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From the 6/4/2021 release of VAERS data:

Found 323,133 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 184 out of 3,232

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VAERS ID: 1280332 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / N/A LA / IM

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

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

Write-up: Patient felt dizzy and fainted after 5 minutes of vaccination.


VAERS ID: 1280334 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall XR One a Day women''s multivitamin Lo LoestrinFe SR vegan omega-3
Current Illness: None
Preexisting Conditions: ADHD ASD
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: The worst abdominal cramps I''ve ever experienced to the point where I could not walk over the course of about 8 hours


VAERS ID: 1280351 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-10
Onset:2021-05-01
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Platelet count normal, Pulmonary embolism, Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Embolic and thrombotic events, venous (narrow), Pulmonary hypertension (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atenolol 25mg PO qd, buspirone 10mg PO qd, lipitor 20mg PO dailu, anastroloze 1mg daily, donepezil 10mg daily, memantine 10mg PO bid, vitamins D/B/E.
Current Illness: Frequent falls
Preexisting Conditions: Dementia, HTN, dyslipidemia
Allergies: None
Diagnostic Lab Data: CT Angio with BL PEs; pt with mild thrombocytopenia (150)
CDC Split Type:

Write-up: The patient developed bilateral pulmonary emboli approximately 2-3 weeks after vaccination


VAERS ID: 1280352 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-23
Onset:2021-05-01
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: fusion bariatic vitamin, metformin Zyrtec, singular, Advair, ProAir
Current Illness: no
Preexisting Conditions: asthma, pre-diabetes, allergies, obesity
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt has a golf ball size swelling at site of injection. Slight pain and radiates heat


VAERS ID: 1280388 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Asthenia, Chills, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Mid-grade fever for 18 hours, 2x325 mg acetaminophen about every 4 hours. Fever did not reduce after 4th dosage at 4pm 05/01/2021. General weakness, chills.


VAERS ID: 1280403 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-25
Onset:2021-05-01
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arteriogram carotid normal, Cerebral artery occlusion, Cerebrovascular accident, Coagulation test normal, Computerised tomogram normal, Full blood count normal, Perfusion brain scan abnormal
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (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: Daily marijuana use from dispensary
Current Illness: Neck pain- seen by ortho
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: CT without contrast _ no acute process, CT perfusion- 1. Abrupt occlusion of the right distal M1 and M2 MCA segments, with reconstitution of a few distal MCA branches. 2. Unremarkable CT appearance of the neck arteries., Normal CBC, Normal Coag
CDC Split Type:

Write-up: patient presented to ed on 5/1/2021 with acute stroke, no family history of stroke. P


VAERS ID: 1280441 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / UNK - / IM

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

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

Write-up: Patient received the Moderna vaccine at 16, under the age of 18. Patient and patient''s parent are aware.


VAERS ID: 1280452 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: The patient received a dose of Pfizer vaccine that was out of the 6 hour window since it was reconstituted. The dose was kept refrigerated the entire time, but was out of the 6 hour window. When realized by the pharmacy, patient was notified immediately and per guidelines from supervisors was offered an additional vaccine to ensure full efficacy. Patient declined an additional dose at the time and said he would decide if he wanted to going forward. As of this reporting, patient has not yet received an additional dose. No negative reaction occurred to our knowledge in response to this incident.


VAERS ID: 1280455 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-29
Onset:2021-05-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Nausea, Pyrexia, Retching
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: diltiazem, warfarin, bumetanide, vitamin c and D , krill oil 1000mg, tylenol
Current Illness: None
Preexisting Conditions: IBS for which I receive remicade every 8 weeks - AFIB under control with Diltiazem
Allergies: Penicillin, The great outdoors- tree pollens,
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Chills for 3 hours and nausea (dry Heaves) 100.4 fever


VAERS ID: 1280481 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Headache, Muscle fatigue, Muscle spasms, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 101F fever, chills, extreme headache, extreme shivering, entire body muscle fatigue, muscle spasms


VAERS ID: 1280486 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 2 LA / SYR

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

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

Write-up: 102 degree fever, muscle aches, headache and earache lasting about 36 hours after onset of symptoms. Tylenol helped control symptoms


VAERS ID: 1280487 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A2A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature decreased, Cold sweat, Disorientation, Dizziness, Dyspnoea, Fatigue, Feeling cold, Feeling hot, Head injury, Immediate post-injection reaction, Injection site pain, Loss of consciousness, Malaise, Nausea, Tinnitus
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), 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: Sertraline 150 mg daily THC/CBD
Current Illness: No illnesses
Preexisting Conditions:
Allergies: No known allergies
Diagnostic Lab Data: No one was called. I was not seen.
CDC Split Type:

Write-up: Immediately after receiving the shot I began to have fairly intense pain at injection site. It continued in waves. I began to walk around the store for the allotted 15 minutes. I began to feel very dizzy and faint. My ears began ringing and I didn?t feel well. I stumbled back to the pharmacy to ask for help. At this point I was also feeling like it was very hard to breathe. I explained all these symptoms to the pharmacists on duty and they told me to just sit down. After sitting down I still felt faint but suddenly felt the need to vomit. I stumbled to the bathroom where I collapsed in front of the toilet and passed out twice, striking my head and throat on the bowl. After awaking I was very disoriented and felt very hot and clammy. The pharmacist then came and found me and told me to once again sit down and continue waiting. After sitting down for about 5 more minutes I began to feel less dizzy and was having an easier time breathing. I left the store as the pharmacist was ignoring me and didn?t seem concerned about my symptoms. After arriving home I was tired and week and very very cold. I noted my body temp was lower than usual. I took a nap and then these symptoms continued for about 24 hours. I am now feeling much better.


