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

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



Case Details (Reverse Sorted by Onset Date)

This is page 181 out of 6,611

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VAERS ID: 1550195 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-27
Onset:2021-07-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH TW0198 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Back pain, Blister, Diarrhoea, Ear swelling, Fatigue, Headache, Hypoaesthesia, Lymphadenopathy, Malaise, Muscle twitching, Myalgia, Nausea, Pain in extremity, Pruritus, Pyrexia, Swelling, Swelling face, Swelling of eyelid, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Sexual dysfunction (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: none
Preexisting Conditions: none
Allergies: Erythromycin
Diagnostic Lab Data: office visit 8/10/2021
CDC Split Type:

Write-up: During the first 5 days after injection, had tiredness, headache, muscle pain, back ache, headache, joint pain, fever, nausea, felt unwell, swollen lymph nodes, diarrhea, arm pain. At 2pm on the 2nd day after the injection, had upper lip twitches, and right side of the face had 50% feeling. Had facial tingling, itching. This lasted 2 days, thought occasion lip twitches lasted several more days. Day 5 developed small blisters on right hand and left side of face, near the ear. This spread into more bumps, and swollen face, neck, ear (and eye lids one evening) with hives.


VAERS ID: 1554149 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Injury associated with device, Multiple use of single-use product, No adverse event, Product dose omission issue
SMQs:, Drug abuse and dependence (broad), Medication errors (narrow)

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

Write-up: On 7/29/2021 patient was suppose to receive Janssen COVID vaccine. Patient was injected with empty need of the Janssen vaccine that her husband received. Vaccine was postponed to identify signs of infection. Patient declined blood draw for her and husband for infections disease because "it is her husband". No infection or adverse reaction to needle stick. Patient was given Janssen Vaccine 8/11/2021. Has tolerated well as of this time.


VAERS ID: 1554195 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-01
Onset:2021-07-29
   Days after vaccination:119
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 LA / IM

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

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

Write-up: patient tested positive for COVID-19 after vaccination


VAERS ID: 1554502 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-05-04
Onset:2021-07-29
   Days after vaccination:86
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Blood test, Computerised tomogram, Eating disorder, Facial paralysis, Migraine, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine, Paroxetine, Veracomile
Current Illness:
Preexisting Conditions: diabetic Menara
Allergies: Sofia, antibiotics, latex, sermonize
Diagnostic Lab Data: CT scan blood work
CDC Split Type: vsafe

Write-up: I started having symptoms on July 25th. I had trouble eating and swelling. My face started to droop. I thought it was a stroke. I went to the ER. They treatment me four hours. They did a CT scan and blood test. I had migraines. I was diagnosed with Bell palsy.


VAERS ID: 1554555 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-17
Onset:2021-07-29
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL 3247 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 5318 / 2 LA / IM

Administered by: Private       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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: admitted to hospital 7/29/2021 until 8/06/2021 Then readmitted 08/09/2021. As of today 8/13, he was in rehab unit and expected to be discharged on Sunday 08/15/2021


VAERS ID: 1558053 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 LA / IM

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1558054 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 1 LA / IM

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

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1558136 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: pt''s wife called back to the pharmacy and said pt had a seizure/tremors and lasted 15 to 20 minutes. the pt had stayed in the pharmacy for 15 minutes with no issues.i asked the wife did they call 911 or go to the er. she said it stopped after about 15 minutes.


VAERS ID: 1558181 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-07-26
Onset:2021-07-29
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Antinuclear antibody positive, Blood test abnormal, Chest X-ray, Chest discomfort, Echocardiogram, Electrocardiogram, Laboratory test, Tachycardia, Troponin
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec Flonase
Current Illness: none
Preexisting Conditions: none
Allergies: penicillin
Diagnostic Lab Data: Echocardiogram, 7/29 EKG, 7/29 Chest Xray, 7/29 troponin test, 7/29 labwork 8/7 chest xray 8/8 ekg 8/8 labwork 8/8
CDC Split Type:

Write-up: Chest tightness, chest heaviness, tachycardia, sent to ER and all tests for myocarditis came back clear. Ran full panel of bloodwork including ANA and tested positive for ANA and RNP--no evidence of symptoms of autoimmune disease prior. Tachycardia is only helped by beta-blocker now and further testing must be done to check for a true positive test of the ANA/RNP.


VAERS ID: 1558401 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-18
Onset:2021-07-29
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 UN / UN

Administered by: Other       Purchased by: ?
Symptoms: Chest X-ray normal, Chest pain, Echocardiogram normal, Intensive care, Troponin
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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:
Other Medications: Weaninf off Lexapro; Cefdinir
Current Illness: Anxiety; sinusitis
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented to outside ED with left-sided chest pain since the previous day. Troponin level was 0.9 so she was admitted to ICU on 7/30/2021. ECHO and CXR were within normal limits. Cardiac MRI was ordered but cancelled due to resolution of symptoms and discharge. Patient was discharged on 8/2/2021. Second COVID vaccine was given 6 weeks prior to onset of symptoms. Patient received the Pfizer vaccine.


VAERS ID: 1559257 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-26
Onset:2021-07-29
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Muscle spasms
SMQs:, Anaphylactic reaction (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3 days after i started getting cramps in my chest. Strange pressure on occasions


VAERS ID: 1569073 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme vertigo and nausea


VAERS ID: 1569080 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-27
Onset:2021-07-29
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abortion spontaneous, Human chorionic gonadotropin decreased, Pregnancy, Ultrasound antenatal screen abnormal, Uterine dilation and curettage
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Termination of pregnancy and risk of abortion (narrow), Normal pregnancy conditions and outcomes (narrow), Fertility disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft Fish oil Prenatal Vitamin daily Vitamin B complex once weekly Vitamin D3
Current Illness: Pregnancy starting May 28, 2021 (first day last menstrual cycle)
Preexisting Conditions: Asthma Obesity
Allergies: Minocycline- hives
Diagnostic Lab Data: Intravaginal ultrasound- no fetal pulse HCG- dropping level
CDC Split Type:

Write-up: Miscarriage Treatment- D&C x2


VAERS ID: 1569086 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad)

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

Write-up: My body started to tingle and my throat started getting tight. It lasted for about 40 minutes.


VAERS ID: 1571630 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-07-29
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204B21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Chills, Feeling cold, Headache, Oropharyngeal pain, Pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210808500

Write-up: CHEST PAIN THAT HURT ALL NIGHT, ALL DAY FRIDAY AND INTO SATURDAY; SORE THROAT; BODY ACHES; CHILLS; REAL COLD ALL NIGHT; HEADACHE; This spontaneous report received from a health care professional concerned a 51 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular and batch number: 204B21A expiry: UNKNOWN) dose was not reported, administered on 29-JUL-2021 14:20 for prophylactic vaccination. No concomitant medications were reported. On 29-JUL-2021, the patient experienced chest pain that hurt all night, all day friday and into saturday. On 29-JUL-2021, the patient experienced sore throat. On 29-JUL-2021, the patient experienced body aches. On 29-JUL-2021, the patient experienced chills. On 29-JUL-2021, the patient experienced "real cold" all night. On 29-JUL-2021, the patient experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the sore throat, headache, body aches, chills, chest pain that hurt all night, all day friday and into saturday and "real cold" all night was not reported. This report was non-serious.


VAERS ID: 1574084 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-27
Onset:2021-07-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Vaginal bleeding


VAERS ID: 1574122 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-12
Onset:2021-07-29
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / SYR

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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Development of Bell''s Palsy


VAERS ID: 1574139 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Adnexa uteri pain, Arthralgia, Cough, Dizziness, Headache, Impaired work ability, Loss of personal independence in daily activities, Nausea, Pain, Syncope, Uterine pain
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: Muscle pain in the entire body, very painful to move, excruciating joint pain, dizziness and faint, nausea, pulsating headache and ovaries pain, cough. Unable to work, take care of children, and perform any daily activities. These symptoms lasted for 3 days. Currently I am feeling pain in the uterus, I need to schedule appointment to see a doctor for this.


VAERS ID: 1574165 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 1 - / -

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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: gabapentin, meclizine, diclofenac, Sprintec
Current Illness:
Preexisting Conditions: tobacco use disorder, depressions, arthritis, hyperlipidemia
Allergies: amitriptylline, penicillins, sertraline, sulfa, tetracyclines
Diagnostic Lab Data:
CDC Split Type:

Write-up: arm rash


VAERS ID: 1574168 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Private       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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No medications reported
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: NKDA
Diagnostic Lab Data: none reported
CDC Split Type:

Write-up: The patient was given the wrong dose.


VAERS ID: 1574199 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2020-12-29
Onset:2021-07-29
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hx of anorexia nervosa Anxiety
Allergies: Pollen Extracts
Diagnostic Lab Data: 08/02/21 1655 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 08/02/21 1351 | Final result | Specimen: Swab from COVID-19 SARS-CoV-2 Overall Result DetectedCritical 08/02/21 1655 COVID-19 PCR Collected: 08/02/21 1351 | Final result | Specimen: Swab from
CDC Split Type:

Write-up: Congestion or running nose


VAERS ID: 1574365 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 AR / -

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling hot, Nausea, Syncope, Tachyphrenia
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Psychosis and psychotic disorders (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? 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 1st dose Pfizer vaccine in the outpatient pharmacy by nurse. 5 min after vaccine, patient felt faint and was nauseated. Medical alert called by outpatient pharmacy. Patient laid across the bench and feet were elevated. 1st BP 11:31 was 91/45 HR 72 sat 100%. Patient was alert but stated her head felt warm. Unable to get a glucose reading. 2nd BP 1133am 94/46 HR 77 SAT 100%. Patient was sitting and stated her heart felt like it was racing. Last BP 1138am 93/66 HR 74. Patient transported via wheelchair to the ED by ED nurse. Accompanied by mother.


