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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 183 out of 8,753

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VAERS ID: 1787920 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-28
Onset:2021-10-13
   Days after vaccination:258
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Dyspnoea at rest, Dyspnoea exertional, SARS-CoV-2 test positive, Treatment noncompliance
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hospital Respiratory Infection Type Unknown Due To COVID-19 Non-Hospital Device Implantable Cardioversion Status Pos Hospital Respiratory Infection Type Unknown Due To COVID-19 Non-Hospital Device Implantable Cardioversion Status Post Hypertension Essential Primary Monitoring For Therapeutic Drug Therapy [Z51.81] Long Term Anticoagulant Treatment [Z79.01] Chronic Diastolic (Congestive) Heart Failure (HCC) Atrial Fibrillation Chronic (HCC) Cancer Skin Squamous Cell Personal History Cardiac Arrest Sudden Personal History Decline Functional Status Gastroesophageal Reflux Disease NOS Hyperlipidemia Hypothyroidism Asthma Severe Persistent (HCC) Dyspnea Multifactorial Body Mass Index 35.0 To 35.9 Adult Primary Osteoarthritis Lumbar Spine Osteitis Pubis Primary Osteoarthritis Hip Right Pain Sacroiliac Pain Low Back Unspecified Spondylosis Lumbar Without Myelopathy Primary Open-Angle Glaucoma Mild Stage Right Morbid Severe Obesity Due To Excess Calories (HCC) Stenosis Aortic Valve Acquired Chronic Kidney Disease (CKD), Stage 3a Glomerular Filtration Rate (GFR) 45 To 59 (HCC) Asthma Moderate Persistent (HCC) Age Related Nuclear Cataract Bilateral
Allergies: Lisinopril
Diagnostic Lab Data: SARS CoV-2, PCR, Rapid, V Detected Abnormal
CDC Split Type:

Write-up: CHIEF COMPLAINT/REASON FOR VISIT Shortness of Breath HISTORY OF PRESENT ILLNESS 85-year-old female past medical history significant for multiple chronic conditions. She is presenting to the emergency department today due to worsening shortness of breath over the past couple of days. It was initially exertional but now she is short of breath at rest and requiring 2 L nasal cannula. She does not normally require 2 L nasal cannula. She reports that she does normally take her Breo and albuterol inhalers. She has not been using these over the past few days. Note she is also on warfarin. She denies fevers, chills, chest pain, nausea, vomiting.


VAERS ID: 1787949 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-05
Onset:2021-10-13
   Days after vaccination:250
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hospital Fourth Degree Perineal Laceration During Delivery Encounter For Supervision Of Normal Pregnancy Unspecified Trimester Anemia Pregnancy Counseling Sterilization COVID-19 Infection 39 Weeks Gestation Pregnant Non-Hospital Polycystic Ovary Syndrome Urinary Tract Infection Pregnancy Labor Threatened Premature
Allergies: NKA
Diagnostic Lab Data: 10/13/2021 SARS CoV-2 RNA, PCR, Varies Asymptomatic
CDC Split Type:

Write-up: CHIEF COMPLAINT / REASON FOR CALL COVID Inquiry/OB ICP enrollment Day 0=10/13/21 Information Discussed Patient was called to follow up on her COVID+ diagnosis from 10/13/2021. She reported receiving a positive COVID test result from her screening test for her upcoming c-section scheduled for 10/15/2021. She denied any symptoms at all. No other family members are sick. All other family members are vaccinated except her 2 year old son. Reviewed with patient what to do if she experienced worsening of symptoms or emergent symptoms. Contact number for OB Triage provided. Discussed OB ICP COVID monitoring with patient. She agreed to participation in the program and she was enrolled. A portal message was sent to patient with parameters for normal limits of vital signs. Patient''s address was verified and it was explained that a COVID vital signs monitoring equipment kit would be mailed to her address.


VAERS ID: 1787954 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-04
Onset:2021-10-13
   Days after vaccination:251
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Hyperglycaemia, Mental status changes, Vaccine breakthrough infection
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient admitted with COVID-19 Breakthrough case on 10/13/21. Presented with AMS and hyperglycemia.


VAERS ID: 1787959 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Illinois  
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 - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Headache, Injection site erythema, Injection site pain, Musculoskeletal pain, Nausea, Pain, Palpitations
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (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: Humalog, symbicort, albuterol
Current Illness: None
Preexisting Conditions: Diabetes. Asthma
Allergies: Penicillin
Diagnostic Lab Data: No medical treatment sought yet
CDC Split Type:

Write-up: Continuing headache, nausea, palpitations (1.5 hrs s/p shot) diarrhea (day 2 s/p shot) red raised pain at injection site, body aches, fatigue, left scapular pain (5 min after shot lasting 24 hrs)


VAERS ID: 1787987 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: North 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 FF2587 / 2 RA / IM

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

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

Write-up: Had headaches immediately after immunization and seen in ED for care and treatment


VAERS ID: 1788002 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Missouri  
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 (MODERNA)) / MODERNA 001C21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered, Extra dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient was given an a dose of Moderna that expired on 10/12/2021 Patient did not have any reactions to our knowledge.


VAERS ID: 1788005 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-12
Onset:2021-10-13
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 6207 / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Respiratory failure
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (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? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted for COVID on 10/13/2021. Currently an inpatient with respiratory failire. Vaccinated with 2 doses of Pfizer COVID vaccine on 4/12/21, and 3/22/21.


VAERS ID: 1788010 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Missouri  
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 (MODERNA)) / MODERNA 001C21A / 3 LA / IM

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

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

Write-up: Patient was administered third dose of Moderna on 10/13/21 but the vial in which the dose was drawn from expired on 10/12/21


VAERS ID: 1788012 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Missouri  
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 (MODERNA)) / MODERNA 001C21A / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered, Extra dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient was given a Moderna dose that expired on10/12/2021 Patient did not have any symptoms to our knowledge


VAERS ID: 1788018 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
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 019F21A / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site pain, Injection site swelling, Injection site warmth, Pain
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling, Pain and warmth at the site of the injection that?s not going away. It?s also causing a dull pain throughout my left arm.


VAERS ID: 1788019 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Missouri  
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 (MODERNA)) / MODERNA 001C21A / 3 RA / IM

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

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

Write-up: Patient received a dose of Moderna on 10/13/21. The vial in which the dose came form expired on 10/12/21.


VAERS ID: 1788020 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Missouri  
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 (MODERNA)) / MODERNA 001C21A / 3 RA / IM

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

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

Write-up: Patient was given a Moderna Dose that expired on 10/12/2021


VAERS ID: 1788026 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Pennsylvania  
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 039D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphasia, Chills, Nausea, Pain, Retching
SMQs:, Acute pancreatitis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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 150 mg q d crestor 300 qhs protonix qhs ? dose lisinopril q d ? dose
Current Illness: none
Preexisting Conditions: hypertension
Allergies: side effect, sick from taking codeine no other allergies
Diagnostic Lab Data: no
CDC Split Type:

Write-up: pt received shot at 9:30 am and experience normal side effects of chills, achy around 10 pm Wednesday am she started nausea and drive heaves. Her sister in law called her on the phone and she reports she was unable to talk. she knew what she wanted to say, but unable to get the words out. Reports she recovered quickly. Event lasted about 15 mins. Did not seek treatment.


