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

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

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 18 out of 8,753

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VAERS ID: 1849025 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-04
Onset:2021-11-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / UNK - / -
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ747AA / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain, Night sweats, Weight decreased
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: FLECAINIDE 50MG; MECLIZINE 50MG; PRAVASTATIN 40MG; DONEPEZIL 5MG; TAMSULOSIN 0.4MG; VIRAMIN D 1.25MG; AZELASTINE 137mcg; KETOCONAZOLE 1%; CYCLOSPORINE 0.05% Ophth; ASPIRIN 81MG; CANNABIS
Current Illness: NO
Preexisting Conditions: COLONIC POLYPS; ATRIAL FIBRILLATION
Allergies: NIGHT SWEATS FOR THE PREVIOUS 4 NIGHTS.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: PT report having night sweats for the 4 previous night after vaccine, lost weight with in the last 2 weeks. Pt was evaluated by PA and pt left and was seen at the urgent care for abdominal pain.


VAERS ID: 1849032 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-02
Onset:2021-11-06
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angioedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine Aspirin Spiriva Wixela
Current Illness:
Preexisting Conditions: HTN, COPD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Angioedema of lips


VAERS ID: 1849034 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-01
Onset:2021-11-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: 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: Small white bumps on torso, not itchy


VAERS ID: 1849035 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Electric shock sensation, Interchange of vaccine products
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: already written about
Other Medications: Metopropol 25 mg Levothyroxine .075 mg Duloxetine 30 mg Atorvastin 10 mg Clonazepam .5 mg
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Twenty-four hours after receiving Moderna (2nd shot), I had terrible brain zaps. I had to lie still and try to avoid any movement, including my eyes. For my booster,, I chose Pfizer, hoping to avoid the previous reaction; however, 24 hour later the same occurred. I just think it is important for you to know; I also informed my psychiatrist, who had not heard of this. These brain zaps were pretty severe, nonstop, and required me to lie still in bed for hours. They stayed with me for about 8 hours.


VAERS ID: 1849036 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-04
Onset:2021-11-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, calcium, diltiazem, fexofenadine, fluticasone, hydrochlorothiazide, methimazole.
Current Illness:
Preexisting Conditions: seasonal allergies, migraine, hyperthyroidism, hyperlipidemia, chronic kidney disease, hypertension
Allergies: aloe vera, valsartan, fosinopril, amlodipine, penicillin, enalapril, clonidine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had swelling of the upper lip that began the morning 11/6/21. Patient states that she has had issues with allergic reactions mostly to molds in the past and takes allegra daily. This morning she awoke with left upper outer lip swelling. She took her allegra and feels that the swelling improved but just "spread out" over her upper lip. No tongue swelling, drooling, difficulty swallowing, dyspnea, nausea, vomiting, diarrhea, fever. No other symptoms. No known exposures. Benadryl administered. On re-evaluation patient''s lip swelling significantly improved. No new symptoms. Return criteria reviewed. All questions answered. Patient discharged in stable condition.


VAERS ID: 1849042 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Injection site urticaria, Rash macular
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: no known
Preexisting Conditions: Failed allergy injections due to adverse reactions
Allergies: Yes, but unknown
Diagnostic Lab Data: 12:15 BP 118/79 and Pulse 90 (normal range)
CDC Split Type:

Write-up: Patient received vaccination about 12:05 and had symptoms of localized hives near injection site. Arms appeared somewhat blotchy on both sides, but some of this blotchiness was reported to be normal skin conditiono. Patient reported no other symptoms of allergy, denyng warmth or itchiness.. Patient was given cold compress on the localized hives which reduced severity of the lesions. After about 30 minutes patient was released with parents, who wanted to give benadryl at home. No benadryl was administered at the vaccine clinic site.


VAERS ID: 1849044 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Posture abnormal, Syncope
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), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient was given first shot for covid vaccine. She was sitting in the chair for her 15 min wait time. Her mom was observing her child that fainted and slumped down in the chair. Mom caught the daughter and gently put her on the floor. She yelled out help the intern and the pharmacist went out to help with the situation. We moved the child to her side in case she''s had seizure or choked in something. Child did lose consciousness for 15 seconds, but then she regained consciousness and was breathing properly. The intern called emergency services and took patient to the local HCF.


VAERS ID: 1849046 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Muscle spasms, Pyrexia, Sleep disorder
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (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: 2008 flu shot
Other Medications: Valtrex, montelukast
Current Illness: None
Preexisting Conditions: None
Allergies: Avocado
Diagnostic Lab Data: None
CDC Split Type:

Write-up: First 2 Pfizer shots were fine. No unusual symptoms, just tired. Booster was Moderna. Woke up in the middle of the night with a fever and feeling like all my bones were on fire. Random excruciating cramps all over my body. Lasted about 8 hours. This was similar but less severe than a bad (paresis?) reaction I had to the flu shot in 2008.


VAERS ID: 1849052 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-04
Onset:2021-11-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Lymph node pain, Lymphadenopathy, Migraine, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Migraine headache, extreme sleepiness, left axillary lymph node swelling and tenderness


VAERS ID: 1849054 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-06
Onset:2021-11-06
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness transient, Blindness unilateral, Visual field defect, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Noninfectious encephalitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

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

Write-up: I experienced temporary partial vision loss. For about 5 minutes, I had a blind spot of about 5 letters as I would read text on a computer screen. As I would read across, the blind spot moved across the words of the screen. After that cleared up, I noticed vision loss out of my right eye''s right side peripheral for about another 5 minutes. Then everything went back to normal.