VAERS ID: 1280533 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Malaise, Pain in extremity, Pallor, Syncope, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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: syncope
Other Medications: - Abilify - Lexapro - Ritalin - Levetiracetam
Current Illness: N/A
Preexisting Conditions: Pt reported history of syncope due to fear of needles. Pt also explained she has hyperthyroidism and anxiety. She is on 4 medications for anxiety.
Allergies: Adhesive
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Pt explained on Covid-19 consent form that she has syncope when seeing a needle. She explained she has an intense fear of needles and has fainted in the past when getting vaccinations. She also explained that she has anxiety. She explained that when she faints it looks like a seizure but it is not. When pt was given shot she was responsive during the needle going in. She was in a seated position. We talked the entire time of administration. After putting the the bandage on her right arm she explained she felt sick(about 40 seconds after injection). She was still responsive for about two minutes then she fainted and her body shook about two times. My coworker and I got her on the ground, she was still responsive enough to ask for a cup of water. Which we gave her, she then went unresponsive for 20 seconds and spilled the water. After this we sat with her on the ground for another 5 minutes and she said she was fine. We helped her to a seated position. We then made her wait another 30 minutes in our waiting area. She assured us she was fine and reiterated that this has happened before in the past anytime a needle was involved. On 5/2/2021 she was contacted and she explained she looked a little pale throughout the day of vaccination, but feels fine now and just has a sore arm.


VAERS ID: 1280537 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Injection site pain, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: headache, muscle aches, pain at injection sight, fatigue, lightheaded


VAERS ID: 1280543 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Alopecia, Dehydration, Fatigue, Injection site pain, Injection site swelling, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Dehydration (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: Trintellix, vyvanse, hydroxyzine, lamictol, ibuprofen, melatonin
Current Illness: N/A
Preexisting Conditions: Anxiety & Depression
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Injection site pain, swelling, muscle aches & fatigue, dehydration, hair loss


VAERS ID: 1280550 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 LA / IM

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

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

Write-up: Vaccine administered by volunteer to an individual less than 18 years of age.


VAERS ID: 1280578 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Exposure during pregnancy, Induced labour, Premature rupture of membranes
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

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

Write-up: Premature rupture of membranes at 34w3d gestation. Treatment= antibiotics, betamethasone injection, labor induction


VAERS ID: 1280674 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chills, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: UNK
Current Illness: N/A
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: ROS: (10+) CONSTITUTIONAL: No fever, no chills, no night sweats EYES: No blurry vision, no loss of vision, no black spots, no curtain of lights. EAR, NOSE, THROAT, MOUTH: No earROS: (10+) CONSTITUTIONAL: No fever, no chills, no night sweats EYES: No blurry vision, no loss of vision, no black spots, no curtain of lights. EAR, NOSE, THROAT, MOUTH: No ear pain, no hearing loss, no ringing in the ears, no nasal discharge, no sore throat, no oral lesions, no dental pain. CARDIOVASCULAR: No chest pain, no syncope, no palpitations RESPIRATORY: No cough, no coughing blood, no shortness of breath GASTROINTESTINAL: No nausea, no vomiting, no diarrhea GENITOURINARY: No dysuria, no hematuria, no discharge MUSCULOSKELETAL: No back pain, no limb pain, Full ROM to all extremities and joints. Nml gait. SKIN/BREAST: hives on forearms and legs, no lumps NEUROLOGICAL: No numbness, no weakness, no dizziness ALL SYSTEMS REVIEWED AND NEGATIVE EXCEPT AS NOTED ABOVE. PAST MEDICAL HISTORY: No significant medical history FAMILY HISTORY: No significant medical history SOCIAL HISTORY: yes tobacco use No alcohol use No recreational drug use PHYSICAL EXAM: (9 systems with 2 per system) CONSTITUTIONAL: No acute distress, A/O x 3, WDWN EYES: PERRLA, EOMI, No redness, no discharge, no vision change. EARS, NOSE, MOUTH, THROAT: TM clear and intact, no nasal discharge, pharynx normal, mucosa moist. NECK: Supple, non-tender, no meningismus CARDIOVASCULAR: RRR, no murmurs/rubs/gallops, peripheral pulses equal and strong bilaterally. RESPIRATORY: Lungs CTAB, no wheezes, rales, rhonchi. Breathing comfortably. CHEST/BREAST: no tenderness, no lumps/masses, no deformities. GASTROINTESTINAL: Soft, non-tender, non-distended, no pulsatile mass GENITOURINARY: exam deferred. LYMPHATIC: no lymphadenopathy, no edema MUSCULOSKELETAL: no deformities, no tenderness, nml gait NEUROLOGIC: CN 2-12 intact. nml UE and LE strength and sensation. No ataxia. Nml gait. No visual deficits. DERMATOLOGIC: hives on arms, No open wounds. PSYCHIATRIC: No psychomotor abnormalities, no gaze avoidance.
CDC Split Type:

Write-up: pt states getting J&J yesterday at 1500 and at 2300 felt fever and chills upon waking noticed hives on arms pt denies N/V/D pt denies change in soap, detergent.