VAERS ID: 1788027 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Missouri  
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 (MODERNA)) / MODERNA 001C21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 was given an expired Moderna dose that expired 10/12/2021 Patient has not had any symptoms to our knowledge


VAERS ID: 1788031 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Wisconsin  
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 30155BA / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: The booster dose was given to the patient, and after that, we found out that the time interval between the second dose and the booster is less than 6 months. No side effects or reactions happened to the patient.


VAERS ID: 1788043 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Ohio  
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 (MODERNA)) / MODERNA 026D21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adnexa uteri pain, Anxiety, Arthralgia, Asthenia, Decreased appetite, Dizziness, Dizziness postural, Dysphonia, Dyspnoea, Fatigue, Headache, Heart rate increased, Heart rate irregular, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Lymphadenopathy, Malaise, Mobility decreased, Nausea, Pain, Palpitations, Productive cough, Rash
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (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: metformin, coq10, tizanidine, melatonin, chaste tree berry, baby aspirin, 5htp time release, tylenol, ibuprofen, voltaren gel, fish oil, fibercon, Adderall XR,
Current Illness: none
Preexisting Conditions: PCOS, ADHD, hyperlipidemia, hypercholesteremia, psoriasis,
Allergies: nka
Diagnostic Lab Data: none- stayed home
CDC Split Type:

Write-up: Rapid heart rate 110-135 bpm (baseline heart rate is 80s), frequent heart palpitations (some in a row), heart rate speeds up and slows down intermittently / seems irregular at times/ seems to beat harder and softer intermittently in the same minute, dizziness for 2 days especially when rising from laying even if slowly, severe joint pain in all joints (feet, ankles, hands, wrists, knees, hips, entire spine from neck to sacrum, Ovary pains off cycle time, nausea, anorexia, headache, lymph node swelling and pain, body aches, malaise, fatigue, general sense of doom as if something bad is very wrong, anxiety, standing and walking is painful and takes all energy to perform. Mild Skin rash on hands (possible flare of eczema or psoriasis, however this condition became much worse since having COVID19 in 01/2021 and vaccines 08/31/21 and 10/13/21). Some breathing changes, such as more mucus production and was unable to take as deep of a breath and noted voice changes. Injection site hot, swollen, red, very painful and unable to use arm for most activity.


VAERS ID: 1788056 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Indiana  
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 FF8839 / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Decreased appetite, Feeling abnormal, Headache, Pain in extremity, Skin warm
SMQs:, Dementia (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: Muralax, Clopidogrel, Candesartan, Levothyroxine, Omeprazole, Amlodipine, Anastrozole, bone supplement (vitamin), multivitamin and mineral supplement, magnesium, Atorvastatin.
Current Illness: None.
Preexisting Conditions: Stroke, high cholesterol, thyroid disease, breast cancer (post radiation).
Allergies: Penicillin.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: She got her vaccine, her arm hurt and did not have any appetite. Her head hurt, her 98.7 and normal 97.1 and also had chills. When she gets a fever she gets strange thoughts. She did not feel like she wanted to vomit, she just did not want to eat. She had to force herself to drink water as she did not want to, but knew that she had to. She did not eat for the whole day or night, but on Thursday was drinking some. She has had coffee today, still not hungry but feeling better. Her arm is getting better, but not as bad as it did. Her head has cleared and not fuzzy feeling like it was. She had called the ER at where she got the vaccination, they told her that they could not help her with her side effects and to go to a satellite office or the ER. Her arm was warm when she called them, but not necessarily swollen.


VAERS ID: 1788058 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-11
Onset:2021-10-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 59267-1000-01 / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 58160-0887-52 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Atrial fibrillation, Chills, Dizziness, Dizziness postural, Dyspnoea, Heart rate irregular, Hyperhidrosis, Injection site pain, Myalgia, Palpitations
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PEPCID; VITAMIN D3
Current Illness: None
Preexisting Conditions: History of atrial fibrillation lasting less than 24 hours on 02/09/2005 and 12/24/2008 during influenza illnesses despite receipt of influenza vaccine
Allergies: Penicillin
Diagnostic Lab Data: None. In addition to the above, prior to the episode above, I had experienced in the first 36 hours after the vaccines severe generalized myalgias, arthralgias, a temperature (measured once at 100.4 degrees F.), chills, and injection site pain. These had all resolved for approximately 18 hours before the atrial fibrillation occurred.
CDC Split Type:

Write-up: I experienced what I believe to be atrial fibrillation (irregularly irregular pulse, intermittent pounding in chest, SOB with exertion, and intermittent dizziness and diaphoresis). Since I have had atrial fibrillation twice in the past with influenza illness, I did what I have been instructed to do in the past in case of recurrence. I took Carvedilol 6.25 mg. Five hours later, after going to bed, my symptoms reduced to an irregular heartbeat (but not what I believed to be atrial fibrillation) with mild intermittent dizziness when standing. I repeated the Carvedilol dose 12 hours after the first. My heartbeat was regular 16 hours after the episode


VAERS ID: 1788070 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-21
Onset:2021-10-13
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient swabbed at our clinic, please contact primary care provider.
Current Illness: Patient swabbed at our clinic, please contact primary care provider.
Preexisting Conditions: Patient swabbed at our clinic, please contact primary care provider.
Allergies: Patient swabbed at our clinic, please contact primary care provider.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient vaccinated and then tested positive from COVID-19


VAERS ID: 1788080 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Ohio  
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 FE3590 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site reaction, 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: Accidentally gave the patient an undiluted injection of the Pfizer Covid vaccine. Checked in with the patient and they were feeling fine. The only reaction was a localized reaction on the arm at the injection site. Nothing different from a properly administered dose.


VAERS ID: 1788092 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Colorado  
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 035C21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Breast pain, Breast tenderness, Lymph node pain, Lymphadenopathy, Nipple pain
SMQs:, Lipodystrophy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Swelling and pain in left armpit lymph nodes, left breast, and nipple. Previous breast implant incision site tender/painful to touch despite being over 4 years old.


VAERS ID: 1788121 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-21
Onset:2021-10-13
   Days after vaccination:265
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 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: 10/14 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1788185 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-10
Onset:2021-10-13
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 LA / 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: Pt had a positive covid test


VAERS ID: 1788196 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Georgia  
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 (MODERNA)) / MODERNA 006C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
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: sertraline, trazodone
Current Illness: none
Preexisting Conditions: anxiety, depression
Allergies: yeast
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Situation: Moderna COVID-19 Vaccine Dose 2 administered too soon Background/Risk Factors: Patient scheduled for dose 1 of COVID Vaccine on 09/22/21. Unclear how patient had second dose appointment scheduled on 10/13/21. For unknown reason (not documented in chart) patient received dose 7 days after first dose. Assessment: Vaccinator must look at vaccine record card or database to ensure appropriate timeframe between first and second dose. Response/interventions: Patient notified that dose administered too soon. Per CDC guidance, doses inadvertently administered earlier than the grace period should not be repeated.


