughter


VAERS ID: 1246220 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 LA / 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: Lightheaded


VAERS ID: 1246263 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 1 LA / IM

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

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

Write-up: Patient was administered 2nd dose covid vaccine of Moderna after receiving 1st dose Pfizer. Pfizer was administered on 3/30/21 and Moderna was given on 4/22/21.


VAERS ID: 1246297 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Body temperature increased, Chills, Diarrhoea, Headache, Nausea, Neck pain, Pain, Pyrexia, SARS-CoV-2 test negative, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, levothyroxine, quetiapine, baclofen
Current Illness:
Preexisting Conditions: Hypothyroidism
Allergies: Demerol, hydrocodone and codeine cause nausea and vomiting
Diagnostic Lab Data: Had Covid test April 7th (negative)
CDC Split Type:

Write-up: Patient had first dose 3/25 and developed severe headache, neck pain and fever/chills starting 5-6 days after first dose. She continued to have neck and back pain despite care of chiropracter. Received 2nd dose 4/22. That night worsened headache, fever to 102.7, increased neck/back pain, bodyaches. Also nausea, vomiting and diarrhea. Normal neurologic exam in Emergency Department early morning 4/23. Treated with supportive care (Toradol) with improvement. Do not suspect any intracranial pathology at this time.


VAERS ID: 1246339 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Sulfa Penicillan
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Headache, Body Aches, Fever and extremely tired.


VAERS ID: 1246366 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA LOT#021 / UNK LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Burning sensation, Chest pain, Headache, Myalgia, Oropharyngeal pain, Pain in jaw, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever 101.7 degrees F on 4/22/2021. Severe headache a whole day. Muscle pains. Taking vitamin C and orange juice. On 4/23/2021: super sore throat, jaw: super sore, chest: pain near the top of the sternum bone, between clavicle bones, head feels like burning. currently taking two pills of acetaminophen 325mg and phenylephrine HCl 5mg.


VAERS ID: 1246385 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-04-22
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Computerised tomogram abnormal, Condition aggravated, Cough, Deep vein thrombosis, Dyspnoea, Pain in extremity, Peripheral swelling, Pulmonary embolism, Ultrasound scan abnormal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: History of DVT and PE
Allergies:
Diagnostic Lab Data: CT imaging indicative of PE on 4/22/2021. Ultrasound imaging indicative of right DVT on 4/22/2021.
CDC Split Type:

Write-up: Patient presented to ED on 4/22/2021 with non-productive cough, mild shortness of breath x 10 days. Acute onset chest pain x 1 day. Chronic bilateral leg swelling, but worsening leg pain. Hx of DVT and PE, not on anti-coagulation.


VAERS ID: 1246397 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 03B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Blood pressure increased, Body temperature increased, Chills, Fatigue, Feeling cold, Headache, Malaise, Myalgia, Nasal congestion, Pain, Peripheral coldness, Rhinorrhoea
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine Centrizine Hydrochloride
Current Illness: No
Preexisting Conditions: Need allergy shots once a month. Taken those for 2 years. Amlodipine for blood pressure that is slowing inching up.
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I woke up at 3:10 am feeling cold and chilling. I took by temperature and it was 98.4. I normally have a temperature of 97.1 - 97.7. I take it daily multiple times. My hands were cold. When I got up and started moving around I didn''t have any more chills. When I got up at 6:30 am. I just didn''t feel well in general. Slight feeling of sniffles, congestion. I would get some aches that went away in a few seconds. They were at various points in my body, knee joints, muscles, and my head. They were simply a nuisance. I felt tired all day. My blood pressure was up 15-20 points on both numbers during the day. I''ve told my doctor when my blood pressure is higher, I''m having more aches and pains as though I''m fighting a virus. I tolerated the symptoms most of the day, letting my immune system try to work it out. My symptoms seemed worse at 5:45 pm, so I took two ibuprofen. My temperature was 98.9 at that point. The highest it''s been. All my symptoms got better until 1:15 am. I woke up feeling like I was chilling, but not as bad as yesterday, so I took two more ibuprofen. I feel 50% better today and haven''t taken any ibuprofen. Here is the really strange part. I had these exact symptoms and similar temperature ranges twic last year. In July and October I think. I didn''t get tested last year because they were minor symptoms. They were just nuisance symptoms. I took ibuprofen right away last year. I followed the masking guidelines, social distancing, etc. So, is it just coincidence I had similar symptoms last year two times, that I had when I getting the inactive Moderna vaccine? I had no reaction to the first shot. I just wanted to provide the information in case it is helpful. Very strange. I expect no other symptoms in a couple of days.


VAERS ID: 1246524 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007621A / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia
SMQs:, Taste and smell disorders (narrow)

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

Write-up: immediate persisting Metal Taste from the throat and front lower teeth leg cramps later 6 hrs later


VAERS ID: 1246567 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-04-08
Onset:2021-04-22
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: 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: none
Current Illness: High blood pressure
Preexisting Conditions: None
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: itchy rash


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