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

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

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 182 out of 8,753

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VAERS ID: 1784919 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Immediate post-injection reaction, Pallor, Tremor, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Patient became very pale, clammy and started shaking immediately after vaccination. Patient almost passed out. The shaking became worse and she was not responding to questions so the paramedics were contacted to attend to the patient.


VAERS ID: 1784930 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram head, Depressed level of consciousness, Drooling, Nausea, Syncope, Vomiting
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), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: AML
Allergies:
Diagnostic Lab Data: CT head - negative for acute abnormality
CDC Split Type:

Write-up: After bone marrow biopsy, patient developed syncopal episode with right side drooling, nausea, vomiting, near loss of consciousness while obtaining post procedure BP. Patient developed responsiveness 2-3 minutes later. Patient referred to MD center for evaluation and subsequently discharged.


VAERS ID: 1784934 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chest pain, Chills, Fatigue, Headache, Muscle spasms, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Only severe side effects to the 1st Covid Vaccine Dose
Other Medications: None
Current Illness: Longterm Covid-19 side effects form April of 2020
Preexisting Conditions: Longterm Covid-19 side effects form April of 2020
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: severe chills, nausea, severe headache, muscle cramping and body aches, chest pain, fatigue


VAERS ID: 1784941 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

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

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

Write-up: Chills, pain at injection site, pain in armpit, body pain, fatigue (several hours).


VAERS ID: 1784946 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: Fever, congestion, muscle aches, runny nose


VAERS ID: 1784948 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Cold sweat, Dyspnoea, Feeling cold, Head discomfort, Headache, Hyperhidrosis, Migraine, Muscle spasms
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: I?ve had 2 seizures in college years ago. Been good for over 5 years
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Cold sweats been going on for 12 hours now. My bed is soaked in my sweat, but I?m freezing. Headache/migraine feel like someone is stabbing me in the forehead repeatedly. I cannot breath and I keep having muscles spasms. Several in my legs but the main area is the muscle between my right shoulder and head keeps spasming. I had covid in May and it was terrible, however the symptoms I am getting from this vaccine are much worse than when I actually had covid


VAERS ID: 1784951 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

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

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

Write-up: No adverse side effects at this time. Client is 11 years old. Pfizer is approved for 12 years and older. Vaccine administered in error.


VAERS ID: 1784959 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Chills, Injection site erythema, Malaise, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, loss of energy, chills, general weakness and feel of illness, body aches and extreme redness at site injection. A red ring surrounding injection site is visible.


VAERS ID: 1784978 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-10-11
Onset:2021-10-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Extra dose administered, Fatigue, Heart rate increased, Hyperhidrosis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: After my third shot on 10/11/2021, I began developing a fever and fatigue around 7pm that evening that lasted until 4pm on 10/12/2021. I woke up on 10/13/2021 and felt good enough to go for a 3 mile run. I had higher heart rate during the run than usual and increased sweating. I had to stop multiple times due to the rapid heart rate. In the shower after the run, I felt light headed and had to sit down to avoid passing out. These symptoms occurred again the next day on 10/14/2021 when I went for another 3 mile run. These symptoms are abnormal because I run 3-5 miles in the morning, 5 days a week.


VAERS ID: 1784990 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-05
Onset:2021-10-13
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 0
Current Illness: 0
Preexisting Conditions: Skin cancer, photodermatitis
Allergies: 0
Diagnostic Lab Data: 0
CDC Split Type:

Write-up: On day 8, I woke up with the injection site red, swollen, itchy, painful, burning, hard and hot. I am currently taking benedryl, cold compresses and over the counter pain medication for it. My pharmacist said it is Covid Arm and should go away in 3 to 5 days.


VAERS ID: 1784995 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043D21A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Immediate post-injection reaction, Mobility decreased, Pain, Pain in extremity
SMQs:, Parkinson-like events (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin 300 mg Creator 10 mg
Current Illness: None
Preexisting Conditions: successful cancer treatment November 2020
Allergies: Pennicillin
Diagnostic Lab Data: This early on, no follow up attempted. May go to emergency if does not improve soon. Plan to call nurses hotline first.
CDC Split Type:

Write-up: Immediate pain on injection, not abating over time. After about 3 hours arm pain was extreme on any movement. After 11 hours pain is still intense even with minor movement. Unable to raise arm forward , lifting sideways is difficult and painful but can be managed. No redness or swelling at injection site and no other reactions.


VAERS ID: 1785028 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 3 RA / IM

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

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

Write-up: PT WAS ADMINISTERED EXPIRED VACCINE. MODERNA EXPIRED ON 10/11/21. IT WAS ADMINISTERED ON 10/13/21.


VAERS ID: 1785039 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 LA / IM

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

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

Write-up: 2nd Dose Covid-19 administered 4 days after expiration date.


VAERS ID: 1785050 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-10
Onset:2021-10-13
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccine breakthrough infection
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: Vaccine breakthrough 8/13/21


VAERS ID: 1785056 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 RA / IM

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

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

Write-up: Patient administered 2nd Covid-19 vaccine 4 days after expiration date.