VAERS ID: 1788197 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Indiana  
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 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Chills, Diarrhoea, Fatigue, Hyperpyrexia, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: High fever 1 day Chills Nausea Fatigue Diarrea


VAERS ID: 1788249 (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: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH A173696 / UNK RA / IM

Administered by: Work       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ethosuximide, Valerean Root
Current Illness:
Preexisting Conditions: Seizure disorder, MS
Allergies: Strawberries, Vicodin, Tylenol c Codeine
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient woke up at 0430 with hives/welts all over trunk and legs. She took 100mg of Benedry and sypmtoms resolved slowly over the next 12 hours


VAERS ID: 1788262 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Puerto Rico  
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 FF8841 / 2 LA / IM

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

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

Write-up: At the moment during the event at the church on 10/13/2021 patient received, PT of 92 years old. Patient''s family member completes the consent indicating that PFIZER was administered and the nurse proceeds. At the office and nurse proceeds to the verification in vaccine page but the page was disabled to check information. When the vaccine page worked, I was able to confirm the patient''s information and indeed her first two doses were MODERNA. During the observation period the patient did not present adverse or secondary effects. The immediate action I took to avoid future incidents was to check the information on the vaccination cards before they proceed to the vaccination. The procedure was carried out when receiving patients is to request their identification, medical plan and vaccination card, they proceed to make a copy (this was stapled on the back of the consent) and they are vaccinated.


VAERS ID: 1788268 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-02
Onset:2021-10-13
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A, 000000 / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: CHF, Hyperlipidemia, CAD, CKD, Parkinson''s, paroxysmal, A-fib, Dementia, Hypertension.
Allergies: No Known Allergies
Diagnostic Lab Data: COVID positive
CDC Split Type:

Write-up: Patient stated he was sent in by nursing home due to being COVID positive. 88% room air and does not normally use oxygen. cough.


VAERS ID: 1788269 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
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 30145BA / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Feeling hot, Induration, Pain in extremity, Peripheral swelling, Swelling, Swelling face
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: Patient mentioned went to the Doctor''s office on 10/15/21 morning with the above side effects and Doctor prescribed two AntiBiotics ie.Bactrim DS and Cephalexin 500mg BID for 7 days.
CDC Split Type:

Write-up: starting from 10/13/21 evening at 3 pm, patient felt swollen arm so took a tylenol at that night and 10/15/21 at 2:30 am patient had left arn, left side of the neck and left side of the face swollen. ANd arm felt hard and hot. Felt pain when touch or move the arm.


VAERS ID: 1788278 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Indiana  
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 30155BA / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adverse event, Arthralgia, Feeling hot, Myalgia, Pain, Pyrexia, Vaccine positive rechallenge
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Same type of adverse event; 66;3/26/21; COVID-19 MRNA, Pfizer
Other Medications: Acetaminophen Anastrozole Atorvastatin Calcium (Lipitor) Cetirizine (Zyrtec) Famotidine Indapamide Levothyroxine (Synthroid or Levothroid) Omeprazole DR 40 Venlafaxine (Effexor)
Current Illness: None
Preexisting Conditions: Hypothyroidism High Cholesterol High Blood Pressure GERD
Allergies: Penicillin
Diagnostic Lab Data: Not applicable.
CDC Split Type:

Write-up: ADVERSE EVENT: Approximately 6 hours after the shot, I began feeling feverish, although my temperature remained at its usual level of 97.6 degrees. I also began experiencing joint and muscular pain. The following morning, (10/14/21) the joint and muscle pain was intense and my temperature was beginning to go up. My first check was around 9 a.m. and it was 99.8. At approximately 7 p.m. it reached it peak level of 101.2 and began to slowly decrease. At 10 p.m. it was 100.6; at 11 p.m. it was 100; at midnight it was 99.2. The next day, Friday, Oct. 15, I felt much better; the joint and muscle pain was almost completely gone, I didn''t feel feverish anymore, and at 9 a.m., my temp was 99.3. it continued to decline and by 1 p.m. it was back at my normal level of 97.6. TREATMENT: I treated the fever, aches, and pain with 650 mg acetaminophen every 6 hours, beginning at 9 a.m. 10/14/21. OUTCOME: Recovered after=effects of booster shot in approximately 36 hours.


VAERS ID: 1788337 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Texas  
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 301308A / 1 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Improper Storage (temperature)-


VAERS ID: 1788345 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Texas  
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 301308A / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Improper Storage (temperature)-


VAERS ID: 1788400 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Michigan  
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 FF2589 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Hyperhidrosis, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Systemic: Flushed / Sweating-Medium, Systemic: Tachycardia-Medium


VAERS ID: 1788430 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-08
Onset:2021-10-13
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249, EM9810, / 3 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, 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: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes, Hypertension, RA, A-fib
Allergies: Betadine, Sulfa drugs
Diagnostic Lab Data: COVID positive
CDC Split Type:

Write-up: SOB, Fever.


VAERS ID: 1788471 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Texas  
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 301308A / UNK AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Improper Storage (temperature)-


VAERS ID: 1788475 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-10-05
Onset:2021-10-13
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Basal ganglia haemorrhage, Computerised tomogram head, Intraventricular haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Duloxetine, lisinopril, pregabalin, zolpidem, amitriptyline, medical marijuana
Current Illness:
Preexisting Conditions: peripheral neuropathy, hypertension
Allergies: Eszopiclone, bee venom, nitrofurantoin, lamotrigine
Diagnostic Lab Data: CT head 10/13/21 CT head 10/14/21
CDC Split Type:

Write-up: Found down, found to have basal ganglia hemorrhage with intraventricular hemorrhage. Cause unclear. Patient has well controlled blood pressure in the community and at presentation. No family history of brain hemorrhages. No evidence of ischemic stroke with hemorrhagic transformation. MRI pending, but already had extensive CT imaging.


VAERS ID: 1788478 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Texas  
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 301308A / UNK AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Improper Storage (temperature)-


VAERS ID: 1788486 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Iowa  
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 FD0810 / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Diarrhoea, Dizziness, Flushing, Headache, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sulfasalazine, Omeprazole, Minocycline, Effexor, Losartan, Metoprolol/HCTZ, Synthroid
Current Illness: none
Preexisting Conditions: High Blood Pressure, Reiters syndrome, Crohns Disease
Allergies: Morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever of 100, horrible body aches, headache, dizziness, diarrhea, chills, flushing