VAERS ID: 1280676 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-10
Onset:2021-05-01
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Military       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: UNK
Current Illness: N/A
Preexisting Conditions:
Allergies: bactrim
Diagnostic Lab Data: ROS: (10+) CONSTITUTIONAL: No fever, no chills, no night sweats EYES: No blurry vision, no loss of vision, no black spots, no curtain of lights. EAR, NOSE, THROAT, MOUTH: No ear
CDC Split Type:

Write-up: Pt called COVID hotline about red small bumps on upper legs. COVID hotline sent pt to ED. Pt had J&J vaccine on April 10.


VAERS ID: 1280786 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

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

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

Write-up: After being vaccinated felt headache, dizzy and nauseous. Notified medical observation staff after his initial 15 minute observation period was over. Vitals obtained, patient assessment performed, give water and observed for an additional 15 minutes. Released after this additional time period.


VAERS ID: 1280809 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / UN

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

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

Write-up: 8 hours after shot developed fever (102) with chills/nausea/headache that has lasted 24 hours


VAERS ID: 1280817 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Exposure during pregnancy, Nausea, Pain, Pyrexia, Somnolence, Uterine spasm
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamin, fish oil, probiotic
Current Illness: None
Preexisting Conditions: None - currently 35 weeks pregnant
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Currently 35 weeks pregnant. Have had no known contact with anyone infected with covid and have never tested positive myself. The morning after my vaccine I felt achy with chills and a fever that reached 101 and slightly queasy. I also had uterine cramping and my belly would get hard - similar to Braxton Hicks contractions which I had not had up until that day and have not had since. For treatment, I slept most of the day and drank lots of water. I did not have much of an appetite but was able to eat a little. The following morning I felt much better.


VAERS ID: 1280918 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / UNK LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None, i had a coffee before but thats it
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hard raised red bump at injection site. About 2x1 inches. Painful to the touch and a bit warm


VAERS ID: 1280923 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal distension, Agitation, Body temperature increased, Decreased appetite, Depression, Eructation, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies: He is allergic to Penicillin antibiotics. He is severely allergic to Timothy Grass, also has allergies to some other trees such as White Ash and Black Walnut. He is also allergic to dust and some other grasses, weeds, and trees. He is also allergic to dogs.
Diagnostic Lab Data:
CDC Split Type:

Write-up: He woke up the day after his vaccine with neurological symptoms such as severe depression and agitation. He then started to have a fever that went from 100 - 103 that lasted a few hours, averaging 101. He was unable to to eat, having some nausea. He also started to have severe bloating in his stomach which started 24 hours after the shot, and would burp incessantly for over 48 hours after the shot.


VAERS ID: 1280948 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Skin mass
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: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Large knot under skin. Swelling, redness, soreness, area surrounding injection site is hot.


VAERS ID: 1280956 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal, Muscular weakness, Nausea, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydroxyzine, sumatriptan, bupropion, ibuprofen, ondansetron, minocycline
Current Illness: Migraine
Preexisting Conditions: Migraine
Allergies: Penecillin codiene nystatin doxycycline marijuana
Diagnostic Lab Data:
CDC Split Type:

Write-up: 14 hours after the vaccine was received, I woke up so uncomfortable, no matter how I moved I couldn?t get comfortable. It was the kind of uncomfortable where I swear I could feel it in my bones. Laid in bed until 8:30 when baby boy woke up, promptly threw up, got so nauseated and dizzy that I could not move from the bathroom floor, and had to ask grandma to bring me my medicines. The mix of ibuprofen, migraine medication, and anti-nausea all combined made me feel no symptoms for several hours until they wore off and I lost all ability to stand. My legs just felt so weak. And now I?m finally starting to feel a little better, and it?s been 2.5 days now. Boy, those side effects are no joke. Still worth it though so I don?t bring a deadly virus home to my baby boy ?????


VAERS ID: 1280973 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-29
Onset:2021-05-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (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: Tinnitus - hearing impaired and ringing in my left ear


VAERS ID: 1280975 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-21
Onset:2021-05-01
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Haematochezia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Duloxetine 90 mg Wellbutrin 300 mg Ibuprofen
Current Illness: None
Preexisting Conditions: Hay fever
Allergies: Latex Lactose intolerance Orange food dye (Cheetos)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fresh red blood in stool lasting the past 3 days, ongoing. Never had this before.


VAERS ID: 1281031 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Fibrin D dimer increased, Pain in extremity, Palpitations, Troponin I increased, White blood cell count increased
SMQs:, Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Troponin I 4.52 D-dimer 0.58, WBC 15.1, EKG - early repolarization, slight ST elevation.
CDC Split Type:

Write-up: The patient received the second dose of the Covid vaccine on 4/30/21, on 5/2/21 at 0230 the patient reported an episode of palpitations, chest pain, and left arm pain that was relieved after 1 hour. On 5/3/21 at 0230 the patient reported a second episode of palpitations, chest pain, and left arm pain that was not relieved, pt presented to the Clinic, to ED at 0340 on 5/3/21, the patient had an EKG and lab work done. Troponin I lab level was 4.52, which is over 100 times the normal limit. Pediatric cardiology was consulted and the patient was sent to Hospital via life flight.


VAERS ID: 1281086 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-29
Onset:2021-05-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abnormal dreams, Diarrhoea, Feeling hot, Flushing, Headache, Tremor, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

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

Write-up: I developed a very bad headache that got worse and worse through the day. Early that night, around 8:30pm, I decided to go to bed to try and sleep off the headache. 2 hours later I woke up after having very intense distorted dreams and began throwing up, had diarrhea, and shaking very bad. I felt flushed and very hot but did not have a fever. This went on for a couple hours.