VAERS ID: 1785060 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Chills, Cough, Diarrhoea, Disturbance in attention, Dyspnoea, Fatigue, Headache, Myalgia, Nausea, Pyrexia, Respiratory rate increased, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamotrigine 200 mg; Xyzal (Levocetirizine); sertraline 75 mg
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills, nausea, vomiting, headache, muscle soreness, chest pain, increased respiratory rate, shortness of breath, cough, diarrhea, difficulty concentrating, fatigue


VAERS ID: 1785061 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-01
Onset:2021-10-13
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zolpidem, Methocarbamol, albuterol
Current Illness: AHRF, Lymphopenia, metabolic acidosis,
Preexisting Conditions: AHRF, Lymphopenia, metabolic acidosis,
Allergies: NKA
Diagnostic Lab Data: rapid covid test
CDC Split Type:

Write-up: Pt hospitalized for + COVID test


VAERS ID: 1785076 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Deep vein thrombosis, Extra dose administered, Lymphadenopathy, Ultrasound scan
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine, Metoprolol tartrate, Omeprazole
Current Illness: None
Preexisting Conditions: HTN
Allergies: NKDA
Diagnostic Lab Data: US upper extremity shows DVT
CDC Split Type:

Write-up: Pt had Covid booster to L Deltoid on 10/12/2021, on Wednesday she started to having lymph swelling to L side of neck. Came to ER on Thursday.


VAERS ID: 1785090 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-11
Onset:2021-10-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Axillary 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: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain in the under arm (on right) where it was inected


VAERS ID: 1785103 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 8/11/2021 1ST MODERNA VACCINE
Other Medications: DIVALPROEX SOD 500MG DR TABLET 1 TABS ORAL TWICE DAILY for 30 Days 30 DAY SUPPLY, PSYCHIATRIC RX ESCITALOPRAM 20MG TABLET # 1 TABS ORAL EVERY MORNING for 30 Days 30 DAY SUPPLY, PSYCHIATRIC RX MINOCYCLINE 100MG CAPSULE 1 CAPS ORAL TWI
Current Illness: none
Preexisting Conditions: none
Allergies: Penicillin BENZODIAZEPINES
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: WITHIN 10 MIN OF VACCINE BEING GIVEN PT BROKE OUT IN HIVES ALL OVER BODY AND FACE. HE SAID THIS HAD ALSO HAPPEN WITH HIS 1ST SHOT BUT THIS TIME IT WAS QUICKER


VAERS ID: 1785105 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Headache, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Age 64, Extreme tiredness and body aches following Shingles Vaccine
Other Medications: Letrozole: 2.5mg; 50+ Daily Vitamin (like Centrum Silver 50+); Over 50 Eye (like Ocuvite); Contains soy which I should avoid. Discontinue?); Omeprazole; Low-dose Aspirin 81mg; Vital 3 (Bronson Labs-Biologically Active Peptide Fragments) f
Current Illness: No Illness. But I had the flu shot at the same time as the booster.
Preexisting Conditions: Obesity.
Allergies: None known
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Severe headache, body aches, nausea and extreme tiredness


VAERS ID: 1785109 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-12
Onset:2021-10-13
   Days after vaccination:243
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: apixaban, atorvastatin, bupropion, furosemide, gabapentin, isosorbide mononitrate, lisinopril, metoprolol, trazodone
Current Illness: HTN, DM, Hyperlipidemia, CAD, diverticulosis,
Preexisting Conditions: HTN, DM, Hyperlipidemia, CAD, diverticulosis,
Allergies: Chocolate, ciprofloxacin metformin, penicillins
Diagnostic Lab Data: rapid test
CDC Split Type:

Write-up: COVID test +


VAERS ID: 1785110 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-10
Onset:2021-10-13
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arteriogram coronary abnormal, Asthenia, COVID-19, Chest discomfort, Cough, Discomfort, Dyspnoea exertional, Electrocardiogram normal, Fibrin D dimer increased, Hyperhidrosis, Hypotension, Limb discomfort, Pain, Pain in extremity, SARS-CoV-2 test positive, Troponin increased
SMQs:, Anaphylactic reaction (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Other ischaemic heart disease (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hospital Contact With And (Suspected) Exposure To COVID-19 Non-Hospital Atherosclerotic Heart Disease Of Native Coronary Artery Without Angina Pectoris Depressive Disorder Diabetes Mellitus Type 1 With Diabetic Neuropathy Hyperglycemic Hypertension Essential Primary Polyp Rectal Adenomatous Personal History Hyperlipidemia Mixed Apnea Sleep Obstructive Reflux Esophageal Cyst Pancreas Stenosis Spinal Spondylosis Lumbar Without Myelopathy Pancreas Intraductal Papillary Mucinous Benign Long Term Use Of Insulin Active Diabetes Mellitus Type 1 With Mild Nonproliferative Diabetic Retinopathy Without Macular Edema Bilateral
Allergies:
Diagnostic Lab Data: SARS CoV-2, PCR, Rapid, V Detected 10/13/2021
CDC Split Type:

Write-up: CHIEF COMPLAINT/REASON FOR VISIT Chest pressure HISTORY OF PRESENT ILLNESS Patient is a 71 y.o. man with history of CAD status post LAD stenting in 2013, diabetes mellitus type 1, hypertension, hyperlipidemia on statin therapy, OSA, and medically complicated obesity who I am evaluating in the ED given left elbow discomfort, chest pressure, and abnormal chest CTA. Patient followed on an outpatient basis with Dr., with most recent evaluation in early 2020 including an exercise stress echocardiogram that was mildly positive for myocardial ischemia in an inferior distribution. A conservative approach was selected with continued medical therapy, inclusive of 3 antianginals (isosorbide mononitrate, amlodipine, and metoprolol). Increase in outpatient diuretic was utilized for exertional dyspnea. Patient tells me that overall he has done well. He has been outside in the woods ambulating as he prepares for deer and bear hunting season. He is in the process of moving and earlier today was going up and down a ladder while working in his garage packing and moving boxes. While doing so, he noticed reduced level of energy. He has had an intermittent cough but denies fever. He developed left elbow discomfort that he describes as "heaviness" or an "ache". Because of this, he went inside and sat down noted that he was diaphoretic. He noted mild chest pressure. He took a sublingual nitroglycerin which improved his discomfort. His wife contacted emergency services and by the time of paramedic arrival his pain had improved but had not completely subsided. Discomfort resolved in the ambulance and out. Initially, he was hypotensive. He denies any dyspnea, palpitations, recent changes in weight, or chills. He did not experience any chest discomfort or elbow discomfort preceding his prior stent. On arrival to the ED, patient receive some fluids given low blood pressure, with resultant normotension. D-dimer was elevated. ECG demonstrated no interval changes compared to prior. CT cardiac angiogram triple rule out was performed (report below). First troponin was 16. COVID swab was positive.


VAERS ID: 1785116 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Injection site induration, Injection site pain, Injection site swelling, Joint range of motion decreased, Limb discomfort, Pain in extremity, Skin warm
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: allergic reaction to Thimerasol, antihistamines
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: All stages of symptoms that can occur from the vaccine throughout a person''s entire body, only occurred in my left arm. About an hour after the shot, the site felt like a wasp sting, and around 1630 EDT a hard lump appeared at the injection site, that grew to about the size of a lemon, then I experienced swelling of the upper arm, pain in the whole arm, heat all over the arm, then chills in the arm, then inability to raise my arm - by evening my arm felt like I had severely injured a rotator cuff or other shoulder muscle, and it felt like it was made of lead (very heavy). These symptoms continued throughout the night, especially the chills, and I couldn''t raise my elbow above waist high. This morning, all the symptoms have receded and I only feel moderate ache in my upper arm, but still have some difficulty lifting it. I tried to find information on the internet about anyone else having experienced a range of symptoms only in the arm of the vaccination, and I haven''t found any evidence of that, so I thought it was worth reporting.


VAERS ID: 1785120 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, lisinopril/hydrochlothiazide, metoprolol tartrate, amlodipine besylate, potassium chloride, loratadine, omeprazole
Current Illness:
Preexisting Conditions: Arthritis
Allergies: Sulfa, mango, costcochroitin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Temperature 99.7


VAERS ID: 1785121 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Dizziness, Pruritus
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: PATIENT COMPLAINED OF FEELING LIGHT HEADED AFTER 1ST DOSE
Other Medications: N/A
Current Illness: REPORTED BEING LIGHT HEADED A FTER 1ST PRIZER VACCINE ADMINISTERED 9/22/21
Preexisting Conditions: N/A
Allergies: BEE STINGS, IBUPROFEN
Diagnostic Lab Data:
CDC Split Type:

Write-up: After 30 minutes, pt c/o of being light headed and an itchy face. Denied SOB or chest pain. Temp 36.4C HR 67 RR 17 B/P 172/108 ( pt believes he may have HTN- ) sat 98%. RA. Administered 25 mg of Benadryl PO and water. After 5 min pt reported feeling better, after fifteen min symptoms subsided, bp 153/103 HR 69. Pt advised to follow up with his PCP, maintain adequate hydration, avoid prolong sun-heat exposure, and rest as much as possible. Pt D/C home with co-worker (driver), ambulatory in stable condition.


VAERS ID: 1785128 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-02
Onset:2021-10-13
   Days after vaccination:225
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/13 SARS/COV-2, NAAT Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1785138 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-10-08
Onset:2021-10-13
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Facial paresis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Patient came into clinic complaining of right sided facial weakness that started on 10/13/21.


VAERS ID: 1785146 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

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

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

Write-up: PATIENT EXPERIENCED HEADACHE, SINUSITIS AND ONE EYE SWOLLEN


VAERS ID: 1785165 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 3 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Extra dose administered, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Similar symptoms on the second dose of Pfizer-BioNTech vaccine which resolved without treatment
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Low grade fever, body aches, and generalized body weakness which started approximately 24 hours after getting the dose that lasted until the following day (duration of symptoms lasted about 24 hours ). Symptoms resolved about 24 hours without treatment - just hydration, rest, and sleep.


VAERS ID: 1785187 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-18
Onset:2021-10-13
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetic CAD Hypertension Former smoker
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Suffering from chest pain, numbness to arm for 5 days, pt is currently still in patient.