VAERS ID: 1788508 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-11
Onset:2021-10-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fatigue, Migraine, Pain in extremity, Product preparation issue, Pyrexia, Skin warm, Speech disorder, Tenderness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: On 10/11/21, Nurse inadvertently retrieved an undiluted vial of COVID-19 vaccine from the shelf of the vaccine room. The undiluted vial of COVID-19 vaccine was sitting out to thaw to room temperature for the appropriate time period before dilution. The nurse then drew up 0.3mL of the undiluted vial of COVID-19 vaccine and administered it to Shayla Chavis at 4:12pm in her left deltoid intramuscularly. was given 800mg of ibuprofen at 4:41pm, observed for 30 minutes. left the office in stable condition. At 8:00pm, CPNP called to see how she was doing. She stated she was doing fine, and was instructed to call with any concerns. was advised to keep hydrated and take 800mg ibuprofen every 8 hours as needed. On 10/12/21 at 8:48am, Clinical Manager called to see how she was doing - complains of sore L arm, sensitive to touch, and also hot to the touch. she feeling tired but with no fever. On 10/14/21 at 8:29am, Clinical Manager spoke again. she states she has had a migraine x2 days/"head feels dizzy", has taken ibuprofen and acetaminophen but headache has not improved. states speech is not right - she feels like she is talking very fast. Also, she states that she had a fever yesterday of 102.3F. has tried to get in touch with her physician but unable to get in touch or get a response. Clinical Manager discussed these symptoms with a Pediatrics provider and advised to go to ER. Relayed advice to mom and mom agrees to be evaluated by ER.


VAERS ID: 1788513 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Arizona  
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 30145BA / UNK LA / IM
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. 312838 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Injection site pain, Nausea, Pain in extremity, Pyrexia, Taste disorder, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No prescriptions / only dietary supplements such as calcium
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa and some forms of penecillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: By the evening of the first day, both arms were sore at the injection site and running slight fever. Slept o.k. through the night with the help of Tylenol Breakfast the following morning didn''t taste quite right By about 11:45 a.m. felt nausiated(October 13th) vomiting by about 1:00 p.m, dizzy, fever


VAERS ID: 1788551 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Oklahoma  
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 (JANSSEN)) / JANSSEN 1822811 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Hyperhidrosis, Injection site rash, Injection site swelling, Injection site warmth, Myalgia, Pain, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Janssen COVID-19 Vaccine EUA On Oct 13 Vaccinated at 12:45. Swelling and hot skin around injection site beginning late afternoon on first day. Super tired and went to sleep around 7 pm. Increasing body aches through the night. On Oct 14 Discovered a rash had formed a few inches around the injection location at 6 am. Extremely tired, severe muscle aches in torso, arms, & legs. Low grade headache all day, and vision became blurred for several hours in late afternoon. Slept most of the day due to fatigue. Alternating chills and sweating starting late afternoon, and throughout the night. On Oct 15 at 6 am the rash, swelling, headache were gone. Aches subsiding and no chills since 8 am.


VAERS ID: 1788597 (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: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
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: atorvastatin, aspirin, multivitamin, lamotrigine, escitalopram, risperidone
Current Illness:
Preexisting Conditions:
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was administered Pfizer vaccine based on the self-attestation, provided by the LTC home where they reside. The home administrator provided the signed vaccine administration questionnaire and the self-attestation. Later, upon entering the information into our system and performing the additional verification (something we do as part of our data tracking), the pharmacist discovered that the patient had completed her COVID19 vaccine series in March, however, with Moderna, not Pfizer. Boarding care/patient was notified immediately, patient has been monitored since and has no complaints of adverse reactions.


VAERS ID: 1788608 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-14
Onset:2021-10-13
   Days after vaccination:272
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL92261 / 2 LA / IM

Administered by: Senior Living       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: ALbuteraol, Amidarone, Eliquis, ASA, Ca Carbonate, aricept, Proscar, Flovent-HFA, Lasix, Imdur, Lutein, melatonin, metoprolol tartrate, MutilVit, Prilosec, Dilantin, Zocor,Flomax, Spiriva
Current Illness: N/A
Preexisting Conditions: Seizure disorder, COPD Primary, Atrial Fibrillation, BPH, CKD Stage 3, Esophageal Reflux Hyperlipidemia Insomnia Osteoarthritis Paroxysmal Nocturnal dyspnea Right Thyroid Nodule S/P Closed FX of Atlas S/P MI S/P Odontoid FX wth nonunion Seasonal allergies Seizure LewyBody Dementia without behavioral disturbance
Allergies: Penicillin, Adhesive tape
Diagnostic Lab Data: PCR test 10/13/21
CDC Split Type:

Write-up: Testing positive during facility outbreak testing


VAERS ID: 1788625 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-08-27
Onset:2021-10-13
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 3 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Blood test, Microembolism, Pulmonary embolism
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Pulmonary hypertension (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: CONTINUE these medications which have NOT CHANGED Details acetaminophen (TYLENOL) 325 mg tablet Take 1 tablet (325 mg total) by mouth every 8 (eight) hours as needed for mild pain., Starting Fri 7/9/2021, No Print cholecalciferol, vitam
Current Illness:
Preexisting Conditions: liver transplant status, SVR hep C, hypertension
Allergies: nafcillin
Diagnostic Lab Data: CTA chest, blood draws
CDC Split Type:

Write-up: COVID19 Pfizer on 8/27/21 (EW0187), 2/14/21 (EL9261), 1/24/21 (EL9262) in Left deltoid for each, administered at Hospital Hospitalized for new acute bilateral PEs showering, unprovoked.


VAERS ID: 1788635 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-23
Onset:2021-10-13
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 UN / SYR

Administered by: Public       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: Unknown
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Positive Covid test 10/13/2021


VAERS ID: 1788650 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-14
Onset:2021-10-13
   Days after vaccination:272
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL92261 / 2 LA / IM

Administered by: Senior Living       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: Keppra, Levothyroxine, Mobic, mecaptopurine, Prilosec, Sennokot, Maxide
Current Illness: N/A
Preexisting Conditions: CKD Constipation E03.9 Hypothyroidism Estential Hypertension GERD Hepatitis autoimmune Hx of compression fractures Hx of seizure Hx of Subdural hematoma Hyperlipidemia Insomnia Obesity osteoarthritis of both knees PVD S/P CVA
Allergies: Azathioprine, codeine, tylenol
Diagnostic Lab Data: Covid-19 PCR test
CDC Split Type:

Write-up: Tested Covid positive during facility outbreak testing


VAERS ID: 1788697 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Idaho  
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 (MODERNA)) / MODERNA 076C218 / 1 LA / IM

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

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

Write-up: Dose given exceed BUD


VAERS ID: 1788704 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-01-27
Onset:2021-10-13
   Days after vaccination:259
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Respiratory symptom, 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: n/a
Current Illness: n/a
Preexisting Conditions: none
Allergies: n/a
Diagnostic Lab Data: + COVID Abbott test on 10/15/21
CDC Split Type:

Write-up: 2 day h/o mild URI sx, + COVID Abbott test on 10/15/21


VAERS ID: 1788706 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Nevada  
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 FF8841 / 2 RA / IM

Administered by: Senior Living       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: Incorrect amount of diluent used. Used 0.5 ml instead of 1.8 ml. Administered 0.3ml dose from the incorrect concentration.