VAERS ID: 1849069 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 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: No known medications.
Current Illness: No known illnesses.
Preexisting Conditions: No known chronic conditions .
Allergies: NKA
Diagnostic Lab Data: No known medical tests were conducted.
CDC Split Type:

Write-up: Patient was given Pfizer Dose 1 after receiving Moderna Dose 1 on 6/30/2021. The pt did not receive Moderna Dose 2 at any point after the first dose


VAERS ID: 1849074 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 3 RA / IM

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

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

Write-up: The patient began to experience lightheadedness and nausea within a few minutes of the vaccine administration. She did not experience this with either of the other two doses. She noted she had not eaten in over 12 hours.


VAERS ID: 1849075 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3521 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Loss of consciousness, Syncope
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), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: influenza vaccine within 30 seconds
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 30 seconds after the immunization was given the patient fainted. She was unconscious for less than 10 second. She did not hit her head or have any other trauma.


VAERS ID: 1849085 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Feeling hot, Hyperhidrosis, Peripheral coldness, Syncope, Tinnitus, Tremor, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), 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: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT COLAPSED AFTER VACCINE BP 114/66 HAD RINGING OF EARS, COLD CLAMY HANDS, GRAINY/DARK VISION. HE HAD NO PAIN OR PHYSICAL INJURY. BP RETESTED 125/85 --PT WAS FEELING BETTER BUT WAS HOT SWEATING AND SLIGHTLY SHAKEN. HE WAS OBSERVED FOR 30 MINS THEN RELEASED IN HIS OWN CARE


VAERS ID: 1849087 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Headache
SMQs:, 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: mild fatigue, 64, 4/17/21, Covid-19, Pfizer
Other Medications: magnesium, vitamin D, probiotics, vitamin C, digestive enzyme, zinc, multi-vitamin, B12, B1, NAC, L-lysine, HCL, DGL, 5-HTP, Vitamin K
Current Illness: none
Preexisting Conditions:
Allergies: Bismuth Citrate Hazelnuts
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Headache, joint pain (knees)


VAERS ID: 1849088 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 2 LA / IM

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

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

Write-up: Pt received a dose of Covid Pfizer 10mcg/0.2ml as a second dose instead of 0.3ml Pfizer 59267-1000-01, 30mcg/0.3ml.


VAERS ID: 1849089 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-11-04
Onset:2021-11-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Lymph node pain, Lymphadenopathy, Neck pain, Paraesthesia, Peripheral swelling, Pyrexia, Skin warm
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: fever 100.8 first day, swollen arm, hot arm, lymph nodes swollen under arm in armpit, neck lymp nodes under ear painful, pain in neck, hands tingling and going numb.


VAERS ID: 1849091 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 UN / IM

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

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

Write-up: 12 05 PM: PATIENT LAY DOWN ON THE FLOOR, SAY HE FEEL DIZZI. SATURATION AT 100%, bp AT 101/61,hr 61/MIN. PATIENT LAY DOWN FLAT. EMS, SITE MANAGER, AND NP PRESENT. 12 11 PM: 106/59 ,SATURATION AT 100%, HR;81/MIN. PATIENT FEEL BETTER, PARENTS STATE THAT PATIENT HAD NO BREAKFAST THIS MORNING AND WENT TO SPORT PRACTICE BEFORE VACCINE. 12 14 PM: SEAT UPWRITH, PATIENT FEEL BETTER, DISCHARGE BY NURSE PRACTITIONAR.


VAERS ID: 1849093 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Cold sweat, Dizziness, Pallor, Photosensitivity reaction
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (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: None
Current Illness: None
Preexisting Conditions: Seizure Disorder
Allergies: None
Diagnostic Lab Data: Vital signs taken at 1027 ? BP 89/59, HR 83, SpO2 95% 1033 ? BP 103/68, HR 95, SpO2 93% 1036 ? BP 105/75, HR 94 , SpO2 99%
CDC Split Type:

Write-up: At 1027 pt claimed they felt dizzy, anxious and photosensitive. Pt presented with pallor and clammy skin. Clinicians layed pt supine on a foam matt. At 1029 pt stated they were ?feeling better.? At 1033 pt say up and stated drinking water and eating snacks. At 1045 pt declines dizziness or anxiety. At 1057 pt was alert awake and ambulatory. Pt ambulated offsite with mom


VAERS ID: 1849095 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 3 RA / IM
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. 308460 / UNK RA / 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? Yes
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: UNKNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was seating in her chair after getting her vaccine and she passed out while waiting in chair and fell down on floor. She did not remember what happened to her and she was in senses after about 10 seconds. We rush to her form pharmacy to waiting area and by the time we reach to her she wan in senses. Her friend was with her who also got the same shot. I asked about her health and she said she is perfectly fine . Her communication was to the point, her vision was normal and she had no complaints of injury in her body. Then she rested in chair for little over 15 minutes and then left. I frequently checked her while waiting she she was fine. They left pharmacy after 20 minutes of waiting and she was fine when leaving the pharmacy waiting area.


VAERS ID: 1849101 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

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

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

Write-up: PT threw up after receiving Pfizer vaccine first dose and complained of feeling lightheaded. PT felt better after throwing up, provided water and crackers and legs were elevated. PT tolerated well. PT left under stable condition ambulated with his father.