VAERS ID: 1574471 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-04
Onset:2021-07-29
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 2 LA / IM

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

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

Write-up: COVID-19 INFECTION


VAERS ID: 1574478 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-25
Onset:2021-07-29
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adenovirus test, Angiogram pulmonary normal, Bordetella test negative, COVID-19, COVID-19 pneumonia, Chlamydia test negative, Computerised tomogram thorax abnormal, Coronavirus test negative, Dyspnoea, Enterovirus test negative, Fibrin D dimer, Human metapneumovirus test, Human rhinovirus test, Hypoxia, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Laboratory test normal, Mycoplasma test negative, Respiratory syncytial virus test negative, Respiratory viral panel, SARS-CoV-2 test positive, Scan with contrast abnormal
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol 2.5 mg /3 mL (0.083 %) nebulizer solution albuterol HFA (PROAIR HFA) 90 mcg/actuation inhaler amLODIPine (NORVASC) 10 mg tablet carvediloL (COREG) 3.125 mg tablet cholecalciferol, vitamin D3, (VITAMIN D3 ORAL) clobetasoL (TEMOVATE
Current Illness:
Preexisting Conditions: Respiratory COPD (chronic obstructive pulmonary disease) (CMS/HCC) Pneumonia due to COVID-19 virus Hypoxia Circulatory Diastolic dysfunction Hypertension PVD (peripheral vascular disease) (CMS/HCC) Pulmonary hypertension, mild (CMS/HCC) Digestive Fatty (change of) liver, not elsewhere classified Vitamin D deficiency Benign colon polyp Genitourinary Cystocele Female stress incontinence Musculoskeletal Bone disorder Osteopenia Disc degeneration, lumbar Presence of artificial hip joint, left Presence of artificial hip joint, right Rectus diastasis Spondylolisthesis Trochanteric bursitis Impingement syndrome of right shoulder Nontraumatic incomplete tear of right rotator cuff Endocrine/Metabolic Hypercholesterolemia Type 2 diabetes mellitus (CMS/HCC) Adrenal cortical adenoma Other Depression Current every day smoker Abdominal hernia Encounter for monitoring antihypertensive use Lumbar canal stenosis Visit for screening mammogram Primary insomnia Body mass index 39.0-39.9, adult
Allergies: LisinoprilSwelling AmlodipineOther (document details in comments) HydrochlorothiazideOther (document details in comments) Oxycodone-acetaminophenNausea and Vomiting
Diagnostic Lab Data: 08/02/21 2024 Respiratory virus detection panel Collected: 08/02/21 1738 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected CT angiogram chest pulmonary embolism with and without contrast Result Date: 8/2/2021 PROCEDURE INFORMATION: Exam: CTA Chest Without And With Contrast Exam date and time: 8/2/2021 6:39 PM Age: 78 years old Clinical indication: Pain; Other: See below; Additional info: Covid positive, hypoxia, elevated ddimer TECHNIQUE: Imaging protocol: Computed tomographic angiography of the chest without and with contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. Contrast material: OMNI 350; Contrast volume: 80 ml; Contrast route: INTRAVENOUS (IV); COMPARISON: CTA CHEST W WO CONTRAST 12/4/2014 4:23 PM FINDINGS: Pulmonary arteries: Normal. No pulmonary emboli. Aorta: Unremarkable. No aortic aneurysm. No aortic dissection. Lungs: Patchy airspace consolidation in both lower lobes, more on the left. The remaining pulmonary parenchyma is clear. No other pulmonary infiltrate or consolidation. No pulmonary nodules or masses. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: Unremarkable. No cardiomegaly. No pericardial effusion. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: 1. Bibasilar pneumonia, worse on the left. 2. No evidence of pulmonary embolus. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD
CDC Split Type:

Write-up: ED to Hosp-Admission Discharged 8/2/2021 - 8/6/2021 (4 days) Hospital Hypoxia Dyspnea, unspecified type Hospital Problems POA * (Principal) Pneumonia due to COVID-19 virus Yes Diastolic dysfunction Yes Hypercholesterolemia Yes Hypertension Yes Type 2 diabetes mellitus (CMS/HCC) Yes COPD (chronic obstructive pulmonary disease) (CMS/HCC) Yes PVD (peripheral vascular disease) (CMS/HCC) Yes Hypoxia Yes


VAERS ID: 1575105 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Atrioventricular block, Chest discomfort, Dysstasia, Flushing, Pyrexia, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Conduction defects (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, pepcid, singulair, advair, sertraline, xopenex, and ketotifen
Current Illness: None known
Preexisting Conditions: Mast cell activation disorder, Pots, Ehlers- Danlos, asthma, allergies,
Allergies: Sulfa, soy, dairy, penicillin,
Diagnostic Lab Data: Fever, O2, on the nebulizer for his asthma, remained at clinic for a couple of hours (didn''t leave until 6 pm), and then went to ER following day.
CDC Split Type:

Write-up: Within just a few minutes, had chest tightness, racing heartbeat, difficulty breathing, tight throat, and getting flushed. The nurses at the clinic monitored his O2 which dropped to 95%, and these symptoms lasted for a couple of days. Also went to the ER the following day as it had evened out for a bit, then seemed to get bad again. Very scary. Got a fever too.


VAERS ID: 1577518 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-07-29
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204B214 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Decreased appetite, Fatigue, Injection site pain, Myalgia
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:
Current Illness: Abstains from alcohol; Allergy; Food allergy; Non-smoker
Preexisting Conditions: Comments: The patient had no history of drug abuse or illicit drug use and no allergy to any medication.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210828956

Write-up: LOSS OF APPETITE; SLIGHT CHILLS; TENDERNESS AT SITE OF INJECTION; FATIGUE; SEVERE MUSCLE ACHE; This spontaneous report received from a patient concerned a 38 year old female. The patient''s weight was 117 pounds, and height was 67 inches. The patient''s concurrent conditions included: non-alcohol user, non-smoker, allergy to lotion, and allergy to gum. The patient had no history of drug abuse or illicit drug use and no allergy to any medication. The patient experienced drug allergy when treated with dimeticone for drug used for unknown indication. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 204B214, and expiry: UNKNOWN) dose was not reported, administered on 29-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 29-JUL-2021, the patient experienced loss of appetite. On 29-JUL-2021, the patient experienced slight chills. On 29-JUL-2021, the patient experienced tenderness at site of injection. On 29-JUL-2021, the patient experienced fatigue. On 29-JUL-2021, the patient experienced severe muscle ache. The action taken with covid-19 vaccine was not applicable. The outcome of the tenderness at site of injection, fatigue, severe muscle ache, slight chills and loss of appetite was not reported. This report was non-serious.


VAERS ID: 1578071 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-07-25
Onset:2021-07-29
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Dermatitis, Eyelid oedema, Papule, Rash erythematous, Xerosis
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
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: Patient presented to my office on 8/2/21 with eyelid edema, no injection, xerosis and papules on bilateral arms and neck, as well as a erythematous plaque with a white scale on the base of her hairline on the back of her neck that had shown up a few days after the vaccine was administered. Both of the skin complaints resolved with Kenalog 0.1% cream but the eyelid edema still recurs occasionally with stress. It resolves with cold water and Zatador ophthalmic drops.


VAERS ID: 1578543 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-02-24
Onset:2021-07-29
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / UNK RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Full blood count, Platelet count decreased, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (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: levothyroxine, remipril, metoprolol, atorvastatin, eliquis
Current Illness: none
Preexisting Conditions: Coronary artery disease, CRF, hypothyroidism.
Allergies: Penicillin
Diagnostic Lab Data: platelets 71 on 7/29/21. confirmed on manual differential. repeat CBC pending.
CDC Split Type:

Write-up: thrombocytopenia noted on 7/20/21. No previously low platelets.


VAERS ID: 1578586 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-02
Onset:2021-07-29
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Exposure to SARS-CoV-2, SARS-CoV-2 test positive
SMQs:, Taste and smell disorders (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: multivitamin 400 mcg tablet venlafaxine XR (EFFEXOR-XR) 37.5 mg 24 hr capsule(Expired)
Current Illness:
Preexisting Conditions: Nervous Cervical radiculopathy Endocrine/Metabolic Multiple thyroid nodules Other Overweight(278.02) Macromastia Anxiety
Allergies: NKA
Diagnostic Lab Data: 08/09/21 0156 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 08/08/21 1835 | Final result | Specimen: Swab from Nares COVID-19 SARS-CoV-2 Overall Result DetectedCritical 08/09/21 0156 COVID-19 PCR Collected: 08/08/21 1835 | Final result | Specimen: Swab from Nares
CDC Split Type:

Write-up: EXPOSURE Loss of taste Loss of smell


VAERS ID: 1578641 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-27
Onset:2021-07-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Dysstasia, Pain
SMQs:, Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: Nome
Allergies: None
Diagnostic Lab Data: No r
CDC Split Type:

Write-up: Incredibly sharp pain in my lower right back - came on gradually over about 30 minutes until I couldn?t stand. Laid down on bed on my side to find relief and couldnt. Worst pain I?d experienced since shattering my elbow. Took 4 Advil and heating pad and eventually pain reduced over the next half hour.


VAERS ID: 1578941 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-27
Onset:2021-07-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fatigue, Feeling abnormal, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: none
Preexisting Conditions: none
Allergies: allergic to Oral cipro, has a rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client reports 2 days after receiving first dose of vaccine c/o fatigue, nausea, headache, mild dizziness, and "cloudy head." reports lasts off and on x19 days. Denies SOB, Chest pain, numbness or tingling, denies reduced mobility, denies rash. Client reports did not see a physician. Reports drinking water and eating helped symptoms. Client at site today for second dose, reports all symptoms resolved, no symptoms today. Sent information to team., give 2nd dose today, observe for 30 min. Educated client to f/u with is symptoms last longer than 1 week.


VAERS ID: 1582130 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-27
Onset:2021-07-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Headache, Nausea, Vision blurred
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), 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: Insulin
Current Illness: None
Preexisting Conditions: Type 1 diabetic
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Blurred darkened vision Severe headache Joint pain Nausea


VAERS ID: 1582339 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-04-15
Onset:2021-07-29
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram, Electrocardiogram, Magnetic resonance imaging, Transient ischaemic attack, Ultrasound Doppler
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: claritin, flonase, albuterol
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CT scan, MRI, EKG, Arterial Ultrasound
CDC Split Type:

Write-up: T.I.A. Admitted to hospital overnight. Released following morning.


VAERS ID: 1582575 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

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

Write-up: Heart palpitations, racing heart, pounding heart


VAERS ID: 1582584 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Numbness in left thumb and forefinger developed within 24 hours which has continued.