VAERS ID: 1788741 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-11
Onset:2021-10-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain lower, Abdominal pain upper, Appendicectomy, Appendicitis, Blood test, Computerised tomogram, Facial discomfort, Headache, Hypoaesthesia, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Motrin 800 mg Melatonin 10 mg
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin
Diagnostic Lab Data: Cat scan blood tests surgery
CDC Split Type:

Write-up: At 1st got headache then body aches, woke up the next day (tuesday 10/12/2021) with a fever 100.05 and 1/2 my face felt numb and strange. Woke up the next day (weds 10/12/2021) and had a stomach ache that slowly progressed to a severe pain in lower right abdomen area. Had to be taken to the ER and was diagnosed with appendicitis and had my appendix removed the next day (thursday 10/14/2021). Ive never had an issue with my appendix prior to this


VAERS ID: 1788950 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-08
Onset:2021-10-13
   Days after vaccination:278
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: covid test on 10-13-21
CDC Split Type:

Write-up: 10-13-21- tested for covid due to exposure- 10-15-21 positive result. Low grade fever 99.4


VAERS ID: 1789126 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Utah  
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 012F21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood lactate dehydrogenase increased, C-reactive protein increased, Chest discomfort, Chest pain, Electrocardiogram ST segment elevation, Headache, Nausea, Pain, Pyrexia, SARS-CoV-2 test negative, Serum ferritin increased, Troponin I increased, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ondansetron
Current Illness: None
Preexisting Conditions: obesity BMI 34
Allergies: None
Diagnostic Lab Data: Troponin I (10/14 @ 00:16): 9.02 ng/mL, peaked at 13.18 on 10/15 @ 11:16 CRP 9.2mg/dL on 10/15 at 00:16 EKG with diffuse ST elevation on 10/14 at 22:24 LDH 273 unit/L on 10/15 @ 6:38 Ferritin 409 ng/mL on 10/15 @ 6:38 SARS-CoV-2 PCR (Cephid) negative 10/15
CDC Split Type:

Write-up: Symptoms: 24h after vaccine developed headache, body aches, fever, nausea, vomiting. 48h after vaccine developed chest pain and tightness.


VAERS ID: 1789140 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-27
Onset:2021-10-13
   Days after vaccination:259
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Diarrhoea, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: simvastatin; Qvar; Flurometholone suspension; prednisolone
Current Illness: none
Preexisting Conditions: Diabetes mellitus, type II. Hyperlipidemia. Chronic kidney disease, stage IIIa. Alzheimer''s dementia. Asthma. Gastroesophageal reflux disease. TCCA of bladder, a) partial cystectomy 1983, b) radical cystoprostatectomy with ileal conduit 2013. Prostate cancer, radical cystoprostatectomy 2013.
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: He has mild chonnic cough and diarrhea which has not changed. No other infectious symptoms. started 10/13/21 comes in for a COVID test after his son was tested positive for COVID 2 days ago.


VAERS ID: 1789150 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-27
Onset:2021-10-13
   Days after vaccination:259
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Diarrhoea
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amiodarone HCl 200 MG Tablet 1 tablet Orally Once a day Losartan Potassium 50 MG Tablet 1 tablet Orally two times a day hydroCHLOROthiazide 12.5 MG Capsule 1 tablet in the morning Orally once a day Warfarin Sodium 2.5 MG Tablet 1 t
Current Illness: none
Preexisting Conditions: Paroxysmal atrial fibrillation. Hypertension. Hyperlipidemia. Polymyalgia rheumatica. Gastroesophageal reflux disease. Irritable bowel syndrome. Peripheral neuropathy. Allergic rhinitis. Pericarditis with pericardial effusion 2009. History of microscopic hematuria - negative IVP in 1999.. Osteopenia. Adenomatous colonic polyps. Lumbar spinal stenosis.
Allergies: lipitor; crestor; prevacid; lisinopril
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient has been having 2-3 loose stools for 4 days and ocassional cough but no fever, sore throat or SOB. starting on 10/13/21 her son was tested positive for COVID 2 days ago. Husband tested positive 10/15/21


VAERS ID: 1789158 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-11
Onset:2021-10-13
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Exposure to SARS-CoV-2, Extra dose administered, SARS-CoV-2 test positive
SMQs:, Medication errors (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Humira; Methotrexate; Folic acid; Prednisone
Current Illness: none
Preexisting Conditions: rhematoid arthrisis multiple sites
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received 3rd Pfizer booster on 10/11/21; exposure at work, tested positive on 10/14/21, asymptomatic


VAERS ID: 1789173 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-10-13
   Days after vaccination:13
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: Work       Purchased by: ?
Symptoms: Heavy menstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Menorrhagia


VAERS ID: 1789317 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Minnesota  
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 039D31A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Decreased appetite, Fatigue, Headache, Injection site rash, Injection site urticaria, Nausea, Pain, Pyrexia, Rash erythematous, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DULOXETINE; CYCLOBENZAPRINE; GABAPENTIN
Current Illness: None
Preexisting Conditions: Chronic pain
Allergies: None
Diagnostic Lab Data: Covid test done 10-14-21 and was negative.
CDC Split Type:

Write-up: Bright red rash at injection site approximately 5 inches in length and 2.5 inches wide with hives located near injection site, fever of 100.6 degrees for 50 hours post injection. Severe body aches and chills for 48 hours, extreme fatigue for 48 hours, headaches for 48 hours, nausea, and loss of appetite for 48 hours. Red rash, hives, and itching at injection site still present at 72 hours post injection. Body aches 72 hours post injection. BENADRYL, IBUPROFEN, and TYLENOL for treatment.


VAERS ID: 1789494 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-01
Onset:2021-10-13
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Taken to hospital via ambulance and administered anti seizure meds.
CDC Split Type:

Write-up: Seizure on 10/13/2021.


VAERS ID: 1790078 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2021-10-13
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Off label use, 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: Comments: Patient had no known allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211025885

Write-up: VACCINE ADMINISTERED TO A 17 YEAR OLD; OFF LABEL USE; This spontaneous report received from a pharmacist concerned a 17 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: Patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 212A21A expiry: 21-DEC-2021) dose was not reported, administered on 13-OCT-2021 for prophylactic vaccination. No concomitant medications were reported. On 13-OCT-2021, the patient experienced vaccine administered to a 17 year old. On 13-OCT-2021, the patient experienced off label use. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the vaccine administered to a 17 year old and off label use was not reported. This report was non-serious.


VAERS ID: 1793537 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF839 / UNK LA / SYR
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. 312871 / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Influenza
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad)

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

Write-up: severe flu symptoms, slowly getting better and treating OTC medicine


VAERS ID: 1793554 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 - / IM

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

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

Write-up: ADMINISTERED DOSE FROM EXPIRED VIAL


VAERS ID: 1793564 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3813 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest pain, Headache, Lymphadenopathy, Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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: Zoloft 100mg daily Famotidine 40mg daily
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Left side lymphadenopathy Chest pain Stiff neck Headache


VAERS ID: 1793576 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-18
Onset:2021-10-13
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram abdomen, Computerised tomogram thorax abnormal, Echocardiogram, Fibrin D dimer, Pulmonary embolism, Ultrasound Doppler, Vena cava thrombosis, Venogram
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: diabetes
Preexisting Conditions: diabetes
Allergies: none
Diagnostic Lab Data: CT PR chest and abdomen 10-12-2021 echocardiogram 10-12-2021 bilat leg doppler, 10-12-2021 ct venogram 10-13-2021 d-dimer 10-12-2021
CDC Split Type:

Write-up: saddle pulmonary emboli, IVC clot


VAERS ID: 1793607 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

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

Write-up: Patient''s wife called on 10/14/21 stating that patient has been experiencing intermittent paralysis starting 10/13/21 after returning home from receiving the COVID-19 vaccine at our pharmacy. Pharmacist advised patient''s wife to take patient to hospital for further evaluation. Unknown if patient went to hospital or now.