VAERS ID: 1849103 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deafness, Paraesthesia, Somnolence, Unresponsive to stimuli, Vision blurred
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: PATIENT GOT VERY SLEEPY, VISION BLURRED, FELT TINGLY, COULDN''T HEAR. 911 WAS CALLED AT THIS TIME. HE THEN BECOME UNRESPONSIVE . A STERNAL STIMULATION REVIVED HIM. WE KEPT HIM AWAKE, MONITORED HIS PULSE WHILE WE WAITED FOR EMS. PATIENT BECAME MORE ALERT AND COLOR RETURNED OVER NEXT FEW MINUTES. WHEN EMS ARRIVED HE WAS COHERENT AND TALKING. PARAMEDICS TOOK VITALS AND EXAMINED HIM. HE WAS RELEASED TO GO HOME NO HOSPITAL TRIP WAS NEEDED1


VAERS ID: 1849111 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypotension, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Patient reported feeling faint after the vaccination. Patient fainted for about a minute. Her blood pressure was low for about 10 minutes. She stated she didn''t have any issues with nausea or difficulty breathing. We watched patient for about half an hour. Her blood pressure returned to normal. Patient reported she fainted sometimes with immunizations.


VAERS ID: 1849113 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / IM

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

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

Write-up: medication was given 7 hours and 3 minutes after dilution outside of the 6 hour window


VAERS ID: 1849117 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Dizziness, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid Moderna
Other Medications: ortho tricyclo
Current Illness: none
Preexisting Conditions: PCOS
Allergies: eggs, flu vaccine
Diagnostic Lab Data:
CDC Split Type: NA

Write-up: punding headache, fever, chest pain, dizziness, body and joint pains of stabbing type


VAERS ID: 1849125 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Throat irritation, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)

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

Write-up: About 15 minutes after vaccination patient stated her throat felt tight and irritated almost like something was stuck in her throat. Patient stated she could still breath normally, no facial, tongue, or throat swelling. I monitored patient for an additional 20 minutes, symptoms did not worsen and patient could still breath properly. Patient mother stated she does have a history of anxiety and could be related to anxiety. Patient was offered dose of benadryl incase of possible allergy, patient denied dose during visit and patient and her mother were counseled to monitor for any facial/tongue/throat swelling and any difficulty breathing while at home. They were advised to call emergency number/go to ER if anything were to worsen. Patient''s mom lives with her and will be monitoring throughout the night.


VAERS ID: 1849145 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-04
Onset:2021-11-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Sleep disorder, Tenderness
SMQs:, 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: mild left shoulder pain which started 12hours after jab #1
Other Medications: oral vitamin D, zinc, fish oil, co Q 10, biotin,
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: left shoulder /deltoid muscle is painful, extremely tender to touch . throbbing unable to rest against shoulder, ie in bed / wearing shirt. no erythema noted pain initiated at 24 hours after injection of JAB #2 discomfort continues despite NSAID use/ ibuprofen


VAERS ID: 1849147 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Erythema, Pain, Pruritus, Rash macular, Streptococcus test negative
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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Light congestion/stuffy nose; lingering mild cough
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Strep test negative 11/6/2021
CDC Split Type:

Write-up: Splotchy, red, hives-like rash prominent on feet, hands, knees, rear thigh/hip area. Itchy and painful. Resolved with Benadryl within 12 hours.


VAERS ID: 1849162 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-11-01
Onset:2021-11-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Unevaluable event
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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: N/A
Preexisting Conditions: OBESITY
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: PATIENT WAS HOSPITALIZED , DIDNT GET MORE INFORMATION FROM SPOUSE AS SHE WAS MAD AND ACCUSED THE PHARMACY OF GIVING A DISCONTINUED VACCINE AS SHE READ ABOUT IT FROM THE CDC WEBSITE


VAERS ID: 1849170 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3203DBD / 3 LA / IM

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

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

Write-up: Hives right bicep, hives near left armpit


VAERS ID: 1849188 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Electric shock sensation, Fatigue, Fear, Headache, Paraesthesia, Sleep disorder
SMQs:, Peripheral neuropathy (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: Emgality
Current Illness: None
Preexisting Conditions: Chronic migraine
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: ?Pins & needles?-type tingles, like very quick mini electric-y shocks as pins and needles. Mainly in fingers/hands, across chest, neck, ears. Some face and some inner thighs. Strong enough to wake me from sleep. Lasted ~4 hours and then decreased in intensity and faded off. Also had other typical side effects (fatigue, headache being the main ones), but wanted to report the tingles since they are not listed as side effects anywhere which really freaked me out.


VAERS ID: 1849189 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (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: lisinopril, metoprolol, tylenol, metformin, atorvastatin
Current Illness: no
Preexisting Conditions: hypertension, diabetes, high cholesterol
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Bell''s Palsy to left face


VAERS ID: 1849193 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Fatigue, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Body aches, fever, fatigue after first Covid shot
Other Medications: Celexa:30 mg Synthroid:75 mcg Multivitamin Vitamin C
Current Illness:
Preexisting Conditions: Hypothyroidism
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: I got my second Covid vaccine yesterday 11/5/21 around 1p.m by 2a.m i had extreme body aches, fever, chest pain, and exhaustion. I had the same symptoms for my first does 3 weeks prior.


VAERS ID: 1849200 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Vomiting projectile
SMQs:, Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Metadata
Current Illness: None
Preexisting Conditions: CHD-Truncus, ADHD and Post Pump Chorea
Allergies: Morphin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Repeat Projectile vomiting


VAERS ID: 1849201 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 2 LA / IM

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

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

Write-up: Itchy skin all over smoke raised/hives over body - appeared 12 hours after receiving 2nd dose. Has gotten more noticeable at 24 hour mark.