VAERS ID: 1785193 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

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

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

Write-up: Patient received full dose of Moderna last Winter/early Spring, received a dose of Pfizer yesterday at the covid vaccine/flu clinic. NO current symptoms


VAERS ID: 1785214 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Body temperature increased, Feeling abnormal, Headache, Myalgia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: HEMIPLEGIA AND HEMIPARESIS FOLLOWING CEREBRAL INFARCTION AFFECTING RIGHT DOMINANT SIDE APHASIA UNSPECIFIED ATRIAL FIBRILLATION HYPERLIPIDEMIA, UNSPECIFIED HYPOTHYROIDISM, UNSPECIFIED
Allergies: NKA
Diagnostic Lab Data: Negative Binax result on 10/13/21 6:20pm
CDC Split Type:

Write-up: 10/13/ 21 17:30 resident observed with T-99.5, P-90, R-19, B/P-150/77, 02-96%RA 10/14/21 6:30am resident stated "I don''t feel good" with VS: BP 148/66, Temperature 100.8 ,PR 67 , RR , 21 , O2sat93% RA vomiting, headache, muscle and joint pain 10/14/21 10:30am BP: 121/60 mmHg, Temp:97.2 ?F, Pulse: 78 bpm, Resp: 20 Breaths/min, O2: 97 %RA


VAERS ID: 1785235 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-23
Onset:2021-10-13
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Debridement, Gangrene, Impaired healing, Impaired self-care, Limb injury, SARS-CoV-2 test positive, Toe amputation
SMQs:, Accidents and injuries (narrow), Depression (excl suicide and self injury) (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient Covid + on 10/13/2021. Hospitalized. Patient received Pfizer vaccine with 1st dose on 03/02/2021 and 2nd dose on 03/23/2021 Per H & P : History of Present Illness The patient is a 70-year-old male, who was presented to the hospital on 10/05/2021, for nonhealing wound of the right lower extremity. The had wet gangrene of the right big toe and underwent amputation on 10/05/2021 of right big toe. He was admitted for post operative care. It was determined that the patient would not be able to care for himself on his own and nursing facility was consulted. Pt was accepted to nursing facility and was discharged to nursing facility. He requires wound care and pain management. Pt is currently able to ambulate short distances with assistance. The patient received forefoot offloading boot for ambulation. The patient is was readmitted to the hospital due to need for debridement of right toe amputation site.


VAERS ID: 1785239 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-10-11
Onset:2021-10-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
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: Swollen lymph node - right collar bone


VAERS ID: 1785256 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-11
Onset:2021-10-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Induration, Pruritus, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion hcl xl 150mg , Amlodipine 5mg
Current Illness:
Preexisting Conditions: brain injury, kidney problems and ashtma
Allergies:
Diagnostic Lab Data: no
CDC Split Type:

Write-up: Have a bullseye on her left arm about 3 to 4 inches long. Its red and raised and underneath it, it feels hard and itchy. Kind of tender and swollen


VAERS ID: 1785259 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Neck mass, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: On 10/13 arm and shoulder area was sore, 2 knots appeared on the neck. Took Tylenol. Visited ER; was prescribed Ibuprofen 800.


VAERS ID: 1785267 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

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

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

Write-up: Patient started feeling dizzy soon after vaccination. While waiting after dose, sitting in chair begin loosing consciousness. He begin breathing heaving and fainted. Lost consciousness for less than a minute. He regained awareness on his own. Emergency service was called and local fire chief responded and check pulse and BP. Were normal . Patient declined ambulance to hospital. Patient was feeling ok next day.


VAERS ID: 1785273 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dizziness, Fatigue, Flushing, Hyperhidrosis, Lethargy, Nausea
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Chest Tightness / Heaviness / Pain-Mild, Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Nausea-Medium, Additional Details: checked pulse, gave water and 2 glucose tablets


VAERS ID: 1785285 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Underdose
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 received 0.4 ml of J+J vaccine instead of normal dose of 0.5 ml


VAERS ID: 1785286 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: she did not provide that information
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: imitrex, latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient called 10/12/21 around 7:20pm to tell the pharmacist that gave the shot that she has hives now after receiving the second shot


VAERS ID: 1785291 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Underdose
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 received 0.4 ml of J+J COVID vaccination instead of recommended dose of 0.5 ml


VAERS ID: 1785295 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 RA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Medium, Additional Details: Approximately 1-2 minutes after IM administration patient developed redness on his face, flushing, blackout and felt the need to lie down on the floor. Patient remain concious during the incidence, asked for water and was provided, fan. After 15-20 minutes, patient feel better and left the store.