VAERS ID: 1582594 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-23
Onset:2021-07-29
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Migraine, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

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

Write-up: 3 days after vaccination, I experienced extreme migraine for over 36 hours. I also had numbness and tingling in my arm and face for about 20 minutes.


VAERS ID: 1582824 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-09
Onset:2021-07-29
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Nasal congestion, SARS-CoV-2 test positive, Sinusitis
SMQs:, Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin 81 mg tablet atorvastatin (LIPITOR) 20 mg tablet calcitriol (ROCALTROL) 0.25 mcg capsule cholecalciferol, vitamin D3, 1,000 unit tablet magnesium oxide (MAG-OX) 400 mg tablet mycophenolate sodium (MYFORTIC) 180 mg EC tablet omeprazo
Current Illness:
Preexisting Conditions: Nervous Acute pain of left shoulder Musculoskeletal chest pain Respiratory Pneumonia of left lower lobe due to infectious organism Digestive Diarrhea of presumed infectious origin Genitourinary Polycystic kidney disease Other Renal transplant recipient Colon cancer screening
Allergies: Iodinated Contrast Media
Diagnostic Lab Data: 08/05/21 1941 POCT COVID-19 PCR Collected: 08/05/21 1940 | Final result | Specimen: Swab from Nares POC COVID-19 PCR DetectedAbnormal Lot # 1000269759 Point of Care COVID-19 PCR Testing Method Cepheid Lot Expiration Date 05/29/2022
CDC Split Type:

Write-up: Chief Complaint Patient presents with ? Cough seen at pcp about 1 week - diagnosed with sinus infection. given amoxicillin. sxs not getting any better since. ? Fatigue ? Nasal Congestion


VAERS ID: 1583170 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Nausea
SMQs:, Acute pancreatitis (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea, ice packs, laid on a cot


VAERS ID: 1583172 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-19
Onset:2021-07-29
   Days after vaccination:101
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Diarrhoea, Exposure to SARS-CoV-2, Myalgia, Pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin 81 mg chewable tablet atorvastatin (LIPITOR) 20 mg tablet cholecalciferol, vitamin D3, 25 mcg (1,000 unit) tablet cyclobenzaprine (FLEXERIL) 5 mg tablet(Expired) omeprazole (PriLOSEC) 20 mg capsule tadalafiL (CIALIS) 5 mg tablet zin
Current Illness:
Preexisting Conditions: Nervous Myalgia Digestive Gastroesophageal reflux disease with esophagitis without hemorrhage Genitourinary Benign prostatic hyperplasia with lower urinary tract symptoms, symptom details unspecified Musculoskeletal Lateral epicondylitis Endocrine/Metabolic Hyperlipidemia Other Insomnia
Allergies: NKA
Diagnostic Lab Data: 08/05/21 2131 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 08/05/21 1052 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result DetectedCritical
CDC Split Type:

Write-up: Dx Fever Generalized Body Aches Chills Myalgia Diarrhea, unspecified type Exposure to SARS-associated coronavirus


VAERS ID: 1586675 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Arthralgia, Chest pain, Feeling abnormal, Headache, Lymphadenopathy, Migraine, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Arthritis (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: Celexa 20mg, Hydrocodone 10-325mg, multivitamin, biotin, vitamin d patch, melatonin.
Current Illness: None
Preexisting Conditions: back pain.
Allergies: Reglan and elastic.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I woke up at 2:00am the following morning after receiving the first vaccine with severe body aches, joint and muscle pain, migraine headache, fever of 100.4 and nausea with abdominal pain. By 10:00am that morning all of my lymph nodes were swollen and painful with the biggest one being under my left arm pit and was the size of a baseball. I continued to have chest pain on the left side of my chest, severe headaches, pain under my armpit and brain fog for the next 10 days before symptoms subsided.


VAERS ID: 1586808 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Flushing, Hot flush, Vaccination site reaction
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: B12 VITAMINS
Current Illness:
Preexisting Conditions:
Allergies: CATS, DUST, POLLEN ALLERGY
Diagnostic Lab Data:
CDC Split Type:

Write-up: RUSH IN VACCINATION AREA, DEVELOPING AS A CHEST RUSH, BODY HEAT FLUSH.


VAERS ID: 1586861 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Limb discomfort, Mobility decreased
SMQs:, Peripheral neuropathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

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

Write-up: PRESENTED 08/18/21 TO GET HER SECOND COVID VACCINE AND TOLD ME ABOUT HER REACTION TO FIRST. THE DAY AFTER RECEIVING HER FIRST DOSE SHE WAS RIDING A LAWN MOWER AND HER LEGS STARTED TO GO NUMB AND FEEL REALLY HEAVY. THEN WITHIN 30 MINUTES IT WAS IN HER ARMS TOO AND SHE COULD BARILY MOVE. HER HUSBAND HAD TO HELP HER INTO THE HOUSE. THEY DID NOT REPORT THE SYMPTOMS TO ANYONE. IT PROGRESSIVELY IMPROVED OVER 4 DAYS. I WAS WORRIED IT WAS GBS,


VAERS ID: 1586954 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
SMQs:, Medication errors (narrow)

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

Write-up: Female client indicated that vaccine would be her 1st dose. Requested Moderna. When clinic reviewed Client had received 3 additional doses of vaccine. Jassen on 05/21/2021, Pfizer -2 doses on 06/28/2021 and 7/16/2021. Client denied have any other vaccines when presented at the clinic. When approached regarding additional vaccines she indicated that "she wanted to be safe". Client was advised to not receive any additional vaccines. Client had changed spelling of her name on consent form.


VAERS ID: 1587060 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-01
Onset:2021-07-29
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Suspected CV19 breakthrough case,


VAERS ID: 1587295 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac flutter, Chest pain, Dizziness, Dyspnoea, Palpitations, Sensory disturbance
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Vestibular disorders (broad)

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

Write-up: She started having chest pain shortness of breath racing heart throbbing heart pinching in heart dizziness lightheaded was fluttering at times to the pain t she asked me to take her to a heart doctor


VAERS ID: 1587473 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-07-27
Onset:2021-07-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21A / 1 RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Angina pectoris, Chest discomfort, Dizziness, Dyspnoea, Headache, Myalgia, Nausea, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin D Supplement- Activated You (Herbal)
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: After receiving the first shot of the Moderna vaccine I experienced nothing more than a sore arm on the first day. The next day I developed a headache, on/off fever, and muscle aches, dizziness and slight nausea. On the third day after receiving the vaccine I started to feel a tightness in my chest, specifically on the left (heart) side of my chest. With this I also starting having tiny shooting pains on my heart side, heart palpitations and irregular breathing- as if I was short on breath. The headache lasted for two weeks, the chest pain/ tightness and palpitations still remain happening three weeks after the first shot and I still catch myself gasping for air once and a while. Before getting this vaccine I had zero health issues, no trouble breathing, no chest pain or heart palpitations. I do not take any medications and have no underlying known health issues. Now I am having trouble with my normal activities such as working out, or simple house cleaning. I feel tired, and my chest pain is constant. I am terrified that my heart is working overtime and that I may have a heart attack or a stroke because of this vaccine. * to note about taking Claritin D the day of getting the Vaccine- I have not taken it since.


VAERS ID: 1588560 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: Rash circling 5 inches in diameter below injection site. Extremely red, hot and painful to the touch. Swollen


VAERS ID: 1590887 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-27
Onset:2021-07-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202AZ1A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, Soft tissue swelling, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losarten 25 mg gabepentin 200 mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Soft tissue swelling in hands, lips, orbital area and tongue along with recurrent times over the last three weeks starting 2 days after vaccine, treated with Benadryl , cortisone cream and a metrology dose pack, this am half of my tongue is swollen with difficulty swallowing but not an emergent life threatening . My symptoms have not yet resolved and have been recurring


VAERS ID: 1590955 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Pain
SMQs:, Arthritis (broad)

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

Write-up: Joint and body aches 36 hours after injection. Lasting 18 hours.


VAERS ID: 1591420 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
SMQs:, Medication errors (narrow)

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

Write-up: PT was a new employee at Health and Rehab Center and consented to take the vaccine (Moderna). PT received Dose 1 of Moderna on 07/29/2021. Administrator was preparing for the 2nd dose to be given on 08/26/2021 when PT informed her that she already has had both doses and that she had her 1st dose at another facility. Administrator asked for her to bring in the documentation so we could properly update our records of vaccinated employees. On 08/20/2021 PT phoned Administrator and informed her that on 07/07/2021 she received the Johnson/Johnson vaccine, she thought she had received the Moderna. At this time PT has not had any specific reaction from receiving 2 different vaccines. With the new guideline for boosters we do not know where she will stand.


VAERS ID: 1591650 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Chest discomfort, Chest pain, Laboratory test normal, Tunnel vision
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal disorders (narrow)

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

Write-up: 3-5 minutes after vaccination patient returned to the front counter requesting to have his blood pressure taken. He was taken back into the vaccine room and given water. I checked his blood pressure using the manual cuff and got ~170/100. He stated he had initially had some chest pain/pressure and was having some tunnel vision while in the waiting area. The emergency response team was called at this point. I remained in the room with patient and discussed any blood pressure medications he was taking. He was calm and stated his symptoms were improving while the emergency response team was on the way. He stood up once while waiting wanting. After standing he reported no dizziness or lightheadedness. We discussed any history of this type of reaction to any other vaccine and he denied any similar history during vaccinations. He reported he had a similar event when given pain meds for a procedure, but could not remember specifically what he was given. After 5-6 minutes from calling out for the response team they arrived and began to further assist patient with his symptoms. He was admitted to the emergency room for a cardiac workup which was unremarkable and resulted in discharge shortly after.


VAERS ID: 1591715 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-01
Onset:2021-07-29
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anti-thyroid antibody, Antibody test normal, Anxiety, Blood magnesium normal, Depressed mood, Depression, Epistaxis, Full blood count normal, Headache, Insomnia, Metabolic function test, Metabolic function test normal, Thyroid function test normal, Tri-iodothyronine free normal, Vitamin D
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hypothyroidism (broad), Hyperthyroidism (broad), Depression (excl suicide and self injury) (narrow), Hypoglycaemia (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: Fish Oil, Daily vitamin, B complex
Current Illness: Pre-diabetes (A1C: 6)
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CBC, CMP, nutrient levels to rule out magnesium, Vitamin B, vitamin D deficiencies. Thyroid testing, including Free T3 and Thyroid antibodies. All normal.
CDC Split Type:

Write-up: On day 3 after injection began to have difficulty sleeping. On day 4, he very suddenly began to have feelings of deep sadness, depression, inability to feel joy, severe headaches, nosebleeds, continued difficulty sleeping. Frequently described by patient as "mental anguish". This lasted for 4 days before began to slowly improve. Three weeks out, the patient has days that are without symptoms and days with symptoms, but nothing like the initial 4 day of max symptoms. No other precipitating factors.