VAERS ID: 1849209 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Pallor, Tinnitus, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: At 2:26pm, client complained of blurred vision and buzzing in ears. Skin color pale. 2 nurses present with client. Client assisted to lie down. BP 100/68 - P 80 - R 18. Skin color improved. At 2:28pm, client''s blood pressure 112/56. Client stable. Client and client''s mom requested EMS. At 2:30pm, EMS arrived, assessed client. Client remained stable. Client and mom refused transport to hospital for further evaluation.


VAERS ID: 1849224 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-11-01
Onset:2021-11-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Condition aggravated, Hypertension
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), 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: amlodipine 5mg, prolensa 0.07% eye drops, hydrochlorothiazide 25mg, olmesartan 40mg, vitamin c, vitamin d3, aspirin 81mg
Current Illness: N/A
Preexisting Conditions: Hypertension, obesity, postsurgical DVT/PE, arthritis, degenerative disc disease
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hypertension, chest pressure


VAERS ID: 1849229 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Feeling abnormal, Headache, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: High blood pressure medication Meloxicam Various votamuns
Current Illness: None
Preexisting Conditions: Connective tissue disease
Allergies: None
Diagnostic Lab Data: I did not go to hospital
CDC Split Type:

Write-up: 102.8 fever, chills, severe body aches, joint and muscle pain, brain fog, terrible headache, fatigue, areas of previous body pain exasperated,


VAERS ID: 1849230 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-11-03
Onset:2021-11-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Flushing
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad)

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

Write-up: Patient was playing basketball morning of 11/6 and complained of chest pain. She was running a lot and flushed in the face. She asked for a sub and sat out for awhile. She said the pain was mostly gone later that day. She plays more games today so will monitor.


VAERS ID: 1849243 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Head titubation, Petit mal epilepsy, Tonic clonic movements, Trance, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Guillain-Barre syndrome (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:

Write-up: Systemic: Seizure-Mild, Additional Details: patient appeared to have absence seizure x2 with very mild tonic symptoms (head bucked once) - he was unresponsive but quickly snapped out of the "trance" after about 10 seconds - a minute later he repeated the seizure and was out after 5 seconds. Offered to contact for ambulance to sister (who was with patient) but deemed unnecessary. Patient had bottle of water and sat for about 30 minutes and was ready to leave. Contacted patient about 2 hours laters and he said that he felt fine.


VAERS ID: 1849244 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 2 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Additional Details: Vital signs were normal. Pt bp was 118/82 pulse was 64. Gave a picec of candy after vaccination and advised to wait. States she is feeling better


VAERS ID: 1849249 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 LA / IM

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

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

Write-up: Error: Wrong dose of vaccine - too high.


VAERS ID: 1849250 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 LA / IM

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

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

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


VAERS ID: 1849264 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 LA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Loss of consciousness, Syncope
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), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: I lost consciousness and collapsed for five mintues. I was sweating so much my close was covered in water.


VAERS ID: 1849267 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 LA / IM

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

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

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


VAERS ID: 1849268 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Headache, Insomnia, Vertigo
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular 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: Shingrix, received first dose 12/2020, flu like symptoms and shivers. Received second dose with no side effects
Other Medications: Telmisartin Simvastatin Multi Vitamin CoQ 10 Vitamin D
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: During the night after receiving the injection I experienced sleeplessness and a dull headache at the base of my neck. Day following injection I experienced a gradual increasing feeling of weakness and lightheadedness along with the aforementioned headache. I felt like the environment around me was spinning.


VAERS ID: 1849278 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, 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: None
Current Illness: Bruises, back pain from car accident 10/28/2021
Preexisting Conditions: Scoliosis (surgically corrected in 1995)
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Arm pain within 2 hours of dose. Extreme fatigue about 24 hours after dose was administered. Headache. 100-degree fever overnight after fatigue started.


VAERS ID: 1849282 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Headache, Malaise, 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: Moderna 1 and Moderna 2
Other Medications: Lorsartan, hydorchloriziade, pantoprazole, atorvastatin, vitamin d , calcium, multivitamin, metformin,
Current Illness:
Preexisting Conditions: High blood pressure, pre-diabetes, spasmodic dysphonia, acid reflux, arthritis
Allergies: Erythromycin, cymbalta, amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: With all three Moderna shots, I had the worst headaches of my life and violent throwing up for 12 hours. My husband had all three shots at the same time and barely felt bad. Health professionals can?t tell me if I?m allergic to a component and if it?s dangerous to get another shot. After my first one, I went to Urgent Care for a pain shot and nausea , but that only lasted a few hours and the headache was right back. After shots two and three, I took my own leftover medication. What?s a person supposed to do when they know ahead of time they are going to be so sick? What should my dr prescribe? I?m all current on my shots and only had a sore arm from the other shots.


VAERS ID: 1849284 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Similar response after covid 19 dose 2 on March 11, 2021.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After third Moderna shot (Covid 19 booster), I experienced a large, red, firm, hot raised lesion around injection site in arm. I?ve seen this referred to as ?Covid arm.?


VAERS ID: 1849287 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Feeling of body temperature change, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, aches, either I?m cold or hot


VAERS ID: 1849289 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Injection site pain, Reaction to previous exposure to any vaccine
SMQs:, Extravasation events (injections, infusions and implants) (broad), 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: After first moderne shots. Same as this time but lasted 2 days
Other Medications: Atorevastatin, zetia, losartin, Allegra, multiple vitamin, coq10, 81 aspirin
Current Illness:
Preexisting Conditions:
Allergies: Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain at shot site Extreme tiredness Slight pain in joints Headache All lasting a full day


VAERS ID: 1849292 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Same as above but exhaustion lasted longer and nausea more severe
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, fever, nausea,extreme tiredness, very sore arm


VAERS ID: 1849297 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Pain on my arm where shot was taken, chills, and headache.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pain in left arm where shot was taken. Headache and chills


VAERS ID: 1849299 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-04
Onset:2021-11-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Nodule
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: NO
Current Illness: NO
Preexisting Conditions: NO
Allergies: NO
Diagnostic Lab Data:
CDC Split Type:

Write-up: i notice a(n) knot on the left side of my neck at approximately 3:20 pm on Saturday, November 07, 2021.