VAERS ID: 1793619 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-10-11
Onset:2021-10-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE 3592 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dysgeusia, Hypoaesthesia, Hypoaesthesia oral
SMQs:, Peripheral neuropathy (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Sexual dysfunction (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: gabapentin, zinc, tylenol, cymbalta, zyrtec, vitamin d 3 -125 mcg, magnesium citrate
Current Illness: None
Preexisting Conditions: Chronic nerve and muscle pain-NTOS
Allergies: Fresh water fish allergy
Diagnostic Lab Data: none
CDC Split Type:

Write-up: At 48 hours felt front tip of tongue and 1/2 back numb. Metallic taste with liquids and solids. Dizziness at times


VAERS ID: 1793635 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast pain, Chills, Decreased appetite, Headache, Injection site swelling, Lymphadenopathy, Pain, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Lipodystrophy (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: Multi vitamin, calcium. Omega3, vitaminD3, acidophilus, Tirosint 13 MCG
Current Illness: None
Preexisting Conditions: Fibrocystic breast disease
Allergies: Lactose, stone fruits, melons, apples
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph node and injection site, radiating to breast. This was so bad that I was not able to move my arm without a severe ache/pain and went on for several days. Also uncontrollable shivering caused me to lie in bed and under covers for about 8 hours. If I moved any part of my body the shivering would return. Headache, loss of appetite were not too bad none


VAERS ID: 1793636 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Pharyngeal swelling, Swelling face
SMQs:, Anaphylactic reaction (narrow), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid
Current Illness: none
Preexisting Conditions: low back pain
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: swelling of face and throat


VAERS ID: 1793637 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Headache, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, sore arm, body aches, joint paint, chills, headache, and fatigue


VAERS ID: 1793656 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 1 LA / IM

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

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

Write-up: Pt came in seeking moderna vaccine dose #1. Did not realize till after vaccination that pt completed 2 dose Pfizer series


VAERS ID: 1793680 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FR3950 / 3 RA / SYR
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR 49281-0121065 / N/A LA / SYR
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 00006-4837-03 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Condition aggravated, Erythema, Injection site pain, Myalgia, Pain, Pain in extremity, Peripheral swelling, Sjogren's syndrome, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Lacrimal disorders (narrow), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine; OSTEO Bi-Flex; CoQ10; turmeric; CULTURELLE - probiotic; calcium; Vit D; famotine
Current Illness: No
Preexisting Conditions: Sjogren''s; Raynaud''s; Hypothyroidism - Grave''s Disease; Celiac disease
Allergies: Celiac - anything with gluten; sulfa; horseradish
Diagnostic Lab Data: No
CDC Split Type: vsafe

Write-up: I had tiny pain at the injection right away and then about 2 hours later, I had considerable muscle pain in that right arm (I have pain in both but the right arm swelled more and turn red on the flu side of the arms) - all of my joints and most of my muscles - and even the bottoms of my feet hurt. Everything hurt. At night I couldn''t sleep. My eyelids stuck together to my eyes - it might have set off my Shogrens. It was very severe pain in my body. The pressure against the bed was even painful. It was hard to find a comfortable spot. Today I still have muscle pain in both arms. It''s minor now. That pain throughout my body stopped about noon the day after vaccines - it lessened by midday and now it still hurts in my arms and arm joints. Mostly muscle pain. No treatment.


VAERS ID: 1793690 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Slight fever after my 2nd dose
Other Medications: Melatonin, Vitamin B
Current Illness:
Preexisting Conditions:
Allergies: Neomycin
Diagnostic Lab Data: None, other than taking my temperature at home - the values are noted in Item 18.
CDC Split Type:

Write-up: On Day 2 (the day after the vaccine), I had a fever that wavered between 100 and 101 and was not very responsive to Tylenol. Also had aches and chills for the entire day. On day 3 (2 days after the vaccine), my fever dropped to between 99.3 and 100 and I was not achy, but have had a malaise and heaviness in my chest that has been persisting (I''m now on day 5).


VAERS ID: 1793691 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Erythema, Injection site erythema, Injection site swelling, Pain in extremity, Peripheral swelling, Skin exfoliation
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (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: Very recent large cut on finger that happened the previous day to vaccination. It''s not infected but may be worth noting.
Preexisting Conditions: Undifferentiated connective tissue disorder. An ongoing autoimmune condition that is hard to pinpoint. Asthma is also ongoing. I have very high antinuclear antibodies and high inflammation levels. However, my doctor cleared me to get the vaccine.
Allergies: Latex, carrots, celery, gluten, mold, and birch pollen.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Extreme swelling and pain of left arm, to the point where it is 2x the size of the right arm in some places. The skin in the left armpit is extremely red and peeling whereas the right armpit is unchanged, so it''s unlikely it''s a reaction to soap or deodorant. The injection site itself is very red and swollen but it''s to be expected. As time goes on from the vaccination date the swelling is getting worse, and the pain is more localized to the armpit instead of the entire arm.


VAERS ID: 1793729 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site pain, Pain, Rash erythematous, Tenderness
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (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: Synthroid 77mcg liothyrodine 5 mg Apri birth control
Current Illness:
Preexisting Conditions: Crohn''s disease, hypothyroid
Allergies: Latex, seasonal
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red rash, raised painful sore spot at injection site the size of an apricot or small apple, painful when arm is lifted or touched at injection site. Symptoms have persisted for 4 days.


VAERS ID: 1793739 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-10
Onset:2021-10-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram abnormal, Myocarditis, Troponin decreased
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Myocarditis. Patient presented with chest pain, troponin leak, and EKG findings consistent with myocarditis. Symptoms stabilized and troponins were down trending. Was able to discharge safely home.


VAERS ID: 1793802 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Neck pain, Swelling, Vaccine positive rechallenge
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 01/30/2021, Moderna (030L20A), same adverse event
Other Medications: Atorvastatin 20mg x 1 (morning) Eliquis 5mg x 2 (morning and evening) Losartan 100mg x 1 (evening) Metroprolol 25mg x 1 (morning) Synthroid 0.05mg x 1 (morning) Multi-vitamin x 1 (morning) Vitamin B-complex x 1 (morning) Vitamin D3 50mcg x
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: No medical tests or lab results
CDC Split Type:

Write-up: Severe neck pain lasting 3+days and starting to abate on the 4th day. Swollen area on back of neck, possibly lymph nodes. This was my third dose of Moderna vaccine. I experienced the same adverse event following my first dose of Moderna vaccine (030L20A) on 01/30/2021 at the same Pharmacy.