VAERS ID: 1281272 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Flushing, Hyperhidrosis, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Additional Details: called 911 but patient recovered before paramedix arrived


VAERS ID: 1281316 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-04-13
Onset:2021-05-01
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Gait disturbance, Musculoskeletal stiffness, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), 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: Occasional vitamin d supplements
Current Illness:
Preexisting Conditions: Mild asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue which prevented in walking at normal speed on may 1 and followed by pain with stiffness in thighs on may 2 which prevented in walking normally. Nothing explains these unusual symptoms.


VAERS ID: 1281364 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site erythema, Rash macular
SMQs:, 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: shingles, only rectangular shaped redness at shot location site Fall 2015
Other Medications: omeprozale, welbutrin, zyrtec, singulair, fluctonase
Current Illness: none
Preexisting Conditions: recently saw nephrologist, in stage 2-3 CKD
Allergies: sulfa, neomycin
Diagnostic Lab Data: none yet
CDC Split Type:

Write-up: Saturday 4/1: Extremely tired around 1:00 pm quarter-size redness around shot site Sunday 4/2: lime size redness around shot site, spotty rash down inside of arms, torso, groin, headache in the afternoon


VAERS ID: 1281396 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-06
Onset:2021-05-01
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Vaccine breakthrough infection
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: METOPROLOL TARTRATE 25 MG TABLET GLIMEPIRIDE 4 MG TABLET ASPIRIN 81 MG TABLET,DELAYED RELEASE FUROSEMIDE 40 MG TABLET CINACALCET 30 MG TABLET FERROUS SULFATE 325 MG (65 MG IRON) TABLET ALLOPURINOL 100 MG TABLET VITAMIN D2 1,250 MCG (50,000
Current Illness:
Preexisting Conditions: -CAD -Aortic valve stenosis -Atrial fibrillation -CKD stage III -HTN -HLD -IDDM -Lymphedema
Allergies: CIPROFLOXACIN,Bactrim,Sulfa (Sulfonamide Antibiotics)
Diagnostic Lab Data: SARS-COVID-19 resulted positive 05/01/21 12:06.
CDC Split Type:

Write-up: VAERS PT admitted 5/1/21. SARS-COVID-19 resulted positive 05/01/21 12:06. PT received dose 1 Pfizer vaccine Lot EN6198 on 3/16/21. Dose 2 Pfizer vaccine received 4/6/21 Lot ER8734.


VAERS ID: 1281515 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

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

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

Write-up: Vasovagal episode without syncope. Patient with dizziness and vomiting.


VAERS ID: 1281616 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / SC

Administered by: Other       Purchased by: ?
Symptoms: Erythema, Feeling hot, Pruritus, Rash, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: no
Allergies: none we are aware of
Diagnostic Lab Data: The doctor in the ER didn?t require any tests.
CDC Split Type:

Write-up: 04/30/2021 Before the vaccine, Patient had a small rush on her face-right cheek. 05/01/2021 12:30 am, the same rush on her face expanded, and appeared a big rush on her left leg. 8:am, her face was warm, swollen, red, and itching. A big rush on her lower and upper back; the rush on her leg expanded and is very red.


VAERS ID: 1281629 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abortion spontaneous, Chills, Dizziness, Dyspepsia, Exposure during pregnancy, Headache, Injection site pruritus, Injection site rash, Nausea, Pain, Pain in extremity, Paraesthesia, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Nicole, codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Estimated due date of pregnancy was november 2021. We experienced a miscarriage during the vaccine symptoms of the first shot. The second dose of vaccine was way worse than the first. I got a sore arm, aches, a headache, nausea, a fever, chills, pins and needles feelings in my hands and feet, heartburn, and dizziness. I kept feeling like I might throw up and I developed a great big rash on my arm again, called covid arm. I spent the entire day on the couch next to a bucket because if I got up, I was too light headed and nauseated to do anything. It lasted 24 hours or so. By day 3 after the shot, I felt okay other than soreness, a headache, and a big itchy rash at the injection site. We are concerned about the miscarriage but don''t know if it was or wasn''t related to the vaccine. I did have a big reaction and we wonder if my immune system gearing up targeted the very early fetus as an intruder. We are deeply saddened by our loss.


VAERS ID: 1281655 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

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

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin Losartan Atorvastatin Glipizide Fenofibrate Low dose 81mg x2
Current Illness: No
Preexisting Conditions: Type 2 Diabetes High blood pressure High cholesterol
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I went into the store to receive a tetanus booster shot. The pharmacist administered the shot Letter that evening I received a voicemail from the pharmacist to call. I called the following morning and the pharmacist told me she had given me a moderna Covid vaccine instead. I already had two doses of the Pfizer vaccine the second dose was administered on March 10.


VAERS ID: 1281780 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blindness unilateral, Blood test normal, Computerised tomogram normal, Neurological symptom, Ophthalmological examination normal
SMQs:, Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Finestiride and tamsolosin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 5/1/21 ER visit for 6 hours, blood tests, two CT scans, eye exam, all reports showed no contributing factors to the loss of vision except for the vaccine.
CDC Split Type:

Write-up: At 8 PM on May 1, the day of the vaccination. I experienced loss of vision in my right eye. The loss was the top half of the eye and symptoms were similar to retinal TIA. Loss of vision was complete in the top half and lasted for several minutes. It resolved eventually but I went to emergency room at the request of my eye doctor.