VAERS ID: 1849306 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / -

Administered by: Public       Purchased by: ?
Symptoms: Chills, Headache, Musculoskeletal stiffness, Pain
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), 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: Antibiotic, multivitamin, Zyrtec, mucinex
Current Illness: Sinus infection
Preexisting Conditions: None
Allergies: Penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body aches and stiffness. Headache. Chills.


VAERS ID: 1849311 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 077C21B / UNK - / SYR

Administered by: Public       Purchased by: ?
Symptoms: Discomfort, Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin, shellfish, some tree nuts such as cashews (not almonds)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 24 hours after receiving the shot I was achy. This lasted for the afternoon and evening. I did not feel comfortable when I went to bed at midnight so I took Tylenol to treat the achiness. I was able to fall asleep and feltuch better the next morning.


VAERS ID: 1849313 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Extra dose administered, Headache, Illness, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Nausea, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna Dose #2 4/13/2021
Other Medications: Metoprolol ER 25mg
Current Illness:
Preexisting Conditions: High blood pressure/high cholesterol/obesity/pre-diabetic
Allergies: Penicillin "family"
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever/chills/headache/body aches/nausea/vomiting. Same reaction as Moderna Dose #2. Very ill. Durations of reactions 16 hours with ongoing soreness/swelling/redness at injection site following Moderna Dose #3. 10 days following Moderna Dose #2 developed COVID Arm with redness and warmth around injection site that was not bothersome.


VAERS ID: 1849319 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Eye movement disorder, Fall, Joint contracture, Laboratory test normal, Muscle rigidity, Seizure like phenomena
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Ocular motility disorders (narrow), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not on any medications
Current Illness: No medical conditions
Preexisting Conditions: None
Allergies: No allergies
Diagnostic Lab Data: EMT services came and took all vitals and labs - all WNL
CDC Split Type:

Write-up: Patient received 2nd dose and was waiting outside of the pharmacy for their 15 minutes. About 10 minutes after the vaccine was given, the patient fell over and seemed to be having a seizure (hands curled back/rigid body, eyes rolled back in head). Patient came to a few minutes later and was confused as to what had happened.


VAERS ID: 1849322 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pruritus, Injection site rash, Pain, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: Covid-19 Moderna, 4/2/2021, 5/4/2021
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, fever, fatigue, swelling, pain, rash and itching at injection site


VAERS ID: 1849323 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 320308D / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Hypoaesthesia, Injection site pain, Pain in extremity, Peripheral swelling, Tenderness
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Thyroid NP (60 mg); DIM SGS +; iodine; ADK 10; Progesterone compounded (100 mg)
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: This Pfizer shot was my booster, after receiving the Janssen vaccine in March 2021. I had no adverse reactions to Jansseen but with this booster my left underarm has swollen, it is somewhat painful (not extreme) but very tender to touch. Basically, I have a small ball under my left arm. The injection site is a little tender but the real reaction seems to be underneath the arm/armpit. My entire left arm - at times, not consistently -feels a little numb. I received the booster shot two days ago and the symptoms are still with me.


VAERS ID: 1849325 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site pain, Nausea, Pain, Respiratory tract congestion, Vaccine positive rechallenge
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Same type of reaction
Other Medications: Vibryyd, naltrexone, pristiq, bupropion, trazodone
Current Illness: None
Preexisting Conditions: Reactive airways
Allergies: Penicillin, pineapple
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, nausea, congestion, body aches, soreness at injection site


VAERS ID: 1849327 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-01
Onset:2021-11-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna
Other Medications: Climara HRT, Turmeric, Bosweilla, B Complex, Grape seed, Repatha, 7 days prior.
Current Illness: Nonexistent
Preexisting Conditions: High Cholesterol
Allergies: Sulfa, Celebrex, Statins, Sensitive to cows milk and Sour cream.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, Severe muscle, Joint Pain, Treatment; Tylenol, Mobic,


VAERS ID: 1849336 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Eye disorder, Eye pruritus, Lacrimation increased, Ocular hyperaemia, Swelling of eyelid
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Lacrimal disorders (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Right eyelid became swollen later in the day 11/6/21. Next morning worse, watery, eye itchy and red.


VAERS ID: 1849339 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 1 RA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Adhesive, sulfonamides
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red lump at injection site 1.5 inches In Diameter at time of report.


VAERS ID: 1849340 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

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

Write-up: Fatigue, fever, chills, body aches, headache. 24 hours


VAERS ID: 1849351 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-01
Onset:2021-11-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: sweet disease
Other Medications: Prp-procedure Oct.. 13 Norco Morphine Gabapentim
Current Illness: uti
Preexisting Conditions: back condition
Allergies: allergies amoxicillin bactrim ceclor cephalosporins cipro dilaudud persocet tetracycline
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Legs could support legs


VAERS ID: 1849356 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-04
Onset:2021-11-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA D32F27A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Intermenstrual bleeding, Muscle spasms
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dystonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall XR 25mg Zinc Vitamin D Vitamin C
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Menstrual Cycle is very regular after having both my children. 3 days after first dose, I have cramping and sense of heaviness in my abdomen and lower back. Currently spotting blood. Period is not due for another week. I never ?spot? and the only time I did was during and after child birth.