VAERS ID: 1793819 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 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 reported
Allergies: NKDA/NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received Moderna Dose 1 on 09/22/2021. the 2nd dose was given a week early on 10/13/2021. Pt was contact post covid vaccine but no response.


VAERS ID: 1793848 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site mass, Injection site warmth
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: diphenhydramine, acetaminophen
Current Illness: none
Preexisting Conditions: diabetes
Allergies: none listed
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: LUMP IN AREA OF INJECTION ON LEFT ARM, WARM TO TOUCH RED APPEARANCE , RESOLVED IN 48 HOURS AFTER TAKING DIPHENHYDRAMINE AND ACETAMINOPHEN


VAERS ID: 1793916 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Full blood count, Influenza virus test, Pain, Pollakiuria, Pyrexia, SARS-CoV-2 test, Urine analysis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

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

Write-up: Fever of 103, fatigue, urinary, frequency, body aches x48 hours after vaccine


VAERS ID: 1793931 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-07
Onset:2021-10-13
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Pulmonary congestion, Sensation of foreign body
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Started as a feeling of swelling or lump in my throat that I couldn?t clear with swallowing and couldn?t clear my lungs. Coughing to the extent I would bend over but still couldn?t clear my lungs.
Current Illness: None absolutely none
Preexisting Conditions: None
Allergies: Levoquin opioids
Diagnostic Lab Data:
CDC Split Type:

Write-up: No treatment as medical people dismiss anything related to the vaccine. ? it can?t be vaccine related ?


VAERS ID: 1793938 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

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

Write-up: Big red rash all over my torso and keep expanding towards my back and legs


VAERS ID: 1793939 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Headache, Hypersomnia, Injection site pain, Injection site swelling, Injection site warmth, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: rosuvastatin, methotrexate, folic acid, Insolar (nicotinamide to reduce risk of skin cancer), gabapentin, hydroxychloroquine, Vitamin B-12, Vitamin D-3, Helioplex (reduce risk of skin cancer), buPROPion, multi-vitamin, melatonin
Current Illness:
Preexisting Conditions: elevated cholesterol (well managed with meds), osteoarthritis, recent Dx of rheumatoid arthritis, anxiety disorder (well managed), skin cancer
Allergies: Lexapro, latex
Diagnostic Lab Data: None
CDC Split Type:

Write-up: pain/swelling/heat at site; low-grade temp (99.3), chills, joint and muscle aches, fatigue, headache. Treatment: slept entire day after the vaccine. Much improved by that night and symptoms gone the next morning (except for mild pain at vaccination site).


VAERS ID: 1793966 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Limb discomfort, Myalgia, Oropharyngeal pain, Sneezing, Vaccination site reaction
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (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: Bupropion
Current Illness:
Preexisting Conditions:
Allergies: Penicillin, honeydew, cantaloupe, insect bites, bees stings
Diagnostic Lab Data:
CDC Split Type:

Write-up: I started feeling dizzy and my arm felt heavy after 20 minutes. That night my muscles started to ache. My muscles ached intensely for 2 days. The third day, today I have felt foggy and dizzy all day. I started sneezing and have a sore throat. I also have the COVID arm where my injection arm has become warm to the touch, swollen, sore, and red.


VAERS ID: 1794039 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes virus infection, Injection site pain, Injection site swelling, Oral herpes
SMQs:, Oropharyngeal infections (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Opportunistic infections (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: Pepcid, protonix, linzess. Cromolyn sodium as needed
Current Illness: Mast cell activation syndrome. Well controlled
Preexisting Conditions: Mast cell activation syndrome. Well controlled
Allergies: Chicken
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Within 2 hours of receiving my covid booster I developed several severe HSV ?cold sores? on my lip/mouth. They worsened over 2 days. They are now starting to heal. No other symptoms other than mild to moderate pain and swelling at injection site.


VAERS ID: 1794040 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Hyperhidrosis, Myalgia, Pain in extremity, Pollakiuria, 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), 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: Adderall, Junel, citalopran
Current Illness: none
Preexisting Conditions: none
Allergies: Amoxicillin, Keflex
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Spiked a high fever (103.4) with sudden onset chills, muscle soreness, headache and fatigue. Fever reduced after ibuprofen to 102 and persisted for 36 hours. Extreme fatigue, muscle soreness, sweating and increased urination for 36 hours. Symptoms have resolved with exception of persistent fatigue and arm soreness


VAERS ID: 1794076 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Electrocardiogram, Eyelid disorder, Facial paralysis, Hypoaesthesia oral
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Periorbital and eyelid disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D with minerals OTC medication
Current Illness: None
Preexisting Conditions: Obesity
Allergies: NKDA
Diagnostic Lab Data: Assessment by provider and EKG performed
CDC Split Type:

Write-up: The day after vaccination of her second dose of Pfizer, she started to experience numbness in tongue, then two days later, she started to have the left side her face droop including eyebrow and mouth and right eye started to droop with left eye unable to close all the way.


VAERS ID: 1794087 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D2Z1 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Biliary colic, Chills, Diarrhoea, Hepatic pain, Nausea, Vomiting
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gallbladder related disorders (narrow), Biliary tract disorders (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft, Losartan, Vitamins A, C, D3, E, Zinc, Garlic oil, Fish oil, Gingko Biloba, Astragalus, Reishi mushroom (daytime,) Risperdal and Temazepam (bedtime)
Current Illness: None
Preexisting Conditions: Depression and back pain
Allergies: Levofloxacin (rash)
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Diarrhea, Chills, Vomiting, Nausea, liver/ gallbladder pain, and weakness


VAERS ID: 1794112 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-10
Onset:2021-10-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Respiratory infection on 09-10-21
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash


VAERS ID: 1794121 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-10
Onset:2021-10-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Bell's palsy, Computerised tomogram head normal, Double stranded DNA antibody, Facial paralysis
SMQs:, Systemic lupus erythematosus (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine, apixaban, losartan, metoprolol, cellcept, protonix, predisone, prograf
Current Illness:
Preexisting Conditions: lupus, lupus nephritis, kidney transplant, hypertension
Allergies: cefazolin, ciprofloxacin, morphine, penicillins, cefaclor, iodine
Diagnostic Lab Data: CT head w/o contrast (10/13): negative for acute intracranial abnormality dsDNA test (10/14): normal
CDC Split Type:

Write-up: Acute onset of right-sided facial paralysis (Bell''s palsy). Symptoms began 3 days after vaccination. Treatment was initiated with short course of steroids (prednisone 60 mg daily for 1 week).


VAERS ID: 1794138 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dysgeusia, Feeling abnormal, Hot flush, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Dementia (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Mild cold
Preexisting Conditions: Stroke 2001, uterine cancer 2004
Allergies: Ceclor, sulfur, zophran, Benadryl
Diagnostic Lab Data:
CDC Split Type:

Write-up: Intense sweating, chills and hot flashes. Metallic taste in mouth. Had flu vaccine with covid vaccine. Over awful feeling for past 5 days.