VAERS ID: 1281795 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-08
Onset:2021-05-01
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Chest pain, Echocardiogram normal, Immunoglobulin therapy, Intensive care, Myocarditis, Troponin I increased, Troponin increased
SMQs:, Myocardial infarction (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None; does have an IUD
Current Illness: Seen at urgent care for abdominal pain about 2 week prior to symptom onset. Workup with CT scan was negative for appendicitis and she got better. She has been also receiving treatment for a rash diagnosed as molluscum contagiosum which has been present for several months prior to vaccinations including acyclovir, topical medications and cryotherapy.
Preexisting Conditions: April 2020 had several episodes of syncope that was evaluated with echocardiography and MRI which were negative
Allergies: None
Diagnostic Lab Data: Echocardiogram Normal right ventricular systolic function. Low-normal left ventricular systolic function. M-mode fractional shortening 27% and biplane left ventricular ejection fraction 56%. Troponin 10.89 ng/mL-max troponin I CRP 5.2 mg/dL
CDC Split Type:

Write-up: acute myocarditis; acute onset chest pain; admitted to the pediatric intensive care unit; about to receive IVIG. Chest pain started 5/1/20 about 2 days after her 2nd Pfizer COVID-19 vaccination


VAERS ID: 1281901 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Throat tightness, X-ray
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: asthma
Preexisting Conditions: asthma
Allergies: none
Diagnostic Lab Data: blood/x-ray
CDC Split Type:

Write-up: developed, "strangulation" feeling in throat, thought initially was her "asthma" until it was "worst attack ever"


VAERS ID: 1282150 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aristocort, differin, adoxa
Current Illness:
Preexisting Conditions: ance, adhd, family stress
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt c/o lightheadedness, nausea, pallor


VAERS ID: 1282182 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Joint swelling, Pain, Swelling, Systemic lupus erythematosus
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Systemic lupus erythematosus (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune 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: None
Current Illness: None systematic lupis
Preexisting Conditions: Lupis non systematic
Allergies: Shrimp
Diagnostic Lab Data: Quest lupis showed positive for lupis may 24 2021
CDC Split Type:

Write-up: Sever flare up of Lupus symptoms. Swelling of joints. Pain internal organ swelling. Symptoms sever for four weeks until infusion of drugs. Symptom relief within 2 hours of treatment.


VAERS ID: 1282201 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-05-03
Onset:2021-05-01
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: Vaccine given 1 month prior to 16th birthday


VAERS ID: 1282295 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-04-27
Onset:2021-05-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Catheterisation cardiac abnormal, Chest pain, Dyspnoea, Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Hyperhidrosis, Left ventricular dysfunction, Ventricular hypokinesia, Vomiting
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Testosterone Cypionate 200mg IM q 2 wk; Valacyclovir 500 mg tab 2 tabs daily for 5 days
Current Illness: Genital Herpes
Preexisting Conditions: Asthma, Seasonal Allergies
Allergies: NKA
Diagnostic Lab Data: 5/1 EKG - Anterolateral infarct, acute (LAD) - INTERPRETATION: ST elevation, consider inferior injury 5/1 Echocardiogram - CONCLUSIONS: 1. Left ventricular ejection fraction, by visual estimation, is 30 to 35%. 2. Severely decreased global left ventricular systolic function. 3. Mild to moderately increased left ventricular internal cavity size. 4. Severe global hypokinesis of the left ventricle. 5/1 Cardiac cath - Final Impression: 1. No epicardial coronary artery disease is noted; 2. Severe global reduction in left ventricular systolic function with an estimated ejection fraction of 30%.
CDC Split Type:

Write-up: Awakened at 2 am 5/1/21 with acute onset of chest pain, SOB, and diaphoresis. No cardiac history; no history of similar episode. Reported that, following his second dose of COVID vaccine, he was ill for 1 day with vomiting. Chest pain continued upon arrival to ER 5/1/21 about 7 am. EKG indicated STEMI. Adm with Acute ST elevation myocardial infarction.


VAERS ID: 1282337 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

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

Write-up: patient became pale and was feeling very weak and dizzy. She did not pass out .


VAERS ID: 1282351 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-16
Onset:2021-05-01
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Fall
SMQs:, Guillain-Barre syndrome (broad), Accidents and injuries (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:
Allergies:
Diagnostic Lab Data: ambulance trip to ED, hospitalization
CDC Split Type:

Write-up: weakness/falls


VAERS ID: 1282451 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-06
Onset:2021-05-01
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute kidney injury, Anticoagulant therapy, Asthenia, Computerised tomogram thorax normal, Cystitis, Deep vein thrombosis, Gait disturbance, Oedema peripheral, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (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), Embolic and thrombotic events, venous (narrow), Parkinson-like events (broad), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tumour lysis syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: APRIIN 81MG DAILY, COLACE 100MG BID PRN, SEE PAGE 2
Current Illness:
Preexisting Conditions: DIABETES,CHF,HTN,
Allergies: NO KNOWN ALLERGIES
Diagnostic Lab Data: CONSULT MADE TO VASCULAR SURGEON NO PLANNED SURGICAL INTERVENTION AT THIS TIME WILL PROCEED WITH CONSERVATIVE TR, STARTED ON ELIQUIS 20MG PO BID THEN WILL TRANSITION TO 5MG PO BID,
CDC Split Type:

Write-up: BLE EDMEA/PAIN, GAIT DISTURBANCE, GENERALIZED WEAKNESS PRESENTED TO ER ON 5/1/2021 SYMPTOMS STARTED ON 4/30/2021. SHE WAS FOUND TO HAVE BLE DVT. NO EVIDENCE OF CT PE. REPORTED HAD J&J COVID VACCINE ON 4/6/2021. RECENT HOSPITAL ADMIT FROM 4/28/2021 TO 4/30/2021 WITH ACUTE RENAL FAILURE AND ACUTE CYSTITIS. PT ADMITTED TO MED SURG FLOOR. CALL REC''D FROM PROVIDER NOTIFIING OF RECENT COVID VACCINE AND NEEDED VAERS REPORT COMPLETED.