VAERS ID: 1785313 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation issue
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: Incorrect Reconstitution-


VAERS ID: 1785318 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product reconstitution quality issue
SMQs:, Medication errors (broad)

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

Write-up: Error: Incorrect Reconstitution-


VAERS ID: 1785323 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product reconstitution quality issue
SMQs:, Medication errors (broad)

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

Write-up: Error: Incorrect Reconstitution-


VAERS ID: 1785326 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-19
Onset:2021-10-13
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Abdominal pain upper, Anaemia, Blood creatinine increased, COVID-19, Cholecystitis acute, Cholelithiasis, Computerised tomogram abdomen abnormal, Decreased appetite, Dyspepsia, Gallbladder enlargement, Haemoglobin decreased, Hepatic cirrhosis, Hyperaemia, International normalised ratio increased, Nausea, Nephrolithiasis, Nothing by mouth order, SARS-CoV-2 test positive, Sleep disorder, Soft tissue swelling, Splenomegaly, Urine analysis abnormal, Vomiting, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Liver-related coagulation and bleeding disturbances (narrow), Acute pancreatitis (broad), Angioedema (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Infectious biliary disorders (narrow), Gallbladder related disorders (narrow), Gallstone related disorders (narrow), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (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? 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: Patient Covid + on 10/13/2021. Received Pfizer vaccine with 1st dose on 04/28/2021 and 2nd dose on 05/19/2021. History of Present Illness Patient is 67-year-old male with past medical history significant for hypertension, hyperlipidemia, coronary disease and atrial fibrillation presented to the ER with complaints of abdominal pain which has been going on since last couple of days. As per the patient pain is more in the upper abdominal area more on the right side. Patient tells me that pain is more when he lies down at night and he could not sleep because of that and he decided to come to the ER for further evaluation he does not have much nausea and vomiting. Patient said that he cannot eat much and initially was thinking that he had some heartburn. He denies any diarrhea or constipation. Patient denies any chest pain. He denies any cough or phlegm production. He denies any fever or chills. He denies any complaints of urination. He denies any headache dizziness or lightheadedness. On further evaluation in the ER he was found to have anemia with hemoglobin of 10.7 WBC was 2.46 INR was 1.33 UA was positive his creatinine was 1.32 CT abdomen and pelvis was performed which showed cirrhosis with mild splenomegaly with cholelithiasis with mild gallbladder wall thickening and adjacent soft tissue edema and hyperemia consistent with acute cholecystitis with small non-obstructing left renal stone. Patient has been kept n.p.o. and surgery services has been consulted.


VAERS ID: 1785337 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / IM

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

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

Write-up: Generalized aching, chills, low-grade fever(99.3?F), fatigue


VAERS ID: 1785339 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Error: Incorrect Reconstitution-


VAERS ID: 1785340 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0810 / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ765AA / 1 LA / IM

Administered by: Senior Living       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 received Pfizer booster dose after having received Moderna doses for his original series. Left voicemail for patient to check in and see how he was doing; awaiting a return call;


VAERS ID: 1785344 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-31
Onset:2021-10-13
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: pt. received 2 doses of vaccination but they failed and pt. ended up covid + requiring Regn-cov administration


VAERS ID: 1785347 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Fatigue, Headache, Nausea, Pain, Pyrexia, SARS-CoV-2 test, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xyzal Rhodiola Magnesium Glucosamine Aleve Melatonin Unisom
Current Illness: None
Preexisting Conditions: Chronic back pain HSV HPV Migraines
Allergies: Walnuts, sesame, peanuts, wheat, egg whites NKDA
Diagnostic Lab Data: PCR Covid Test at 10:20 am 10/14/21
CDC Split Type:

Write-up: Moderate/Severe headache Nausea Emesis x1 Diarrhea Dizziness Fatigue Body Aches Fever (100.8 oral 1h after antipyretic) Treatment: Rest Fluids Benadryl and Tylenol for headache, nausea, body ache


VAERS ID: 1785349 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-01
Onset:2021-10-13
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Decreased appetite, Diarrhoea, Malaise, SARS-CoV-2 test positive, Taste disorder, Urinary tract infection
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient originally Covid + on 10/02/2021. Sent home and came back to the hospital for worsening symptoms. Tested positive again on 10/13/2021. Now hospitalized. Per ED Note; Patient is a 95-year-old male with past medical history of hyperlipidemia, hypertension, GERD, hypothyroidism, TIA presenting to the emergency department chief complaint of generalized weakness. Patient states he was in the emergency department approximately 1 week ago and records show that the patient was diagnosed with Covid 10/2/2021. Patient also had a urinary tract infection at that time. He does note that he has been at home with this illness and that he has had decreased appetite as his food tastes like rubber and cardboard. He states he called his primary care physician who sent him in for a "full work-up "and to receive some IV fluids "so that (he) could regain his taste buds". The patient also complains of cough and chronic intermittent episodes of diarrhea. He otherwise denies headache, chest pain, shortness of breath, abdominal pain, nausea, vomiting, urinary symptoms, numbness, loss of coordination.