VAERS ID: 1794144 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Activated partial thromboplastin time shortened, Cerebral haematoma, Haematocrit normal, Haemoglobin normal, Headache, International normalised ratio increased, Platelet count decreased, Prothrombin time prolonged, Seizure, Venogram abnormal
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Convulsions (narrow), Embolic and thrombotic events, venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Melatonin Trazodone Clonidine
Current Illness:
Preexisting Conditions: Macrocephaly - cutis marmoata telangiectasia
Allergies: Diphenhydramine
Diagnostic Lab Data: MRV with dural venous sinuses patent Hemoglobin 11.8, Hematocrit 34.7, platelet count 143,000 PT 14.9, INR 1.33, PTT 22
CDC Split Type:

Write-up: Headache occurring 2 hours after vaccine administration on 10/13. Morning of 10/15 had seizure. Found to have a right posterior temporal lobe hematoma.


VAERS ID: 1794170 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Injection site erythema, Injection site pain, Lip swelling, Skin weeping, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Calcium Carbonate 600mg, PO daily. Docusate Sodium 100mg at bed PRN. Hydrochlorothiazide 25mg daily. Centrum multi vitamin.
Current Illness: None
Preexisting Conditions: Hypertension. Hypercholesterolemia. Postmenopausal. Colonic polyps. Pre-diabetes. OA of left hip.
Allergies: None
Diagnostic Lab Data: None indicated
CDC Split Type:

Write-up: Reported to urgent care for upper and lower lip swelling which started the morning after getting her 3 pfizer COVID-19 shot (booster). She reported having pain and redness at the injection site with all 3 shots. The 3rd shot had first lower and then upper lip swelling and weeping with tenderness. Vaccine was on the 12 with swelling noted on the 13th. Reported to Urgent Care today on the 17th. The urgent care is part of the hospital system so I can see her booster shot information.


VAERS ID: 1794185 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-08
Onset:2021-10-13
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aphonia, Chest X-ray normal, Chest pain, Cough, Electrocardiogram normal, Head discomfort, Malaise, Peripheral swelling, Pharyngitis, Productive cough
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Agranulocytosis (broad), Angioedema (broad), Oropharyngeal infections (narrow), 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), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 10/13/21 she went to ER and her vital signs were good, EKG clear, and chest xray was clear. 10/16/21 she went to immediate care and they diagnosed her with "pharyngitis" and patient declined COVID test.
CDC Split Type:

Write-up: Few days after receiving 2nd dose of Moderna, patient reports arm swollen, overall sick feeling, coughing, chest pain, lost her voice, balloon head, coughing up bloody mucous. Patient did state she had the first vaccination on 8/10/21 then on 9/ 11/21 she got COVID and received antibody treatment at the hospital on 9/14/21. She has been to ER and immediate care but was discharged from both with no official diagnosis.


VAERS ID: 1794216 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 RA / IM

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

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

Write-up: patient was vaccinated by a technician who inadvertently selected an expired vial and adminstered an inert dose.


VAERS ID: 1794219 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

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

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

Write-up: patient was vaccinated by a technician who inadvertently selected an expired vial and adminstered an inert dose.


VAERS ID: 1794226 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hallucination, Injection site pruritus, Injection site rash, Injection site reaction, Injection site warmth, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall 30mg three times daily, Vyvanse 70mg - one per day , Motegrity 2mg one per day, Rosuvastatin 5mg once daily.
Current Illness: None documented
Preexisting Conditions: ADHD, Chronic Constipation, Hypercholesterolemia
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received Pfizer/BioTech COVID booster shot at approximately 12:30pm on 10/13/21. Patient stated that right arm was slightly sore and that she experienced some mild hallucinations the same evening. The next morning (10/14/21) she noticed what appeared to be an "X" on the right arm where the injection had been administered. She thought it may have been a contact irritation (mentioned possibly a latex reaction) but I advised the patient that we only use non-latex bandages and nitrile gloves during administration of vaccines. The patient continued to monitor the area which was warm to the touch, itchy and continued to grow in size. She presented mid-day to the pharmacy on 10/17/21 to ask the pharmacist their professional opinion of what to do about the reaction. The pharmacist advised the patient that the incident needed to be reported to VAERS for documentation but that the patient could treat the area locally with over the counter antihistamines (i.e. Benadryl, Claritin) and 1% Hydrocortisone. I advised the patient to draw around the borders of the rash to monitor the response to the OTC treatments and that as a precaution she should follow up with her PCP Monday morning 10/18/21.


VAERS ID: 1794228 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

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

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

Write-up: patient was vaccinated by a technician who inadvertently selected an expired vial and adminstered an inert dose.


VAERS ID: 1794248 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Burning sensation, Chillblains, Chills, Echocardiogram, Erythema, Gait disturbance, Inflammation, Insomnia, Lymphadenopathy, Nausea, Neck pain, Odynophagia, Pain, Pharyngeal swelling, Pregnancy test negative, Pyrexia, Rash, Rash macular, Rash vesicular, Skin lesion, Spinal pain, Swelling, Urine analysis
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flu vaccine at age 21, bed ridden with fever, chills, aches for 5 days
Other Medications: Vitamin C, vit E, vit B complex, Vit D, thuja homeopathic, echinacea, ginger.
Current Illness:
Preexisting Conditions: Celiac, small intestinal bacterial overgrowth, ibs
Allergies: Gluten (celiac), dairy
Diagnostic Lab Data: Tested for blood bacteria with blood cultures - negative Pregnancy test and uti - negative Heart ultrasound - normal
CDC Split Type:

Write-up: Tuesday night 10/12 had chills, fever, nausea, whole body inflamed, neck and spine so painful I couldn?t move. Swelling of lymph nodes and throat hurt to swallow. Then Wednesday night 10/13 started excruciating burning sensation in toes and fingers. All extremities turned deep red and developed chilblains. Felt like someone had lit every finger and toe on fire. Couldn?t walk or use hands or feet. Worst pain I?ve ever experienced. Didn?t sleep Wednesday or Thursday night due to pain. Also developed lesions and puss filled cracking red splotches on my face starting Thursday afternoon 10/14. Doctor told me to go to ER Friday morning to check circulation and compromised blood vessels. ER gave me Tylenol and was sent home. Swelling redness and burning sensation in hands feet and face lessened Saturday afternoon and was gone by Sunday with residual blisters and splotches from chilblains. Scheduled doctor appointment to review long term autoimmune side effects.


VAERS ID: 1794259 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Mobility decreased, Pain, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Had chills and fever and achy. Woke up on the floor next to my bed and had a lot of trouble getting back in bed. Had fever most of the day and slept most of the day.


VAERS ID: 1794275 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE2590 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Injection site erythema, Injection site pruritus, Injection site warmth, Rash, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Feeling bad, red rash on chest and back, injection site red, hot and itchy.


VAERS ID: 1794327 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (narrow)

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

Write-up: Tinnitis (fluttering) started a day post booster shot, 8 weeks pregnant due date may 27th, 2022.


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