VAERS ID: 1591842 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abnormal behaviour, Alanine aminotransferase normal, Albumin globulin ratio normal, Albumin urine absent, Ammonia normal, Analgesic drug level, Analgesic drug level therapeutic, Anion gap normal, Antidepressant drug level, Aspartate aminotransferase normal, Bacterial test negative, Basophil count increased, Basophil percentage increased, Benzodiazepine drug level, Bilirubin urine, Blood albumin normal, Blood alcohol normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium normal, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood lactic acid normal, Blood magnesium normal, Blood pH normal, Blood potassium normal, Blood sodium normal, Blood thyroid stimulating hormone normal, Blood urea normal, Blood urine absent, C-reactive protein normal, Carbon dioxide normal, Chest pain, Chromaturia, Computerised tomogram head, Computerised tomogram neck, Computerised tomogram normal, Drug screen negative, Electrocardiogram normal, Eosinophil count normal, Eosinophil percentage increased, Globulin, Glomerular filtration rate, Glucose urine absent, Granulocyte count, Haematocrit normal, Haemoglobin normal, Headache, Lymphocyte count, Lymphocyte percentage, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume normal, Memory impairment, Monocyte count, Monocyte percentage increased, Neutrophil percentage decreased, Nitrite urine absent, Opiates negative, PCO2 normal, PO2 increased, Pain, Platelet count normal, Pregnancy test urine negative, Protein total normal, Red blood cell count normal, Red blood cell sedimentation rate normal, Red blood cells urine, Red cell distribution width normal, SARS-CoV-2 test negative, Specific gravity urine normal, Troponin I normal, Unresponsive to stimuli, Urinary casts, Urinary sediment present, Urine alcohol test negative, Urine amphetamine negative, Urine ketone body absent, Urine leukocyte esterase, Urobilinogen urine, Venous oxygen saturation increased, White blood cell count normal, White blood cells urine negative, pH urine normal
SMQs:, Rhabdomyolysis/myopathy (broad), Agranulocytosis (broad), Haematopoietic leukopenia (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Fish oil 1200, Vitamin B complex, hydroxychloroquine 200mg, vitamin D
Current Illness: NONE
Preexisting Conditions: Lupus
Allergies: Shellfish, penicillins, and sulfa antibiotics
Diagnostic Lab Data: Admission on 07/30/2021, Discharged on 07/31/2021 Component Date Value Ref Range Status ? White Blood Cells 07/30/2021 6.47 3.8 - 10.8 K/uL Final ? Red Blood Cells 07/30/2021 4.68 3.90 - 5.11 M/uL Final ? Hemoglobin 07/30/2021 14.5 11.7 - 15.7 g/dL Final ? Hematocrit 07/30/2021 43.7 35.1 - 45.6 % Final ? MCV 07/30/2021 93.4 80 - 97 fL Final ? MCH 07/30/2021 31.0 26.4 - 33.0 pg Final ? MCHC 07/30/2021 33.2 31.8 - 35.3 g/dL Final ? RDW 07/30/2021 13.3 11.2 - 15.6 % Final ? Platelet Count 07/30/2021 204 140 - 390 K/uL Final ? MPV 07/30/2021 10.7 8.6 - 11.9 fL Final ? Neutrophil % 07/30/2021 52.5 % Final ? Lymphocyte % 07/30/2021 30.4 % Final ? Monocyte % 07/30/2021 10.7 % Final ? Eosinophil % 07/30/2021 4.6 % Final ? Basophil % 07/30/2021 1.2 % Final ? Immature Granulocyte % 07/30/2021 0.6 % Final ? Absolute Neutrophils 07/30/2021 3.39 1.8 - 7.1 K/uL Final ? Absolute Lymphocytes 07/30/2021 1.97 0.9 - 3.5 K/uL Final ? Absolute Monocytes 07/30/2021 0.69 0.2 - 0.9 K/uL Final ? Absolute Eosinophils 07/30/2021 0.30 0.0 - 0.5 K/uL Final ? Absolute Basophils 07/30/2021 0.08 0.0 - 0.2 K/uL Final ? Absolute Immature Granulocyte 07/30/2021 0.04 K/uL Final ? Sodium 07/30/2021 140 136 - 145 mEq/L Final ? Potassium 07/30/2021 3.8 3.5 - 5.3 mEq/L Final ? Chloride 07/30/2021 107 100 - 108 mEq/L Final ? Carbon Dioxide 07/30/2021 23 22 - 30 mEq/L Final ? Anion Gap 07/30/2021 10 10.0 - 20.0 mEq/L Final ? BUN 07/30/2021 13 7.0 - 19.0 mg/dL Final ? Creatinine 07/30/2021 0.91 0.60 - 1.00 mg/dL Final ? Glomerular Filt Rate 07/30/2021 70 $g60 mL/min Final CKD-EPI calculation used. For African Americans multiply result by 1.159. ? Glucose 07/30/2021 105 60 - 125 mg/dL Final ? Albumin 07/30/2021 4.0 3.4 - 5.0 g/dL Final ? Calcium 07/30/2021 9.1 8.3 - 10.3 mg/dL Final ? AST 07/30/2021 31 10 - 34 IU/L Final ? ALT 07/30/2021 21 10 - 44 IU/L Final ? Alkaline Phosphatase 07/30/2021 79 32 - 122 IU/L Final ? Bilirubin, Total 07/30/2021 0.4 0.3 - 1.5 mg/dL Final ? Total Protein 07/30/2021 7.1 6.0 - 8.2 g/dL Final ? Globulin 07/30/2021 3.1 1.8 - 3.7 g/dL Final ? A:G Ratio 07/30/2021 1.3 1.2 - 2.7 Final ? Troponin 07/30/2021 <0.01 0.0 - 1.0 ng/mL Final Troponin I method ? Lactate 07/30/2021 1.3 0.5 - 1.9 mmol/L Final ? Magnesium 07/30/2021 2.2 1.8 - 2.4 mg/dL Final ? Alcohol 07/30/2021 <10* 10 - 300 mg/dL Final Comment: (NOTE) To convert mg/dL to BAC, divide result by 1000. ? CK 07/30/2021 160 21 - 215 IU/L Final ? Source 07/30/2021 URINE Final ? Color, Urine 07/30/2021 Light Yellow Final ? Appearance, Urine 07/30/2021 Clear Final ? Glucose, Urine 07/30/2021 Negative NEG Final ? Bilirubin, Urine 07/30/2021 Negative NEG Final ? Acetone, Urine 07/30/2021 Negative NEG Final ? Specific Gravity, Urine 07/30/2021 1.010 1.003 - 1.035 Final ? Occult Blood, Urine 07/30/2021 Negative NEG Final ? pH, Urine 07/30/2021 6.5 4.6 - 8.0 Final ? Albumin, Urine 07/30/2021 Negative NEG Final ? Urobilinogen, Urine 07/30/2021 Normal NORM Final ? Nitrite, Urine 07/30/2021 Negative NEG Final ? Leukocyte Esterase, Urine 07/30/2021 Negative NEG Final ? Reflex Request 07/30/2021 No culture per provider criteria Corrected ? Squamous Epithelial Cells, Urine 07/30/2021 0.648 0 - 10 /hpf Final ? Casts, Hyaline 07/30/2021 0 0 - 6 /lpf Final ? Bacteria 07/30/2021 Negative NEG Final ? Red Blood Cells, Urine 07/30/2021 1 0 - 2 /hpf Final ? White Blood Cells, Urine 07/30/2021 0 0 - 2 /hpf Final ? Cannabinoids, Urine 07/30/2021 Negative NEG Final ? Phencyclidine, Urine 07/30/2021 Negative NEG Final ? Cocaine, Urine 07/30/2021 Negative NEG Final ? Methamphetamines, Urine 07/30/2021 Negative NEG Final ? Opiates, Urine 07/30/2021 Negative NEG Final ? Amphetamines, Urine 07/30/2021 Negative NEG Final ? Benzodiazepines, Urine 07/30/2021 Negative NEG Final ? Tricyclics, Urine 07/30/2021 Negative NEG Final ? Methadone, Urine 07/30/2021 Negative NEG Final ? Barbiturates, Urine 07/30/2021 Negative NEG Final ? Oxycodone, Urine 07/30/2021 Negative NEG Final ? Propoxyphene, Urine 07/30/2021 Negative NEG Final ? Buprenorphine, Urine 07/30/2021 Negative NEG Final ? Comment, Drug Screen 07/30/2021 Final Value:SEE NOTE (NOTE) Cutoff concentrations, ng/mL: Cannibinoids................ 50 Phencyclidine............... 25 Cocaine..................... 150 Methamphetamines............ 500 Opiates..................... 100 Amphetamines................ 500 Benzodiazepines............. 150 Tricyclic Antidepressants... 300 Methadone................... 200 Barbiturates................ 200 Oxycodone................... 100 Propoxyphene................ 300 Buprenorphine............... 10 These are screening methods. All results should be used for medical purposes only. Further confirmatory testing recommended for any positive screening result. ? Pregnancy, Qualitative Urine 07/30/2021 Negative NEG Final Comment: Very dilute urine specimens can lead to false negative BhCG results. If pregnancy is still suspected, consider ordering a serum BhCG. ? Ventricular Rate 07/30/2021 90 BPM Final ? Atrial Rate 07/30/2021 90 BPM Final ? P-R Interval 07/30/2021 138 ms Final ? QRS Duration 07/30/2021 68 ms Final ? Q-T Interval 07/30/2021 356 ms Final ? QTC Calculation(Bezet) 07/30/2021 435 ms Final ? Calculated P Axis 07/30/2021 64 degrees Final ? Calculated R Axis 07/30/2021 69 degrees Final ? Calculated T Axis 07/30/2021 71 degrees Final ? Diagnosis 07/30/2021 Final Value:Normal sinus rhythm Normal ECG No previous ECGs available ? Ammonia 07/30/2021 25 10 - 50 umol/L Final ? Salicylate 07/30/2021 <5* 5 - 20 mg/dL Final ? TSH 07/30/2021 1.07 0.35 - 5.50 uIU/mL Final ? Acetaminophen 07/30/2021 <1* 1 - 30 ug/mL Final ? pH 07/30/2021 7.36 7.31 - 7.41 Final ? PCO2, Venous 07/30/2021 46 45 - 55 mm Hg Final ? PO2, Venous 07/30/2021 65* 30 - 50 mm Hg Final ? Saturation, Venous 07/30/2021 91* 60 - 80 % Final ? Specimen type 07/30/2021 Venous Final ? Erythrocyte Sedimentation Rate (ES* 07/30/2021 4 0 - 20 mm/Hr Final ? C Reactive Protein, Quantitative 07/30/2021 0.02 0.0 - 0.50 mg/dL Final ? SARS-CoV-2 Source 07/30/2021 NASAL Final ? SARS-CoV-2 by PCR 07/30/2021 Not detected NOTD Final Comment: The SARS-CoV-2 test on the GeneXpert is intended for the qualitative detection of SARS-CoV-2 nucleic acid. This assay has EUA from the FDA for nasopharyngeal, nasal, and mid-turbinate swab and nasal wash/aspirate specimens from individuals suspected of COVID-19 by their healthcare provider. The SARS-CoV-2 Letter of Authorization, Fact Sheet for Healthcare Providers, and Fact Sheet for Patients can be found at: ? Troponin 07/30/2021 0.01 0.0 - 1.0 ng/mL Final Troponin I method ? White Blood Cells 07/31/2021 5.78 3.8 - 10.8 K/uL Final ? Red Blood Cells 07/31/2021 4.79 3.90 - 5.11 M/uL Final ? Hemoglobin 07/31/2021 14.7 11.7 - 15.7 g/dL Final ? Hematocrit 07/31/2021 44.8 35.1 - 45.6 % Final ? MCV 07/31/2021 93.5 80 - 97 fL Final ? MCH 07/31/2021 30.7 26.4 - 33.0 pg Final ? MCHC 07/31/2021 32.8 31.8 - 35.3 g/dL Final ? RDW 07/31/2021 13.2 11.2 - 15.6 % Final ? Platelet Count 07/31/2021 208 140 - 390 K/uL Final ? MPV 07/31/2021 11.0 8.6 - 11.9 fL Final ? Sodium 07/31/2021 141 136 - 145 mEq/L Final ? Potassium 07/31/2021 4.3 3.5 - 5.3 mEq/L Final ? Chloride 07/31/2021 109* 100 - 108 mEq/L Final ? Carbon Dioxide 07/31/2021 23 22 - 30 mEq/L Final ? Anion Gap 07/31/2021 9* 10.0 - 20.0 mEq/L Final ? BUN 07/31/2021 12 7.0 - 19.0 mg/dL Final ? Creatinine 07/31/2021 0.77 0.60 - 1.00 mg/dL Final ? Glomerular Filt Rate 07/31/2021 85 $g60 mL/min Final CKD-EPI calculation used. For African Americans multiply result by 1.159. ? Glucose 07/31/2021 141* 60 - 125 mg/dL Final ? Calcium 07/31/2021 8.8 8.3 - 10.3 mg/dL Final ? Glucose 07/31/2021 131* 70 - 100 mg/dL Final ? Glucose 07/30/2021 93 70 - 100 mg/dL Final CT scan of the head as well as CT of the head neck were completed which were negative. 7/29/2021
CDC Split Type:

Write-up: Severe headache, body aches, and some chest pain that afternoon of 7/29 after COVID vaccine. Pt took medication for headaches and had no relieve. The next morning went to her daughters whom she was to babysit and was acting funny. Per ER report patient can''t recall much of that day but her daughter reports finding patient on the floor . Patient was brought to ER and does not recall much of the ER visit until she was being admitted to the floor for overnight observation. CT and lab work was ran which was unremarkable.


VAERS ID: 1591869 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

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

Write-up: Patient experienced rash on lower arm (opposite arm from vaccinated arm) a couple hours post vaccination.


VAERS ID: 1591899 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 RA / IM

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

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

Write-up: This patient received her first dose of the Pfizer COVID vaccination on 7/29/21. She had already received a dose of the J&J vaccination and receiving the Pfizer vaccination series after the J&J vaccine has not yet been shown to be safe and effective. When patient attempted to get the 2nd dose of the Pfizer series the state registry was checked and patient was counseled that she cannot get the 2nd dose of Pfizer.


VAERS ID: 1591908 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / UNK - / SYR

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Loss of consciousness, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: While waiting in the post-vaccination observation area, patient reported feeling nauseous and briefly lost consciousness shortly thereafter. A Health Department Nurse caught the patient, safely lowered her to the ground, and raised the patient''s legs. The patient quickly regained consciousness and was given a cold compress, water, and crackers while an ambulance was called. Her BP was taken as 118/85 approximately two minutes after the syncopal episode. The patient stood up briefly to then lay on the stretcher once the ambulance arrived, at which point the EMS performed their own evaluation. The patient was not transported to the hospital and was instead driven home by another individual. 8/20/21


VAERS ID: 1591973 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-03
Onset:2021-07-29
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PAA 156051 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PAA 156051 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Altered state of consciousness, Chest X-ray abnormal, Dyspnoea, Fatigue, Lung infiltration, Pneumonia, SARS-CoV-2 test positive, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: T2DM, HTN, Dizziness, meningioma, CKD Stage 3a
Allergies: NKDA
Diagnostic Lab Data: SARS CoV 2 PCR COVID-19 Positive 7/29/2021 SARS CoV 2 PCR COVID-19 Negative 8/10/2021 SARS CoV 2 PCR COVID-19 Positive 8/14/2021
CDC Split Type:

Write-up: 7/29/2021: Pt found unresponsive by a relative at home and her blood sugar was around 30s. She was taken by EMS and D10W given during transfer to ED. Pt returned to her baseline of consciousness but was noted to have low O2 Sat% in her vitals signs with 87% at RA. Pt was feeling dyspneic and fatigued recently, when asked. Pt received Pfizer COVID vaccine, last dose Feb 2021. She was taking Pioglitazone for management of T2DM. Chest x ray was done because the low O2Sat% and showing Bilateral perihilar infiltrates which could represent multifocal pneumonia in the appropriate setting. 8/17/2021: Patient still admitted at time of this report submission


VAERS ID: 1592007 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA4784 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disturbance in attention, Eye swelling, Feeling abnormal, Headache, Lip swelling, Swollen tongue, Vision blurred, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: Autoimmune occasional swelling usually facial and feet history of symptomatic PVCs
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 12:15 the next afternoon, I got visual blurring, difficulty with mental clarity and focus, and then developed a severe headache. At about 3:00 I vomited 4 times while at work! The rest of the evening, I had a bad headache and mental fog. The nest day my left eye and right lower lip were swollen. I don''t know if this is related but 4 days later, my tongue was swollen.


VAERS ID: 1592034 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris
SMQs:, 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? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heart pain


VAERS ID: 1592578 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? 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: Took Blood Pressure at home to for 2 days
CDC Split Type:

Write-up: SEVERE Tachycardia lasting for a sold 30 minutes before subsiding that randomly for the next 36 hours before completely being resolved. Almost went to ER for further evaluation, would have if symptoms didn''t improve at 48 hours. Called a doctor which stated to take Benadryl for possible allergic reaction which helped along with monitoring Blood Pressure, also took Ibuprofen and Tylenol to help with discomfort and inflammation.


VAERS ID: 1594423 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-07-29
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802072 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Atrial fibrillation, Blood test, Chest X-ray, Echocardiogram, Electrocardiogram, Venogram
SMQs:, Supraventricular tachyarrhythmias (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Obesity
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210729; Test Name: Echocardiogram; Result Unstructured Data: Normal; Test Date: 20210729; Test Name: EKG; Result Unstructured Data: Atrial Fibrillation; Test Date: 20210729; Test Name: Chest X-ray; Result Unstructured Data: Normal; Test Date: 20210729; Test Name: Blood test; Result Unstructured Data: Normal; Test Date: 20210729; Test Name: Venogram; Result Unstructured Data: Normal.
CDC Split Type: USJNJFOC20210835730

Write-up: ASYMPTOMATIC ATRIAL FIBRILLATION; This spontaneous report received from a consumer concerned a 57 year old white, not Hispanic or Latino male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: obesity. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 1802072 and expiry: UNKNOWN) dose was not reported, frequency one total, administered on 11-MAR-2021 on left deltoid for prophylactic vaccination. No concomitant medications were reported. On 29-JUL-2021, the patient went for a well check up and the EKG (Electrocardiography) showed atrial fibrillation, the patient visited to emergency room, as the patient experienced asymptomatic atrial fibrillation, was hospitalized and treated with some type of medication (beta blocker) and was fine. Laboratory data included: Blood test (NR: not provided) Normal, Chest X-ray (NR: not provided) Normal, EKG (Electrocardiography) (NR: not provided) Atrial Fibrillation, Echocardiogram (NR: not provided) Normal, and Venogram (NR: not provided) Normal. The number of days hospitalized was not reported. Patient was on medication to keep to his heart in check and had an appointment on the 2nd week of September with the cardiologist. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from asymptomatic atrial fibrillation. This report was serious (Hospitalization Caused / Prolonged).; Sender''s Comments: V0: 20210835730-Covid-19 vaccine ad26.cov2.s-asymptomatic atrial fibrillation. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


VAERS ID: 1594453 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-07-29
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Feeling cold, Headache, Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210837611

Write-up: BODY IN PAINING; I FEEL COLD; HEADACHE; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported) dose was not reported, administered on 29-JUL-2021 for prophylactic vaccination. The batch number was not reported. Per procedure no follow-up will be requested for this case. No concomitant medications were reported. On 29-JUL-2021, the patient experienced body in paining. On 29-JUL-2021, the patient experienced I feel cold. On 29-JUL-2021, the patient experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the headache, I feel cold and body in paining was not reported. This report was non-serious.