VAERS ID: 1785377 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Injection site bruising, Pain
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Bruising at Injection Site-Mild, Systemic: Allergic: Difficulty Breathing-Mild, Systemic: Chest Tightness / Heaviness / Pain-Mild, Additional Details: called 911 for pt. who had chest tightness after getting the covid shot. pt recovered after being seen by paramadics


VAERS ID: 1785385 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Apathy, Asthenia, Confusional state, Diarrhoea, Headache, Nausea, Photophobia, Vertigo
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

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

Write-up: started with like a vertigo event for hours, then violent headache and lights were making it worse? slept, woke up, confusion, headache, nausea and now diarrhea where i have nothing left but water coming out. general weakness and lack of motivation for anything


VAERS ID: 1785388 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation issue
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: Incorrect Reconstitution-


VAERS ID: 1785394 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-22
Onset:2021-10-13
   Days after vaccination:264
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), 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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet budesonide (PULMICORT) 0.25 MG/2ML nebulization suspension ALBUterol (PROAIR RESPICLICK) 108 (90 Base) MCG/ACT inhalation powder atorvastatin (LIPITOR) 20 MG tablet loratadine (CLARITIN) 10 MG table
Current Illness:
Preexisting Conditions: Diabetes Hypertension Liver fibrosis Bronchiectasis Latent tuberculosis Type 2 diabetes mellitus Hyperlipidemia
Allergies: Amoxicillin-Pot Clavulanate Diatrizoate Iodinated Diagnostic Agents
Diagnostic Lab Data: POSITIVE COVID TEST 10/13/21
CDC Split Type:

Write-up: FEVER, COUGH, SOB


VAERS ID: 1785398 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation issue
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: Incorrect Reconstitution-


VAERS ID: 1785401 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation issue
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: Incorrect Reconstitution-


VAERS ID: 1785422 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / UNK UN / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1785430 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 - / -

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

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

Write-up: Administration error : On 05/03 patient received 1st dose of vaccination was Janssen, and received Pfizer vaccination on 10/14.


VAERS ID: 1785456 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Product preparation issue
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: Incorrect Reconstitution-


VAERS ID: 1785461 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 1 - / -

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

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: Injection given at 3:56. Pt seated in chair at 4:05, Pt complained of dizziness, became diaphoretic, fainted. Regained consciousness. Alert and oriented x3. At 4:05 -Vital Signs- 113/57-56-20 Pulse Ox 100% At 4:25- 130/83 - 59 - 20 patient eating and drinking without difficulty. At 4:50- 131/91-64-20 Temp 97.1


VAERS ID: 1785463 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 LA / IM

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

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

Write-up: Vaccine was given one day to early after the 4 day grace period. No treatment given


VAERS ID: 1785465 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3592 / 2 LA / IM

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

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

Write-up: Severe headache that could not be alleviated with Tylenol or Aleve for 24 hours Extreme muscle soreness, especially in left arm for 24 hours. Low-grade fever for 48 hours


VAERS ID: 1785469 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW 0182 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Lymphadenopathy, Musculoskeletal stiffness, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ibuprofen, vitamins, Claritin
Current Illness: None
Preexisting Conditions: Asthma
Allergies: eyrthromycin, pet dander, dust mites, hayfever
Diagnostic Lab Data:
CDC Split Type:

Write-up: Stiffness and swelling in lymph nodes around the neck. Painful swelling in the armpit . I was told to manage with ibuprofen and allergy meds.


VAERS ID: 1785522 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Chills, Cough, Discomfort, Dyspnoea, Extra dose administered, Headache, Hyperhidrosis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Got a fever on the second shot
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: The next day I felt better but I still felt heavy, dizzy, sweaty and couldn''t breathe deeply
CDC Split Type:

Write-up: The night after Moderna''s third dose began a low-grade fever of about 100 degrees Fahrenheit, accompanied by headaches, sweating, chills, and coughing.


VAERS ID: 1785577 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Injection site swelling, Injection site warmth, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Advair, Vyvanse, Allegra, Escitalopram
Current Illness: none
Preexisting Conditions: asthma, anxiety, ADHD, seasonal allergies
Allergies: Sulfa antibiotics - hives and vomiting
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: swollen and hot injection site, chills and nausea/vomiting


VAERS ID: 1785602 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 UN / IM

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

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

Write-up: 2nd dose given 14 days after 1st dose


VAERS ID: 1785624 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea, joint pain, severe headache. Zofran is not helping with the nausea. Pain releaver is not working for headache or joint pain.


VAERS ID: 1785634 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 1 LA / IM

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

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

Write-up: The patient received a Moderna vaccine but does not meet the age requirement.


VAERS ID: 1785640 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. P100358553 / N/A RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Exposure during pregnancy, Hiccups, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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: Chronic back pain
Allergies: Pineapple, strawberries. NKDA
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PFIZER COVID-19 VACCINE EUA: After receiving the Pfizer COVID-19 and Afluria vaccines on 101321, the patient called on 101421 complaining of arm soreness to the extent of "feeling like my arm is broken" on the side in which the Pfizer vaccine was administered. She also complained of persistent hiccups that began after receiving the vaccines. The patient was known to be pregnant at the time of vaccine administration, however, the estimated date of delivery is unknown.


VAERS ID: 1785647 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-22
Onset:2021-10-13
   Days after vaccination:264
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 RA / IM

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

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

Write-up: Tested NAAT positive for COVID 10/13/21 after being fully vaccinated.


VAERS ID: 1785689 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: High fever, chills, muscle aches, joint pain, nausea and fatigue.