VAERS ID: 1282483 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-16
Onset:2021-05-01
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, Cerebral infarction, Computerised tomogram normal, High density lipoprotein normal, Hypotension, Low density lipoprotein normal, Magnetic resonance imaging head abnormal, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: MRI Head showing acute infarction in right posterior frontal lobe. LDL of 97 and HDL of 65. BP remained low entire visit, 112/80
CDC Split Type:

Write-up: reported to ER with 1 day history of change in status of left arm weakness/imbalance with walking. Within 1 day symptoms were improving by time of presentation to ER. Ultimately was admitted and found to have an area of 1 to 2cm area of acute infarction in right posterior frontal lobe found on MRI after initial CT scan and other labs were normal.


VAERS ID: 1282670 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood test 5/01/2021
CDC Split Type:

Write-up: after five minutes that I pull vaccine Moderna my face left side numb and my battle lip I put my vaccine 2:30 pm I feel my symptoms at 2:35pm they can''t control it so they transfer me and ambulance to the hospital


VAERS ID: 1282674 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Sensory loss
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad)

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

Write-up: 3:35pm Post vaccination reports sensation loss right arm and fingertips. Medical monitoring w/vital assessment: BP 113/78 P 66 O2 sat 99%, rest, and po hydration. Symptoms resolve, released from facility home w/self


VAERS ID: 1282797 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac failure
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atorvastatin, Bacitracin ointment, carbamazepine, divalproex sodium, enoxaparin, esomeprazole, fluticasone/salmeterol, gabapentin, insulin glargine, isosorbide mononitrate, lisinopril, metoprolol succinate, polyethylene glycol, tamsulosin,
Current Illness: Worsening shortness of breath over the last 4-5 days prior to vaccination, possible pneumonia versus HF exacerbation, hypercapnic respiratory failure and acidosis
Preexisting Conditions: COPD, neuropathy, HTN, hyperlipidemia, bladder cancer, T2DM, paroxysmal afib, obstructive sleep apnea, morbid obesity, HFpEF, recurrent bilateral DVTs, seizures, bipolar disease
Allergies: codeine (shortness of breath), vancoymcin (itching/rash), iodanated contrast media (hives; gets premedication)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt had progressive shortness of breath 4-5 days prior to vaccine administration that resulted in hospital admission and ICU transfer for hypoxic respiratory failure (possible secondary to pneumonia, acute HF exacerbation with fluid overload, etc.). Unclear if related to vaccine given patient''s underlying comorbidities and progressive nature of the respiratory failure starting even prior to vaccine administration.


VAERS ID: 1282930 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: none
CDC Split Type:

Write-up: dose given off label, patient was only 117 years old


VAERS ID: 1283086 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Pt felt nauseous. Did not vomit. Allergy to sulfa. Stats @ 11:34pm: BP: 95/61 HR: 75 O2: 99 RR: 16 Stats @ 11:42pm: BP: 108/60 O2: 100 Pt feeling better. Has not lost consciousness & has not vomited. Symptoms resolved.


VAERS ID: 1283105 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Presyncope, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Vasovagal response (pt fainted). BP: 110/45 HR: 68 All symptoms resolved.


VAERS ID: 1283163 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-22
Onset:2021-05-01
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: Clinic visit on 5/3, no tests given
CDC Split Type:

Write-up: Hive like rash on elbows and knees. Began 9 days after injection on elbows. Raised and itchy. 10th day had spread to both knees and some finger joints.


VAERS ID: 1283185 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: C-reactive protein increased, Chest X-ray, Chest X-ray normal, Chest pain, Chills, Dyspnoea, Echocardiogram, Electrocardiogram ST segment elevation, Full blood count abnormal, Magnetic resonance imaging heart, Metabolic function test abnormal, Myalgia, Myocarditis, Pyrexia, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: EKG, ECHO, Cardiac MRI, CXR, Labs (CBC, CMP, Trop, Inflam markers,
CDC Split Type:

Write-up: Previously healthy 16 year old young man presenting with chest pain admitted for myopericarditis. He was in his usual state of good health until 2 days ago when he experienced fever, chills and myalgias after receiving his 2nd dose of COVID pfizer vaccine. He improved until 5/2 when he developed a crushing, non-radiating, substernal chest pain which was waxing and waning in nature without specific alleviating factors. He had shortness of breath, but no palpitation, dizziness, or changes in pain on exertion vs rest. Family activated EMS who gave 325 mg of aspirin en route to the ED. In the ED, he was afebrile and hemodynamically stable. He was mildly diaphoretic, but otherwise, unremarkable on physical exam. STAT EKG showed ST elevations in V5 and V6 and ST depressions in V1 and V2 as well as PR depressions, which persisted on repeated EKG. Given concern for myopericarditis, they ordered labs including CBC, CMP, troponin and inflammatory markers which were only remarkable for troponin of 1.94 and CRP 3.5. Chest x-ray was normal. Cardiology was consulted and they recommended transthoracic echo which is pending. Cards also recommended starting Ibuprofen 600 mg q8 hrs and admission to cards for further management.