VAERS ID: 1849363 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling abnormal, Headache, Hunger, Injection site pain, Pyrexia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (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: Age 58, 04/05/2021, 1st Pfizer Covid-19 shot, just a little tired the next day
Other Medications: Xarelto - 20mg per day, B complex vitamin, D3 - 5000iu per day
Current Illness:
Preexisting Conditions: Obesity, Asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: When I woke up on 11/6/2021, my left upper arm where the shot was given was quite sore. I felt a little off around 10:30 am . Within about 15 minutes, I felt tired and felt the need to nap. I laid down. At about noon, I started getting chills. I slept for about an hour. When I woke up, I felt feverish. I also had a slight headache. At 2:30 pm, I took my temperature, and it was 100.9. I drank water all day (84oz), rested, and put a cold compress on my forehead around 5:00 pm. At 10:00 pm, my fever broke. I fell asleep around 11:30 pm feeling hungry, and my arm was less painful. The next morning, 11/7/2021, the arm pain and headache were gone, and I felt much better.


VAERS ID: 1849365 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Fall, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Wheat
Diagnostic Lab Data:
CDC Split Type:

Write-up: Five minutes after the vaccine was administered, my 11 year old son was walking around. Then he fainted and hit the ground hard. Then he recovered and was ok, but he was dizzy and nauseous throughout the day.


VAERS ID: 1849367 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-01
Onset:2021-11-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / -

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose fluctuation, Neuralgia, Pain, Pyrexia
SMQs:, Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Heart disease, type2 diabetes, blindness
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mild fever achiness but disabling neuropathy pain that will not subside in bilateral feet and ankles and one leg. (never had been like this before.) now going for day and a half none stop. Sugars extreme both directions with no change in diet.


VAERS ID: 1849369 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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: Wife states he "faints after shots and blood draws".
Other Medications: None disclosed
Current Illness: None disclosed
Preexisting Conditions: None disclosed
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: The patient received Pfizer vaccine as his tertiary series for COVID-19 vaccination. He arrived with his wife and two sons for vaccination. He received Moderna as the booster. He was immunized first, followed by his wife and then the two children. While the nurse was immunizing the first of the two children, she looked over and noticed he was very pale. She asked him if he was OK. He replied that he just needed "some fresh air." He got up to go outside and his wife followed him. As he exited the building, he slumped against the brick wall and slid down the wall to a sitting position. He told his wife that he felt like he "was going to faint." He did not hit his head or hurt himself in any way. Staff brought him water to drink. The nurse finished immunizing his children. After 15 minutes, he said he felt better and got up. His wife stated "he does this after every shot and blood draw." He was accompanied to his car by his wife and sons.


VAERS ID: 1849378 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA IT IS NOT ON MY / 3 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Extra dose administered, Fear, Feeling abnormal, Hallucination, Pain
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac 40mg 2 capsules every morning Wellbutrin 150mg 1 every morning Topamax 100 mg 1 tablet twice a day Ability 5mg 1 tablet once a day Adderall 20mg. 1 tablet 3 times a day Imitrex 100 mg. Take as needed Ativan 1mg. Take 1 tablet
Current Illness: A couple of weeks before I had a sinus infection. I was in good health the day of the vaccination.
Preexisting Conditions: Bi-Polar ADD
Allergies: Codeine, Penicillin
Diagnostic Lab Data: I?ve not been able to leave the house due to the circumstances surrounding the adverse reaction from the COVID Booster. There?s no way I could leave this house in the shape I?m in right now. I have work tomorrow. I have no idea what I?m going to do. Pray I gues
CDC Split Type:

Write-up: Around 7:30 Saturday evening, I began to feel very bad. My body ached, all the normal symptoms one would expect to have after a vaccination of this time. However, I started having Hallucinations, hearing people talking to me, etc. throughout Saturday night the Hallucinations began to get worse. At first, I saw people walking through the house. In the beginning would tell them to get out. But it was such a strange night. My mind felt like it was floating. I sat down mostly and children came and sat all around me. They were trying to tell me something. I didn?t listen to them. I was too scared. They didn?t hurt me. Thiese Hallucinations are still happening. I just went to try to wash a load of clothes. I bent over to swirl the bleach around in my water. Horrible things came up out of that water. I know they were not real. I?m scared. I have never had this happen to me. I need this to stop. How am I going fo work? I have kids. I have never had anything like this happen to me until I took that COVID Booster Vaccination. This is a scary situation and someone needs to fix it.


VAERS ID: 1849385 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / UNK - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Interchange of vaccine products, Mobility decreased, Pain
SMQs:, Parkinson-like events (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), 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: Sertraline 75mg qD, AuviQ pen PRN, Vitamin D3 2,000 iu once weekly, Metanx 3/90/314/35/2mg qD, Ventolin HFA PRN
Current Illness: N/A
Preexisting Conditions: Asthma, Anxiety
Allergies: Shellfish, wasps/bees, birth control
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: I had the J&J vacc the got the Pfizer booster. I noticed the injection seemed unusually high up on my arm. By 1230 my shoulder started to hurt with movement and by 2-3 PM I couldn''t lift my arm without significant pain. I iced the area for 20 minutes around 4pm. I noticed a new clicking sensation in my shoulder joint as well. I awoke this morning with the same symptoms (minor improvement, though), so I took Tylenol 650mg PO at 0930AM. If the pain does not improve I plan to see an orthopedic MD this week.