VAERS ID: 1602755 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Influenza like illness, Injection site pain
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:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: After the first couple hours I received pain in my left arm near the injection site throughout my entire shoulder. The next day I was exhausted I felt like I had the flu. This lasted for 3 days. I just took Tylenol and rested.


VAERS ID: 1602778 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-26
Onset:2021-07-29
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Infection, Injection site hypoaesthesia, Vaginal haemorrhage
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Guillain-Barre 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: NuvaRing
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm was numb from shot site down, Vaginal bleeding which occurred from July 29, 2021 to August 18, 2021, piercings not healed all the way got infected


VAERS ID: 1617495 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-25
Onset:2021-07-29
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011DZIA / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blister, Pruritus, Scratch
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Accidents and injuries (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamin, Vitamin D, Mega Red Krill Oil (Omega-3), Vitamin C with Zinc, Collagen with Peptides
Current Illness: None.
Preexisting Conditions: Osteoarthritis in finger knuckles
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Blisters formed on skin on the right side trapezius area. Blisters were itchy and broke open when scratched to release clear fluid. Patch of blisters was about 4 inches wide/long and lasted about 5 days before drying/clearing up.


VAERS ID: 1617608 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Discomfort, Dizziness, Dysgeusia, Feeling abnormal, Sensation of foreign body, Swollen tongue, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid 175 mcg 1 in morning Losartan/HCT 50-12.5 mg 1 in the morning
Current Illness: None
Preexisting Conditions: Hypothyroid Hypertension
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had Moderna on 7/29/21 at 2:30 PM. 6:30 PM at home in a chair, had a very sudden, strong metallic taste in mouth. 5 minutes later head felt light and huge, and felt like it was floating away from body. 5 minutes later throat became very tight and felt as though there was a golf ball size lump in my throat toward the bottom of the neck, where it needs the clavicle. I took one tablet Benadryl 25 mg and waited. Within a few minutes my tongue became swollen and heavy, so I took another Benadryl. Nothing happened and throat felt tighter, started considering a fast trip to Emergency Department. Took a THIRD 25 mg Benadryl tablet and one 200 mg Tagamet at same time. Started to feel that throat was not as tight and tongue was getting smaller shortly thereafter. I have never had an allergic reaction and this was truly frightening.


VAERS ID: 1618496 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-22
Onset:2021-07-29
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (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: daily vitamins
Current Illness:
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Per client 1 week after receiving Pfizer Covid vaccine (lot# EW0191), had one episode of palpitations. Client denied shortness of breath or chest pain at this time. Client reported palpitations lasting seconds and resolved on its own. Per Mother did not give medication or consult with medical provider. Per Mother no medical history, current medication is daily vitamin and no known allergies.


VAERS ID: 1618513 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-07-25
Onset:2021-07-29
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash, Rash erythematous
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: unknown childhood vaccination caused fever, age and date unknown
Other Medications: Levothyroxine, HCTZ, Baby Aspirin, Vitamin C, Vitamin D, Zinc
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Strawberry rash under breast, no symptoms, localized, not diffuse. Almost gone after 24 days.


VAERS ID: 1623260 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-01
Onset:2021-07-29
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Ageusia, Anosmia, Chest X-ray normal, Cough, Fatigue, Nausea, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: I was taking Synthroid, Simvastatin and Levothyroxine.
Current Illness: I was not experiencing any illness.
Preexisting Conditions: I have a hypothyroid and high cholesterol.
Allergies: I am allergic to demerol.
Diagnostic Lab Data: I was tested for COVID twice and both times the results came back negative. I also had a chest x-ray which came back negative for pneumonia.
CDC Split Type: vsafe

Write-up: I started to feel fatigue, a fever, very sore throat, severe hacking cough, nausea and lack of taste and smell. I went to two urgent cares and I was tested for COVID both times and the results were negative. After going to the first urgent care, I was given a steroid shot and cough syrup. I did not feel any better. At the second urgent care, I went 7 days later, I had a chest x-ray which came back negative for pneumonia. I was given a Z-pack and that a medicine to control my cough. Both prescriptions ran out before I started to feel any better. It took 16 days for me to start feeling better. I still cannot taste anything and my sense of smell is still off, but all other symptoms have gone away.


VAERS ID: 1623284 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Expired product administered, No adverse event
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: The patient MAY have received a dose of Janssen vaccine that was administered after the Beyond Use Date. The provider may have given the dose outside of the 6 hour window after the vial was opened. No symptoms or signs. Pt will be contacted and offered to be re-vaccinated to offer full protection, per our Medical Group.


VAERS ID: 1623662 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: zinc, C, D, magnesium, iron, probiotics
Current Illness: none
Preexisting Conditions: acne
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: I experienced light-headedness only *when seated* - This effect went away when standing and lasted only the morning.


VAERS ID: 1624237 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-24
Onset:2021-07-29
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Akinesia, Aortic valve calcification, Aortic valve stenosis, Aortic valve thickening, Arteriogram coronary normal, Arteriosclerosis, Arthralgia, Cardiac ventriculogram abnormal, Catheterisation cardiac abnormal, Chest discomfort, Condition aggravated, Coronary artery disease, Coronary artery occlusion, Diastolic dysfunction, Echocardiogram abnormal, Ejection fraction normal, Electrocardiogram low voltage, Hypokinesia, Left ventricular dysfunction, Left ventricular hypertrophy, Myocardial bridging, Peak expiratory flow rate, Pericardial effusion, Pericarditis, Sigmoid-shaped ventricular septum, Sinus rhythm, Throat tightness, Troponin I increased, Wall motion score index abnormal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Congenital, familial and genetic disorders (narrow), Embolic and thrombotic events, arterial (narrow), Parkinson-like events (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: Shingirx- ocular migraine 5/23/2019 -GlaxoSmithKline - NE3TG, 11/16/2018 GlaxoSmithKline 49R72
Other Medications: ? Levothyroxine (LEVOTHROID/SYNTHROID) 50 mcg Oral Tab Take 1 tablet by mouth daily on an empty stomach to replace thyroid medicine in hypothyroidism ? Ketotifen (ALAWAY) 0.025 % (0.035 %) Opht Drop Instill 1 Drop in both eyes 2 times a day
Current Illness:
Preexisting Conditions: HYPOTHYROIDISM HYPERLIPIDEMIA HTN (HYPERTENSION) CARPAL TUNNEL SYNDROME. METATARSALGIA. HX OF TOTAL HIP ARTHROPLASTY. DERANGEMENT OF MEDIAL MENISCUS OF KNEE. PERSONAL HISTORY CARPAL TUNNEL RELEASE. DJD/OSTEO, FOOT/ANKLE.. MITRAL VALVE REGURGITATION HX OF BILAT SALPINGO OOPHORECTOMY HX OF TOTAL HYSTERECTOMY OSTEOARTHRITIS OF HAND. OVERWEIGHT SCREENING FOR COLON CANCER HX OF COLONOSCOPY DEQUERVAINS TENOSYNOVITIS MAJOR DEPRESSIVE DISORDER, RECURRENT EPISODE, IN FULL REMISSION SPINAL STENOSIS OF LUMBAR SPINE W NEUROGENIC CLAUDICATION SENILE PURPURA SPINAL STENOSIS OF LUMBAR SPINE HX OF RIGHT TOTAL HIP ARTHROPLASTY OPHTHALMIC MIGRAINE MENINGIOMA, BRAIN AGE-RELATED ATROPHY OF BRAIN CEREBRAL ATHEROSCLEROSIS ATHEROSCLEROSIS OF AORTA HX OF ACTINIC KERATOSIS CHRONIC LOW BACK PAIN LEFT ARM LYMPHEDEMA LEFT LEG LYMPHEDEMA
Allergies: Amlodipine 6/22/2018 Colchicine suspected in Rash Full body blanching maculopapular rash. Darvocet A500 [Acetaminophen + Propoxyphene Napsylate Itching. Hydrochlorothiazide Dizzy, Hyponatremia Hyponatremia, dizzy at 12.5 mg/day Penicillins Class - rash Vicodin [Hydrocodone-acetaminophen] Nausea/Vomiting Egg Yolk Diarrhea Stomach pain Shingrix (pf) [Varicella-zoster Ge-as01b (pf)] - ocular migraine
Diagnostic Lab Data: EKG Impression Sinus rhythm Low voltage, extremity and precordial leads 7/29/2021 2:30 pm TROPONIN I 0.84 7/29/2021 4:10 pm TROPONIN I 1.03 7/29/2021 10:20 pm TROPONIN I 0.53 7/30/2021: cardiac catheterization Procedure Summary Mild coronary artery disease involving mid RCA Mild bridging of the mid LAD Segmental wall motion abnormality of the mid-septum, findings do not correspond with the coronary anatomy Recommendations Secondary prevention for CAD Reassess LV function following a few months of therapy Dual antiplatelet therapy for 6-12 months given ACS Angiographic Findings Dominance: Right Coronary Angiography LMCA: Normal (no stenosis %). LAD: No obstructive coronary artery disease. Very tortuous. Midvessel with mild myocardial bridging. Large LAD D1 branch with 2 terminal subbranches. LCx: No obstructive coronary artery disease. Nondominant vessel. Large OM 1 branch. Small tortuous OM 2 and OM 3 branches RCA: Atherosclerotic midvessel with 20% narrowing. Large PDA, small terminal PL branch Ramus: No obstructive coronary artery disease. Medium sized branch Ventriculography Ventriculography Findings Performed in biplane views. Overall EF estimated at 60%. Hypokinesis of a medium sized segment of the septum. Also noted on echocardiogram. LV function assessed as: Abnormal. Ejection Fraction - Method: LV gram estimated. EF: 65 % Echocardiogram 7/30/2021: Technically difficult study due to poor acoustic windows and/or the patient''s body habitus. 1. Normal left ventricular size. Mild concentric left ventricular hypertrophy. Sigmoid septum, which is likely a normal variant with aging with no evidence of outflow obstruction. The basal to mid septum is akinetic. Limited views suggest apical and anterior hypokinesis (foreshortened views, clip 63-64). The left ventricular systolic function is preserved/low normal with an ejection fraction of 50-55% by visual estimate. Grade I diastolic dysfunction. 2. Grossly normal right ventricular size and systolic function. 3. Normal atrial sizes. 4. The aortic valve leaflets are thickened, calcified, and restricted. Mild aortic stenosis is present with a peak velocity of 1.8 m/sec, peak gradient of 13 mmHg, mean gradient of 7 mmHg and estimated aortic valve area of 1.6 cm2 based on LVOT diameter of 2 cm, LVOT VTI of 20 cm, and AV VTI of 39 cm. Peak aortic velocity may be underestimated. 5. Mild-moderate pericardial effusion measures 1.2 mm adjacent to the right atrium (clip 32) without echocardiographic evidence of tamponade physiology.
CDC Split Type:

Write-up: Initially in ER for hip pain then 7/29/2021 1:43 PM - had 5/10 chest pressure without shortness of breath, nausea, vomiting,, radiation or migration of the pain. Pain resolved after 30 minutes and was gone by the time she notified staff. She felt her throat was closing. This has happened to her x2 this year, typically while she is falling asleep ACUTE NON ST ELEVATION MI ACUTE PERICARDITIS, UNSPECIFIED


VAERS ID: 1624300 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 RA / IM

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

Write-up: Patient presented for a "2nd dose" of Pfizer vaccination when it was discovered via database that the patients initial dose was Moderna 2/16/21.