VAERS ID: 1283200 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chills, Computerised tomogram, Confusional state, Dyspnoea, Electrocardiogram, Gait disturbance, Heart rate increased, Muscle contractions involuntary, Supraventricular tachycardia, Tremor
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NP thyroid, Low dose naltrexone, pantoprazole, vitamin D
Current Illness:
Preexisting Conditions: Hasimotos thyroiditis
Allergies: Penicillin, Sulfa, Biaxin, tetracycline, flagyl
Diagnostic Lab Data: blood tests, ekg, chest xray, cat scan
CDC Split Type:

Write-up: My body started to shake and have extreme chills. Muscles kept contracting and I felt couldnt catch my breath. Within minutes I was confused and could barely walk. My husband drove me to ER. When I arrived my Heart rate was 177. They administered medication to bring down heart rate but that did not work enough. Ultimatly they had to shock my heart to bring it back to normal. I was diagnosed with supraventricular tachycardia. I spent the night in the hospital and was released the following morning around 10am.


VAERS ID: 1283418 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Vaccination 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: The information provided on the screening and consent form was filled out incorrectly. The person put that they were born in 2004, but they were born in a different year. They do not meet the FDA age criteria to receive the vaccine.


VAERS ID: 1283459 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

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

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

Write-up: The screening and consent form had the wrong date of birth. The person wrote they were born in a specific year, when they were born in a different year. They did not meet the age eligibility per FDA to receive this vaccine.


VAERS ID: 1283728 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO165 / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Illness, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: About 24 hours after the vaccine, at 2 PM, I had body aches and mild nausea. The body aches and nausea increased over the course of the day and by about 7 PM I also had a mild fever of 99.7 F. I still felt sick and feverish when I went to sleep a little past midnight, but I was fine when I woke up at 9:15 AM.


VAERS ID: 1283967 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-04-11
Onset:2021-05-01
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Follicular non-Hodgkin?s lymphoma
Preexisting Conditions: Follicular non-Hodgkin?s lymphoma
Allergies: Difinity
Diagnostic Lab Data:
CDC Split Type:

Write-up: Syncope


VAERS ID: 1284476 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase normal, Anion gap, Aspartate aminotransferase increased, Basophil count normal, Basophil percentage, Blood albumin normal, Blood alkaline phosphatase increased, Blood bilirubin increased, Blood calcium normal, Blood chloride normal, Blood creatine normal, Blood creatine phosphokinase MB increased, Blood creatine phosphokinase increased, Blood glucose normal, Blood magnesium increased, Blood urea normal, Brain natriuretic peptide normal, C-reactive protein increased, Carbon dioxide normal, Cardiac imaging procedure abnormal, Chest pain, Chills, Cytomegalovirus test, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Eosinophil count normal, Eosinophil percentage, Globulin, Haematocrit increased, Haemoglobin normal, Headache, Hepatitis B core antigen, Hepatitis B surface antigen negative, Hepatitis C virus core antigen, Lymphocyte count normal, Lymphocyte percentage, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Monocyte count increased, Monocyte percentage increased, Myocarditis, Neutrophil count normal, Neutrophil percentage, Pain, Platelet count normal, Protein total normal, Pyrexia, Red blood cell count normal, Red blood cell sedimentation rate decreased, Red cell distribution width normal, Reticulocyte count decreased, SARS-CoV-2 antibody test negative, Vomiting, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (narrow), Haematopoietic erythropenia (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Biliary system related investigations, signs and symptoms (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Obesity
Allergies: None
Diagnostic Lab Data: 5/2/2021 18:58 WBC: 7.49 RBC: 5.49 (H) Hgb: 15.5 Hct: 45.1 MCV: 82.1 MCH: 28.2 MCHC: 34.4 RDW: 12.4 Plt: 205 Differential type: Automated Abs neuts: 4.22 Abs immature grans: 0.02 Abs lymphs: 1.99 Abs monos: 1.10 (H) Abs eos: 0.09 Abs basos: 0.07 Neuts: 56.3 Immature grans: 0.3 Lymphs: 26.6 Monos: 14.7 Eos: 1.2 Basos: 0.9 NRBCs: 0.0 Abs NRBCs: 0.00 Sed rate (ESR): 2 BNP: <10 Magnesium: 2.0 Troponin I: 3.357 (H) Na: 138 K: 3.5 (L) Cl: 99 CO2: 27 Anion gap w/o K: 12 BUN: 12 Creatinine: 0.82 Glucose: 93 SGOT/AST: 37 SGPT/ALT: 18 Alk Phos: 230 Bilirubin total: 1.6 (H) Protein: 7.3 Albumin: 4.4 Globulin (calc): 2.9 A:G Ratio: 1.5 Calcium: 9.0 C-reactive protein: 5.7 (H) 5/2/2021 20:47 Hep B Surface Ag: Negative Hep C Ab: 0.07 Hep B Core Total Ab: Negative Hep B Surf Ab: 0.69 Cytomegalovirus IgG: 1.6 (H) Cytomegalovirus IgM: <0.2 Interpretation: Prior infection,probably not active COVID 19 ab igG: Negative Comment: (note) 5/3/2021 03:30 Troponin I: 4.768 (H) C-reactive protein: 4.4 (H) 5/3/2021 11:00 Troponin I: 6.240 (H) CK: 559 (H) CK-MB: 42.6 (H) Index: 7.6 (H) Interpretation: MB(CK2) is associ... C-reactive protein: 3.6 (H) 5/3/2021 11:00 CK: 559 (H) 5/3/2021 18:45 5/3/2021 18:50 Troponin I: 5.361 (H) C-reactive protein: 2.3 (H) EKG 5/2 and 5/3 with ST segment elevation. Echocardiogram 5/3 with normal function and no wall motion abnormalities Cardiac MRI 5/3 with evidence of myocarditis, no ischemia, normal coronary arteris
CDC Split Type:

Write-up: 16 year old male who got first Pfizer Covid vaccine 4/30, then by the next morning experienced non-bilious emesis for a few hours, as well as fever, chills, body aches, and HA. The body aches and HA continued through today when he began experiencing chest pain while lying down. Chest pain improved on sitting up, standing, sitting forward. No shortness of breath.