VAERS ID: 1849405 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 2 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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: Tingling and partial loss of feeling in left arm within 30 minutes of injection. Tired, severe body aches and chills within 12 hours.


VAERS ID: 1849407 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / -

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

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

Write-up: Muscle aches, headache, fatigue, chills


VAERS ID: 1849420 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site erythema, Injection site inflammation, Injection site nodule, Injection site pruritus, Injection site warmth, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vyvanse 50mg, Lo Loestrin Fe, Ibuprofen
Current Illness: None
Preexisting Conditions: Obesity
Allergies: None known
Diagnostic Lab Data: None - treating at home unless progresses/worsens.
CDC Split Type:

Write-up: Symptoms- large knot at injection site that has a red, inflamed circle (has grown from 1 inch diameter (Saturday, 11/6/21) to 3 in diameter (Sunday, 11/7/21)), that is warm to the touch and itches. Have taken ibuprofen for pain in arm (normal soreness following vaccine injections) and warm compress to reduce swelling. Headache and muscle soreness experienced on Saturday, 11/6/21, but went away with ibuprofen and rest. No fever.


VAERS ID: 1849423 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Hawaii  
Vaccinated:1959-11-05
Onset:2021-11-06
   Days after vaccination:22647
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Hypersomnia, Injection site reaction, Myalgia, Pain, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Headache, body, muscle and joint pain. Severe rash on stomach. Arm where injection site was, quivering . Fatique for 26 hours straight sleep


VAERS ID: 1849432 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chills, Disorientation, Headache, Injection site pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amphet/ dextr 10mg
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Received vaccine at 9:30 am, began exhibiting symptoms around 7 pm. Symptoms included fever (101+ for over 12 hours), chills, full body aches and pains, sharp headache, pain at injection site, disorientation. It has now been over 28 hours since receiving the vaccine and the fever, aches, and chills are persisting.


VAERS ID: 1849436 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 RA / SYR

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

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

Write-up: Chills, high fever, fatigue


VAERS ID: 1849450 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, Lymphadenopathy
SMQs:, Medication errors (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: Cymbalta 60mg, Adderall Instant Release 15mg, propranolol 20mg, L-tyrosine 500mg, ibuprofen 800mg
Current Illness: None
Preexisting Conditions: Fibromyalgia, POTS, chronic non allergic rhinitis, heart arrhythmia
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Significantly swollen lymph nodes in arm pit of right arm. Started 24 hours after receiving booster shot.


VAERS ID: 1849451 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Mental status changes, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Reports of high fever and chills as well as mental status changes within 24 hours of vaccine. Patient was administered ibuprofen at home and seemed to reduce symptoms. Today patient states she is still chilling but has improved


VAERS ID: 1849453 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood urine present, Feeling cold, Pain, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac and minipress
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: Allergies to sulfa and amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever of 100-ish, body aches, chills, blood in urine-all same day onset around 6-7:00 pm


VAERS ID: 1849477 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of personal independence in daily activities
SMQs:, Dementia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Back and knee pain due to arthritis
Allergies: Alpha gal allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: I signed up for the database and just noticed that I gave an incorrect answer to the Health Check-In. The answer should have been that I was unable to perform normal daily activities. I''m entering this here because I could find no other way to correct my response.


VAERS ID: 1849483 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None done. It is the weekend and I have not notified my Primary Care Physician yet. I plan to call Monday morning if still have these side effects.
CDC Split Type:

Write-up: Tingling in lower legs, sometimes in feet also started morning after vaccine. Periods of dizziness started 2nd day after vaccine.


VAERS ID: 1849496 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-04
Onset:2021-11-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Erythema, Extra dose administered, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Arm soreness, but not the swelling I?m experiencing with the Moderna booster
Other Medications: Levorphanol, tramadol, Arthrotec, sulfamethoxazole
Current Illness: None
Preexisting Conditions: Osteoarthritis
Allergies: Vancomycin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Quite a bit of Swelling, red skin color, itchy. Seems to worsen by the day.


VAERS ID: 1849497 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Gastrointestinal disorder, Hyperhidrosis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Fever of 101. 2 Chills Sweats Stomach


VAERS ID: 1849507 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-11-03
Onset:2021-11-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Angiogram abnormal, Coronary artery dissection, Echocardiogram normal, Ejection fraction normal, 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), Other ischaemic heart disease (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Buproprion 300 mg daily, Vitamin D 2000 daily, flonase as needed, azelastine as needed
Current Illness: None
Preexisting Conditions: Pseudotumor cerebri (2014)
Allergies: None
Diagnostic Lab Data: Angiogram showing dissection; echo showing EF of 55%, elevated hs-troponin of 1,428
CDC Split Type:

Write-up: Patient had NSTEMI secondary to spontaneous coronary artery dissection. She was managed medically.


VAERS ID: 1849510 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pallor, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient had an episode of syncope lasting approximately 10-15 seconds following administration of vaccine. Patient was seated at the time. After getting up to walk to the waiting room he vomited. Patient''s face was very pale. After waiting 15 minutes he felt well enough to leave with his parents.