VAERS ID: 1785699 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-11
Onset:2021-10-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 2 RA / IM

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

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

Write-up: Patient called complaining of entire injection site and shoulder area red, inflamed and hot to the touch with some soreness. No itching.


VAERS ID: 1785702 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 RA / IM

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

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

Write-up: 17 Y/O PATIENT GOT A PFIZER BOOSTER WHICH IS ONLY RECOMMENDED FOR 18 Y/O AND ABOVE. PATIENT CURRENTLY HAS NO ADVERSE REACTIONS OR SIDE EFFECTS. WE CONTACTED PFIZER AND PER PFIZER NO RECOMMENDATIONS RIGHT NOW BUT PFIZER SAFETY DEPARTMENT WILL CALL US BACK IF NEEDED. PFIZER INTERACTION I.D NUMBER


VAERS ID: 1785716 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-13
Onset:2021-10-13
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ALBUTEROL, PREDNISONE, ADVAIR, ELIQUIS, BUMEX, FERROUS SULFATE, CRESTOR, CYANOCOBALAMIN, METOPROLOL, MULTIVITAMIN, KDUR,FLOMAX
Current Illness: NONE NOTED
Preexisting Conditions: ATRIAL FIB, CONGESTIVE HEART FAILURE, CAD, GERD, BPH, ALLERGIC RHINITIS, ALLERGIES, HYPERCHOLESTEROL
Allergies: DUST MITE, SMOKED FOODS
Diagnostic Lab Data: POS COVID 19 TEST 10/13/21
CDC Split Type:

Write-up: BREAKTHROUGH COVID INFECTION


VAERS ID: 1785719 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-11
Onset:2021-10-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Injection site swelling, Injection site warmth, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prilosec Zovirax Prozac Amlodipine Multi vitamins
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data: N/a
CDC Split Type: Not sure which Hep B vacc

Write-up: Very painful arm. Swelling and heat at injection site. Painful through the arm and down the top part of body under armpit. I have been taking Tylenol. Did not go to dr. I was told I should report.


VAERS ID: 1785740 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache
SMQs:, Anticholinergic syndrome (broad), 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt states he started to feel fatigue, lightheaded, mild headache on 10/13/2021. Pt reports symptoms are improving.


VAERS ID: 1785745 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-09
Onset:2021-10-13
   Days after vaccination:65
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS - / N/A RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Inappropriate schedule of product administration, 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: Patient received Pfizer Booster only 2 months after series completion. Patient didn''t express any adverse reactions while waiting her 15 minutes after her vaccination. Discussed with provider, no additional recommendations. Left message on voicemail to inform patient.


VAERS ID: 1785750 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

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

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

Write-up: Pt has swollen lymph nodes. Told her to monitor and call if it gets worse. She usually takes aleve and told her it would be okay to take that. Explained to patient this is a common reaction but watch out for fever or redness or signs of infection. Told her it should go down in a few more days. Patient had no complaints of severe allergic reaction or breathing difficulty.


VAERS ID: 1785751 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lip swelling, Oral disorder
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Iodine, cipro
Diagnostic Lab Data: Saw allergist and doctor on 10/14/21
CDC Split Type:

Write-up: Lip swelling and lesions on inner lips


VAERS ID: 1785764 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 RA / IM

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

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

Write-up: The patient''s mom called to verify that we had the Janssen COVID vaccine in stock and stated that she would be sending her son. The patient arrived with his father to the pharmacy. The father asked me for the single dose COVID vaccine for his son. I confirmed that he wanted the single dose Janssen COVID vaccine. I administered the vaccine. When processing the vaccine later in the evening, I discovered that the patient is only 17 (3 weeks shy of 18).


VAERS ID: 1785770 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: XARELTO MELATONIN VITAMIN D3 WIXELA 100/50 LORATADINE
Current Illness: NONE
Preexisting Conditions: DVT UNDER TREATMENT SINCE 05/2021 WITH XARELTO ASTHMA OBESITY
Allergies: PENICILLIN MOBIC SULFA
Diagnostic Lab Data:
CDC Split Type:

Write-up: FEVER, ACHES, DIAPHORESIS, HEADACHE, BODY ACHES, FATIGUE, MENTAL FOGGINESS, & INSOMNIA. BEGAN 13 HOURS AFTER VACCINATION AND CONTINUED STRONGLY UNTIL 3 AM 10/14/2021. MUCH STRONGER THAN SIDE EFFECTS EXPERIENCED AFTER SECOND SHOT ON 3/30/2021.


VAERS ID: 1785786 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / IM

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

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

Write-up: Patient was given vaccine from a vial that had been punctured for more than 6 hours. Spoke to client 10/14/21 via telephone. Client denied any adverse signs or symptoms besides a sore arm at administration site.