VAERS ID: 1624546 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-18
Onset:2021-07-29
   Days after vaccination:133
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Impaired work ability
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Since vaccine, my periods have become worse. Heavy bleeding for days at a time. Using multiple boxes Prior to the vaccine my period would be 4 days average with the heaviest day being day number 2. By day 4 the cycle was over. Now my cycle is 8 days with 5 days using anywhere up to 24 over night pads during a an 8 hour work shiftpads a day. I realize that I?m at an age nearing menopause (for my families female members) Just know that this iwill affect teenage girls. This is affecting the quality of my work every hour I spend 5-10 minutes in the bathroom.


VAERS ID: 1625280 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dysmenorrhoea, Menstruation irregular
SMQs:, Fertility disorders (broad)

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

Write-up: I had gotten off my period in 6/25 and the day after I got the shot I began ANOTHER period for 7 days with HORRIBLE a cramping. I had my tubes tied in June 2020 and have had REGULAR periods since I should now be on by period today 8/23 and I have not had one yet.


VAERS ID: 1625445 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Blood thyroid stimulating hormone, Full blood count, Human chorionic gonadotropin, International normalised ratio, Metabolic function test, Muscle spasms, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dystonia (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: Nexplanon, inserted 2019
Current Illness: none
Preexisting Conditions: migraine allergic rhinitis
Allergies: none
Diagnostic Lab Data: CBC, CMP, TSH, hcg , PTT, PT/INR ordered 8/23/2021, pending at time of writing.
CDC Split Type:

Write-up: Starting 7/29/21, one day after receiving vaccination, and continuing for fourteen days, the patient experienced light vaginal bleeding, varying in character from bright red blood, dark blood, to brown blood, and accompanied by moderate cramping. She denied any other symptoms. Her previous periods were $g 2 years ago. She has not had vaginal bleeding since Nexplanon was placed 2 years ago (to be replaced 2024). I saw patient 8/23/2021 for a wellness visit, at which time she reported occurrence of the above sx. The sx are resolved. No other bleeding issues, personal or family history of bleeding disorder. Vital signs and Physical exam were normal; some minimal R-sided abd discomfort/fullness w/o G/T/R, I felt was c/w stool/gas. Pelvic exam was not done (bleeding stopped, Pap not due, no vag sx, and in a LTMR). She didn''t call or seek medical attn at the time of the bleeding, but she may have if she did not already have a well visit scheduled with me .


VAERS ID: 1628600 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-18
Onset:2021-07-29
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 - / -

Administered by: School       Purchased by: ?
Symptoms: Bronchitis, COVID-19, Dyspnoea, SARS-CoV-2 test positive, Sinus headache
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient is fully vaccinated for COVID-19. Patient was hospitalized due to COVID-19. She stated she began to have what she believed to be a sinus headache on 7/24/2021. Over a few days it developed into bronchitis. Her doctor was out of town so she took over the counter meds. On 7/29/21 she went to Urgent Care and they did a COVID test which was positive. She was given some pills by the physician at Urgent Care which she was told is usually given to dogs. She was to take 5 pills one day and another 5 the next day. After the first dose of the medicine she developed severe diarrhea. By Sunday 8/1/21 she went to the Hospital ER because of shortness of breath where she was kept in their ER until 8/3/21 when they found a room for her. She was admitted to a room and then discharged 8/4/21 to home. She stated she had been vaccinated in January with the Pfizer vaccine.


VAERS ID: 1628765 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, No adverse event
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: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received 3rd dose of moderna COVID vaccine no adverse reactions at time or thereafter from Patient. This submission is to inform of 3rd dose.


VAERS ID: 1631949 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-27
Onset:2021-07-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Neuralgia
SMQs:, Peripheral neuropathy (narrow), Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Site: Pain at Injection Site-Medium, Additional Details: pain (possible nerve pain) on the radial and ulnar nerve on the left arm.


VAERS ID: 1632372 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-02-14
Onset:2021-07-29
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 LA / SC
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / SC

Administered by: Other       Purchased by: ?
Symptoms: Blister, Cheilitis, Discomfort, Ear pain, Lymph node pain, Oral herpes, Pain, Rash erythematous, Rash pruritic
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Oropharyngeal infections (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: bupropion, Vit D3, diazepam, gabapentin, hydrocone with APAP, estradiol vag tab, lisinopril, pantoprazole, ubrelvy, hair, and nails vitamins, cyanocobalamin inj,
Current Illness:
Preexisting Conditions: migraines, hypertension, anxiety, fibromyalgia, chronic low back pain
Allergies: penicillin, rochepin, jelly beans, mangos
Diagnostic Lab Data:
CDC Split Type:

Write-up: developed itchy rash under left lip about the size of a nickel. Treated with steroid cream with helped to alleviate the itching. Painful blisters occurred 4 days later. Lymph nodes under chin on left side became very tender all the way to my ear. This caused ear pain that required use of heating pad to alleviate some of the discomfort. On day 5, lymph nodes in neck also became tender. Decided to go the urgent care on Aug 2. He treated me with Valacyclovir 1000mg twice a day for 7 days. He thought it could be herpes labialis even though I have never had this previously. I completed this treatment but I still have a red bumpy spot where the original rash was.


VAERS ID: 1632506 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-03-17
Onset:2021-07-29
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram thorax, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levocetrizine 5mg, Montelukast 10mg, Pantoprazole 40mg, Trokendi XR 125 mg, Ubrelvy (only at onset of migranes) 50mg, Naproxen at onset of migranes 500 mg, flonase nasal spray, multi vitamin, immunotherapy allergy injections every other day
Current Illness: allergies are the only known.
Preexisting Conditions: CMT neurology disorder.
Allergies: Outdoor allergies to trees, weed, grasses.
Diagnostic Lab Data: CT scan showing blood clots.
CDC Split Type:

Write-up: I was diagnosed with Pulmonary Embolism in the Emergency Room on 7/31/21 (blood clots in my lungs)


VAERS ID: 1632558 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008021A / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspepsia, Heart rate increased, Hot flush
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific dysfunction (narrow), Dehydration (broad)

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

Write-up: Within first 5 minutes of receiving the injection I had a hot flash which continued for approx. 1.5- 2 hours. Also within 20-25 minutes of the injection I started having a rapid heart rate and extreme heart burn for an hour and forty-five minutes if not longer, until it subsided.


VAERS ID: 1632563 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-25
Onset:2021-07-29
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH BR8735 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Dehydration, Echocardiogram, Electrocardiogram, Heart rate increased, Laboratory test, Pain, Pericarditis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pericarditis flare up after a flu vaccine. It resolved on its own. It was a long time ago. It could have been a coincidence.
Other Medications: Otezla; levothyroxine; spironolactone; Acyclovir
Current Illness:
Preexisting Conditions: Asthma; Psoriasis; Pericarditis
Allergies: Penicillin; cipro; doxycycline
Diagnostic Lab Data: Echo test, EKG, lab work
CDC Split Type: vsafe

Write-up: It was pretty subtle at first and then it became more noticeable. On Saturday, it was unbelievably painful. My heart rate was in the 140s or 150s. I thought maybe I was dehydrated. It just became more and more persistent. Even at rest, it was hanging out between 90-110. If I just got up and did anything minimal it would shoot to the 120s-130s. I almost went to the ER Sunday night. I went to see my doctor on Monday afternoon. By Tuesday, it was very minimal. Sometimes when I get a pericarditis flare up, I get an exacerbated heart rate. She did an echo. She did an EKG. Everything looked fine. We don''t know what triggered my pericarditis. I have not experienced anything like this again since about 3 days after my 2nd dose.


VAERS ID: 1633139 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthmatic crisis, Burning sensation, Condition aggravated, Dyspnoea, Facial pain, Lacrimation increased, Lymph node pain, Lymphadenopathy, Lymphoedema, Mast cell activation syndrome, Nausea, Pyrexia, Retching, Rhinorrhoea, Swelling face, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Asthma/bronchospasm (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Lacrimal disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Zyrtec, Singulair, famotidine, cromolyn sodium oral and nebulized, Nasalcrom, Combivent inhaler
Current Illness: see chronic conditions
Preexisting Conditions: Mast Cell Activation Syndrome, asthma, endometriosis
Allergies: amoxicillin, prednisone, egg, dairy, gluten, fish
Diagnostic Lab Data:
CDC Split Type:

Write-up: *mast cell mediated respiratory anaphylactoid and asthmatic crisis: shortness of breath, airway constriction, watery eyes, dry heaving, mucus production, and nausea-duration approximately 4 hours critical and 3 days elevated *lymphodemia: swollen, burning, and painful lymph nodes in armpit of injection site and around face/neck-duration approximately 21 days *fever-duration approximately 3 days


VAERS ID: 1633363 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-03
Onset:2021-07-29
   Days after vaccination:87
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Fatigue, Headache, Nausea, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prosaic, cannabis
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Positive COVID test 8/03/21 & 8/15/20.
CDC Split Type:

Write-up: Positive COVID test. Fever , shortness of breath, headache congestion, fatigue , cough, Nausea


VAERS ID: 1633762 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-03
Onset:2021-07-29
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-08-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted with COVID positive result despite fully vaccinated March 20201.