VAERS ID: 1849511 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-02
Onset:2021-11-06
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Intra-aortic balloon placement, Laboratory test, Myocardial infarction, Myoclonus, Resuscitation, Stent placement, Therapeutic hypothermia, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: allopurinol, amoxicillin, apixaban, Coreg, Vitamin D3, cyanocobalamin, ferrous sulfate, gabapentin, glucosamine, Humalog, Lantus, oxycodone, potassium, Flomax, Zanaflex, Torsemide
Current Illness: Recent root canal. See chronic conditions
Preexisting Conditions: Anemia; ASVD (arteriosclerotic vascular disease); stent in 2007; Atrial fibrillation Chronic anticoag; DM type 2 (diabetes mellitus, type 2); Insulin dependent; HF (heart failure); Chronic anticoag; Hypercholesteremic; MI (myocardial infarction) Obesity; OSA (obstructive sleep apnea); Prostatic hypertrophy; S/P AVR (aortic valve replacement) bovine Oct 2010; Thrombocytopenia
Allergies: N/A
Diagnostic Lab Data: Labs drawn every 4 hours while on induced hypothermia protocol. Patient requiring vassopressor support.
CDC Split Type:

Write-up: Pt had a heart attack while at home. EMS called and patient was coded with CPR and medications. Patient went to cath lab an received a stent and IABP was placed for cardiac support. Induced hypothermia protocol was started and pt remained unresponsive with myoclonus.


VAERS ID: 1849514 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deafness, Fall, Fatigue, Hypoaesthesia, Loss of consciousness, Screaming, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: UNKOWN, PARENT DID NOT SPECIFY
Other Medications: UNKNOWN, NOT SPECIFIED BY PARENT
Current Illness: NONE REPORTED BY PARENT
Preexisting Conditions: NONE REPORTED BY PARENT
Allergies: NONE REPORTED BY PARENT
Diagnostic Lab Data: EMERGENCY SERVICE CALLED AND PT WAS HOSPITALIZED.
CDC Split Type:

Write-up: PATIENT COMPLAINED TO PARENT THAT SHE COULDN''T HEAR ANYTHING, THAT SHE COULDN''T "FEEL HER EARS" WITHIN 5 MIN AFTER BEING VACCINATED. PT SOON AFTER BECAME UNSCONSCIOUS AND FELL ON THE FLOOR. RPH WAS CALLED TO THE SITE AT THIS TIME. PT GAINED CONSCIOUSNESS ~2-5 MIN AFTER RPH WAS PRESENT. PT THEN HAD A SEIZURE THAT LASTED ABOUT 5 MIN; PT WAS SCREAMING, ASKING MOM "TO MAKE IT STOP." SHE LATER FELT BETTER BUT WAS FEELING TIRED.


VAERS ID: 1849528 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: father of patient scheduled the faxing for patient with the wrong date of birth 10/31/2008 instead 10/31/2010. Per father, he mixed up birthdates for his two sons and as a result patient was administered adult Pfizer dose of 0.3ml instead of pediatric Pfizer dose of 0.2ml. Wrong vaccine. Patient was doing good after 15 minutes of monitoring and a follow up call on 11/07/2021 with his Father.


VAERS ID: 1849536 (history)  
Form: Version 2.0  
Age: 8.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Altered state of consciousness, Cold sweat, Dizziness, Feeling hot
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient received vaccination then went to sit in chairs for 15 minutes. Several minutes later his mother stated he was feeling hot, clammy, and faint. The patient was seated but was asking to lay down. We kept him in a supported, seated position in case he vomited. His skin was cold and clammy and he was acting as if he might faint. We monitored for a few minutes and he seemed to fade in and out of consciousness. No signs of anaphylaxis were noted. I asked the mother if she wanted me to alert EMS. Store management and 911 were called. The patient was transported to the hospital.


VAERS ID: 1849543 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-04
Onset:2021-11-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Leg pain calf area starting 11-6-21, reduced leg pain 11-7-21. Leg swelling calf area starting 11-7-21


VAERS ID: 1849545 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Extra dose administered, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: penicllian
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Severe fever, chills, aches, pain, headache This was the booster. I had a one week reaction to the second vaccine in March 2021.


VAERS ID: 1849551 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformen, Atorvastan, fish oil, B12 complex, iron 40mg,
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: none
CDC Split Type: ff2593

Write-up: Swolen lip nod under left arm pit.


VAERS ID: 1849555 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

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

Write-up: Since around 6 p.m. on 11/6/21 I''ve been dealing w/ diarrhea non-stop.


VAERS ID: 1849560 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Feeling cold, Headache, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: patient''s mother called and said patient developed chills and headache within 2 hours of getting vaccine. called to check on later that night and was told temp had gone up to 103 and patient had vomited once. temp had gone down to 100 with medication


VAERS ID: 1849567 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Injection site erythema, Injection site mass, Injection site pain, Injection site pruritus, Injection site rash
SMQs:, Dementia (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: HURT GOING IN, DIDNT FEEL GOOD 30 MINUTES AFTER, HURT MORE ON 2ND DAY WITH A RED ITCHY LUMP/RASH NEAR INJECTION SITE. ITCHINESS HAS SUBSIDED BUT STILL HURTS AND TENDER TO TOUCH.


VAERS ID: 1849576 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH IK5127 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Erythema, Musculoskeletal chest pain
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: pt was diagnosed with walking pneumonia 3 weeks prior per mom
Preexisting Conditions: unknown
Allergies: Penicillin
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Mom called following morning saying pt had redness on arm and also chest pain. After further questioning, said "chest pain when pushing chest" Recommended she have him evaluated by physician/ER and also page his doctor for their opinion. Asked mom to call back with update. No update received.


VAERS ID: 1849586 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Cough, Fatigue, Headache, Pain
SMQs:, Anaphylactic reaction (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: Influenza, 5 years
Other Medications: Rosuvartin for cholesterol ; Losartan for hypertension ; 81-mg dose aspirin
Current Illness:
Preexisting Conditions:
Allergies: Sensitivity to milk products
Diagnostic Lab Data:
CDC Split Type:

Write-up: fatigue , dry cough , overall body aches , chills , headache


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