VAERS ID: 1785930 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Lymphadenopathy, Pain, Pain in extremity
SMQs:, 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: Same as this event, 48, 3/12/2021
Other Medications: Birth control pills, omega 3
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph node under the arm of the injection site, sore arm, severe headache, body ache


VAERS ID: 1785944 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-01
Onset:2021-10-13
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Disturbance in attention, Eye pain, Feeling abnormal, Headache, Injection site pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Glaucoma (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C
Current Illness: N/a
Preexisting Conditions: Possible EoE
Allergies: dairy and penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Began with some brain fog, soreness at injection site 12 hours after. By 24 hours fever of 102, pain, chills, headache, eye pain, difficulty concentrating


VAERS ID: 1785945 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Bradycardia, Hyperhidrosis, Hypotension, Pallor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Patient became bradycardic, hypotensive, pale and diaphoretic. AOx4, GCS 15. Able to speak but slow in response.


VAERS ID: 1785955 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Headache, Injection site inflammation, Injection site rash
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (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: RHEUMITOID ARTHRITS
Allergies: NO KNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: rash and inflammation at injection site extreme joint pain headache


VAERS ID: 1786187 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-09
Onset:2021-10-13
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol for pain
Current Illness: No illnesses, I have a pretty good immune system.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: No tests yet, as I have not been seen by a medical professional
CDC Split Type:

Write-up: Small itchy bumps appeared at baseline of hair on right side of neck, right shoulder, back of arm, right elbow, down back in spuratic spots . rash started early Wednesday 10-13 morning 3:30-4:00am and still have itchy rash as of today Thursday 10-14 7:30pm


VAERS ID: 1786356 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-10-09
Onset:2021-10-13
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily b12, D3, fiber supplement ( 1000 mcg) and vitamin c 1000 ius.
Current Illness: None
Preexisting Conditions: None
Allergies: No know medical or food allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe hives 4 days after. Seem to be getting worse by the hour. Managing with OTC antihistamine oral and it h relief topical skincare.


VAERS ID: 1786551 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Heart rate increased, Lymph node pain, Lymphadenopathy
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Elevated heart rate after 2nd dose of Covid vaccine, fever/aches/fatigue after Tetanus booster
Other Medications: Nutrafol, Vitamin D, Zyrtec-D
Current Illness: No illnesses
Preexisting Conditions: Mitral valve prolapse
Allergies: No known allergies
Diagnostic Lab Data: No tests (have not consulted my physician yet for this)
CDC Split Type:

Write-up: Headache, elevated heart rate, fatigue, achy joints, very swollen/painful lymph node on right side under arm of injection site.


VAERS ID: 1786563 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Axillary pain, Chest pain, Flank pain, Injection site erythema, Injection site swelling, Lymphadenopathy, Musculoskeletal stiffness, Pain, Skin warm
SMQs:, Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Glimipiride, Actos, Vit D3, Calcium
Current Illness: None
Preexisting Conditions: Type 2 Diabetes
Allergies: Penicillin, Sulfa, Codeine, grasses, plants(juniper, pine) eucalyptus, jasmine, mock orange, most animals.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Left arm red at injection site, swollen all around upper arm , stiff neck left side, arm Hot, not normal. Swollen left side arm pit ( hard lump, pain) pain radiates toward side chest- breast to opposite direction towards elbow. Trying massage plus ice to relieve swelling and pain.


VAERS ID: 1786677 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), 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: Sybthroid, Merformin, Atorvastatin
Current Illness: None
Preexisting Conditions: Hypothyroidisn, Eczema, Adult onset diabetes, Hyperlipidemia, Meningioma
Allergies: Erythromycin, Bacitracin, Neosporin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tremor in right hand/arm when I left anything. Has continued for past 2 days and is still occurring.


VAERS ID: 1786683 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Lymphadenopathy, Myalgia, Neuralgia, Pyrexia, Skin sensitisation
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever , Swollen Lymph Nodes , Lymphadenopathy, muscle aches, nerve pain, skin sensitivity,


VAERS ID: 1786689 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Migraine, Palpitations
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tdap
Other Medications: Protonix 40mg, azelestine nasal spray
Current Illness: None
Preexisting Conditions: IBS, exercise induced asthma, recent hysterectomy
Allergies: Gluten, tdap
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe diarrhea (more than 10 episodes per day), racing heart, dizziness, migraine


VAERS ID: 1787046 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 3 RA / IM

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

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

Write-up: Tender lymphadenopathy


VAERS ID: 1787895 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain, Breast inflammation, Breast pain, Chest pain, Dyspnoea, Electrocardiogram, Headache, Lymphadenopathy, Muscle spasms, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Lipodystrophy (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: Pfizer Vax 04/21, 06/21
Other Medications: Gabapentin Savella Naproxen Cyclobenzaprine Vitamins C D Daily multivitamin
Current Illness:
Preexisting Conditions: Migraines Carpal Tunnel Neurapathy/ Fibromialga Anxiety /Depression COPD
Allergies: Penicillin Sulfur/ Bactrim
Diagnostic Lab Data: Electrocardiogram
CDC Split Type:

Write-up: Lymph nodes under left arm left breast inflammation/ sore, chest pain, abdominal cramping, nausea, headache, right leg cramping, difficulty breathing


VAERS ID: 1787898 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

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

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

Write-up: Swelling of the lips


VAERS ID: 1787917 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Chills, Headache, Injection site swelling, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Same symptoms but 9 days after injection
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Aspirin and Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe swelling in injection site, Headache, fever, chills, chest pain, heaviness in chest.


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