VAERS ID: 1636404 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-18
Onset:2021-07-29
   Days after vaccination:133
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Cough, Dyspnoea, Fatigue, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), COVID-19 (broad)

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

Write-up: Cough, fatigue, SOB


VAERS ID: 1636506 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-27
Onset:2021-07-29
   Days after vaccination:93
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / UNK - / IM

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

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

Write-up: Headache


VAERS ID: 1636517 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-11
Onset:2021-07-29
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chest X-ray, Pyrexia, SARS-CoV-2 test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chicken pox, measles, mumps, osteoporosis.
Allergies: Contrast dye, feldene, prinvil, voltaren
Diagnostic Lab Data: CXR, covid test.
CDC Split Type:

Write-up: Fever and right knee pain.


VAERS ID: 1636534 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-01
Onset:2021-07-29
   Days after vaccination:89
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Cough, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Anemia, asthma, bronchitis, GERD, HTN, hypercholesterolemia, ulcerative colitis.
Allergies: Biaxin, Cafergot, Levaqin
Diagnostic Lab Data: CXR, covid test.
CDC Split Type:

Write-up: Cough, congestion, fever.


VAERS ID: 1636565 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Expired product 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: na
Preexisting Conditions: na
Allergies: fish, strawberries, wasp, sulfa drugs
Diagnostic Lab Data:
CDC Split Type: AR2162

Write-up: vaccine used past the 12 hour window of use after vial punctured. Stored in fridge entire time and cleaned between each use with alcohol. Pt contacted and no adverse reaction, pt states no problems


VAERS ID: 1636846 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / SYR

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

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

Write-up: Smell and taste changed to constant metallic burnt coffee smell and taste in mouth. There all the time. Has. It gone away and has been four weeks. Very frustrating as it effects taste of all food.


VAERS ID: 1636851 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Limb injury, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Arthritis (broad)

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

Write-up: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-


VAERS ID: 1636970 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

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

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

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


VAERS ID: 1637187 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-28
Onset:2021-07-29
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Headache, Nausea, Paraesthesia oral
SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (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: Multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: My doctor ran routine bloodwork and didn?t find anything abnormal. She also sent me to the eye doctor who also didn?t find anything abnormal.
CDC Split Type:

Write-up: I have had a persistent headache for the duration of time since my first Covid shoot. I also experience nausea. I previously has Covid in March. I also am experiencing tingling of the tongue since the shot.


VAERS ID: 1637409 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-29
Onset:2021-07-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Rash, Rash papular
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: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: widespread upper body papular rash within 12 hours of shot -- affecting face, neck, torso, back, upper extremities and palms


VAERS ID: 1638438 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-14
Onset:2021-07-29
   Days after vaccination:76
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test abnormal, Chest discomfort, Chest pain, Computerised tomogram normal, Eye disorder, Headache, Magnetic resonance imaging head normal, Magnetic resonance imaging neck, Pain in extremity, SARS-CoV-2 test negative, Scan with contrast, Thrombosis, Ultrasound Doppler abnormal
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Corneal disorders (broad), Retinal disorders (broad), Tendinopathies and ligament disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: My mother said that I had an adverse reaction when I was about 5 years old. I think it was my final MMR vaccination. I had a h
Other Medications: losartan 2*25mg (1 tablet morning, 1 tablet evening) Fexofenadine HCL 4*180 mg (2 tablets morning, 2 tablets evening) Vitamin B-12 1000 mg (1 tablet in morning) xolair 300 mg (1 shot every 28 days. 1st shot on 5/7/2021)
Current Illness: Tinnitus (started 2/26/2021) Chronic hives (started August 2020)
Preexisting Conditions: Marfans Factor-V Leiden
Allergies: Naproxen (Angiodema in hands)
Diagnostic Lab Data: 8/6/2021 - Full panel of bloodwork. Showed elevated levels that could indicate a blood clot. 8/6/2021 - CAT scan with and without contrast in my head and neck. They did not show evidence of a dissection, clot, or aneurysm. 8/6/2021 - Lower Limb Venous Duplex. It showed a superficial blood clot in my right calf, but no DVT. 8/7/2021 - MRI scan of my head and neck. They did not show evidence of a dissection, clot, or aneurysm.
CDC Split Type:

Write-up: Around July 29, 2021 noticed a sharp pain in my right calf. I thought it was likely a superficial blood clot. I had two other superficial blood clots in my right calf on 11/18/2020 and 12/13/2020 that felt the same. In Nov and Dec I was also checked for DVT, but it was negative. I believe these were my first blood clots. In Jan 2021, I was diagnosed with Factor V Leiden. On Aug 6, I had another xolair injection at 10:30 am. Around 4:30 pm I developed a moderately painful headache localized on the right side of my head - especially around my eye. Around 6:30 my husband noticed that my right eye was pointing inward unless I was consciously focusing my eye. I did have a lazy eye in my right eye when I was 4-6 years old. I have had localized headaches in the past, but never with the odd eye movement. I observed it in the mirror as well. Although, it stopped. I''m not sure when, but before 9:00 pm. I went to the ER around 7:00 pm, but wasn''t seen for a few hours. I was given lots of blood work and a CAT scan with and without contrast in my head and neck. They came back negative. They sent me home (around 1:30 am) with instructions to return at 8:00 am for Lower Limb Venous Duplex. I came back as instructed. The doppler showed a superficial blood clot in my right calf. The ER doctor, noting I still had a localized headache around my right eye, ordered a MRI of my head and neck. They also came back negative. In coordination with my hemotologist, I was prescribed 2*10mg xarelto (1 tablet morning, 1 tablet evening) for 12 days. I was given tylenol and discharged. The headache went away after about 24 hours. And the superficial blood clot stopped hurting within a few days. Note - I have had a tight chest since around June 1. I was tested for COVID with PCR test on June 3, but it was negative. For the next few weeks, my chest felt tight and hurt mildly, especially when breathing deeply. I had a spirometry test on 6/11/2021 that showed a slightly reduced FEF25-75. I went to the ER on 6/17/21 for the breathing problems. They did a ECG and CAT scan of my chest, but didn''t find an aneurysm or pulmonary embolism. I followed up with a pulmonologist on 7/21/21 and they prescribed Flovent HFA 220 mcg/actuation inhaler (2 puffs twice a day) for two months. We think the problem was likely dust caused by having the siding replaced at my house. My tight chest is mostly better now.


VAERS ID: 1641577 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-27
Onset:2021-07-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory failure, Angiogram normal, Asthenia, Cardiac function test normal, Chest X-ray normal, Fatigue, Full blood count normal, Gait inability, Laboratory test normal, Muscle twitching, Myalgia, Palpitations, Scan with contrast normal, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: LOSARTIN 100MG, TESTOSTERONE 200MG, IBUPROFEN, MULTIVITAMIN
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: ON 7/29/2021 THE FOLLOWING WAS PERFORMED: CBC, CHEM PANEL, CARDIAC, CT ANGIO CHEST WITH CONTRAST, CHEST X-RAY. NO ACUTE FINDINGS.
CDC Split Type:

Write-up: AFTER HAVING FIRST DOSE OF PFIZER COVID-19 VACCINE ON 7/27/2021 HAD FATIGUE, MUSCLE ACHES WHICH INCREASED ON 7/29/2021 EXPERIENCING PALPITATIONS, WEAKNESS, MUSCLE ACHES, SHAKINESS, MUSCLE TWITCHING. ON 7/29/2021 ARRIVED TO MEDICAL CENTER ER WITH ACUTE RESPIRATORY FAILURE WITH HYPOXIA, PALPITATIONS, GENERALIZED WEAKNESS, UNABLE TO AMBULATE. WAS PLACED ON OXYGEN, ADMITTED TO THE FLOOR AND MONITORED OVERNIGHT.


VAERS ID: 1644538 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-05
Onset:2021-07-29
   Days after vaccination:54
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Myelitis transverse, Paralysis, Product dose omission issue
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Medication errors (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ANTIDEPRESSANTS
Current Illness:
Preexisting Conditions: Comments: No medical history was reported.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Transverse myelitis; being paralyzed; not receiving 2nd dose of the Moderna COVID19 vaccine; This spontaneous case was reported by a consumer and describes the occurrence of PARALYSIS (being paralyzed) and MYELITIS TRANSVERSE (Transverse myelitis) in a 27-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 054c21a) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No medical history was reported. Concomitant products included ANTIDEPRESSANTS for an unknown indication. On 05-Jun-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 29-Jul-2021, the patient experienced PARALYSIS (being paralyzed) (seriousness criteria hospitalization, disability and medically significant). On an unknown date, the patient experienced MYELITIS TRANSVERSE (Transverse myelitis) (seriousness criteria hospitalization, disability and medically significant) and PRODUCT DOSE OMISSION ISSUE (not receiving 2nd dose of the Moderna COVID19 vaccine). At the time of the report, PARALYSIS (being paralyzed) had not resolved, MYELITIS TRANSVERSE (Transverse myelitis) outcome was unknown and PRODUCT DOSE OMISSION ISSUE (not receiving 2nd dose of the Moderna COVID19 vaccine) had resolved. mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was withdrawn on an unknown date. It was reported patient had multiple tests in the hospital. No concomitant medications were reported. No treatment information was provided by the reporter. Company Comment : Very limited information regarding these events has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding these events has been provided at this time. Further information has been requested.


VAERS ID: 1644582 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-27
Onset:2021-07-29
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Angina pectoris, Chest pain, Heart rate
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20220729; Test Name: heartbeat; Result Unstructured Data: High
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Had heart pain; Chest was hurting; This spontaneous case was reported by a consumer and describes the occurrence of ANGINA PECTORIS (Had heart pain) in a 39-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 27-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 29-Jul-2021, the patient experienced ANGINA PECTORIS (Had heart pain) (seriousness criterion medically significant) and CHEST PAIN (Chest was hurting). At the time of the report, ANGINA PECTORIS (Had heart pain) and CHEST PAIN (Chest was hurting) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 29-Jul-2022, Heart rate: high (High) High. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Relevant concomitant medications were not reported. Patient felt as if he was going to have a heart attack and it happened while lying down at bedtime. The symptoms would disappear whenever he got up & walked around. Treatment information was not provided.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


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