VAERS ID: 1284487 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Condition aggravated, Dizziness, Hyperhidrosis, Nausea, Pallor, Respiratory rate increased, Skin warm
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient reported feeling lightheaded status post first dose Pfizer COVID vaccine (Lot: EW0167, expiration date: 08/31/2021) to medic. Medic noted that the client was CAOx4, her skin was pale, warm and slightly moist, pupils were equal, round, reactive to light and accommodating (PEARRL), respiration rate (RR) was 20. The client''s sister stated the client had a history of anxiety and that "she gets this way whenever she gets a shot". Medic walked patient to the zero gravity chair. The client was given water to sip on. At 1213 baseline vitals were taken with client sitting: Blood pressure (BP): 110/82, heartrate (HR): 98, RR: 20, PEARRL. Medic reports she coached the client on her breathing to help alleviate her complaint of feeling lightheaded, mild nausea and anxiety. Client reported she felt anxious prior to her vaccination and that her last oral intake was 15 minutes prior to vaccine. Client denied headache, blurry vision and chest pain. At 1220 a second set of vitals were taken while standing: BP 108/80, HR 86, RR 16, CAOx4. Client stated her symptoms were diminishing. Client''s RR slowed down to normal rate and rhythm, vital signs were trending to normal and client was negative for orthostatic pressures. Client was advised to stay for additional 30 minute observation. Client''s symptoms resolved completely and she was able to ambulate away from observation site without assistance and with a steady gait.


VAERS ID: 1284498 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-01
Onset:2021-05-01
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 2 LA / SYR

Administered by: Other       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: None
Current Illness: None
Preexisting Conditions: Anemia
Allergies: None
Diagnostic Lab Data: Tested positive for COVID-19 on 5/1/2021
CDC Split Type:

Write-up: Tested positive for COVID-19 on 5/1/2021


VAERS ID: 1284509 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-03-29
Onset:2021-05-01
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / N/A LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Body temperature increased, COVID-19, Chest pain, Cough, Dyspnoea, Oxygen saturation decreased, Pyrexia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: COVID positive rapid antigen 2MAY2021 and PCR on 3MAY2021
CDC Split Type:

Write-up: Patient developed COVID symptoms 01MAY2021 (coughing, chest pain, fever, difficulty breathing) and was placed in observation by medics and physician. During initial evaluation vitals: temperature 102.7 ?F, SpO2 95%, RR: 14, BP 132/90 and HR 115. The morning of 02MAY2021, patient had worsening difficulty breathing, lower oxygen saturations (88-92%) and sent to local hospital where he was admitted and found to have rapid antigen COVID test and confirmed with COVID PCR test. Patient was fully vaccinated as he received the vaccination 29MAR2021. Patient received antibiotics, 10L oxygen with non-rebreather mask, fluids and steroids.


VAERS ID: 1284513 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Contusion, Fatigue, Headache, Injection site rash, Lymphadenopathy, Pain in extremity, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Diabetes type II
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Arm soreness, bruising, large rash at injection site thsg got bigger overnight, headache, fever (102 F), chills, fatigue, swollen lymph node in left collarbone,


VAERS ID: 1284715 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-05-01
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210502244

Write-up: HIVES ON THE UNDER SIDE OF BOTH ARMS AND LOWER LEGS; This spontaneous report received from a patient concerned a 39 year old of unspecified sex. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (form of admin and route of admin were not reported, batch number: 043A21A, expiry: UNKNOWN) dose was not reported, administered on 25-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 01-MAY-2021, the subject experienced hives on the under side of both arms and lower legs. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from hives on the under side of both arms and lower legs. This report was non-serious.


VAERS ID: 1284891 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NOT SURE / 2 LA / SYR

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

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

Write-up: I received the vaccine with no issues, within a few hours i experienced a minor headache. I went to class and woke up the next morning cold. I couldn?t get out of bed, I was weak, Nauseous, head was pounding. I was brought 800mg of ibroprofen and a thermometer. I temperature was a 103.7. I monitored my temperature all day long. My fever broke around noon, still sick. Around 3:00pm it returned at a 100.6. I went to bed for the day with the fever after taking more ibroprofen later that day and woke the next morning with a headache but other than that without symptoms. On today (May 4th) I still have a headache, but without symptom.


VAERS ID: 1284931 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Arizona  
Vaccinated:0000-00-00
Onset:2021-05-01
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210502414

Write-up: NUMBNESS IN LEFT LEG; This spontaneous report received from a patient concerned a 53 year old female. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 28-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 01-MAY-2021, the subject experienced numbness in left leg. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from numbness in left leg on 02-MAY-2021. This report was non-serious.


VAERS ID: 1284963 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Joint injury, Limb injury, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Accidents and injuries (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: Shoulder Joint Injury (prolonged pain, tingling, etc.)


VAERS ID: 1285086 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Dyspnoea, Endotracheal intubation, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Interstitial lung disease (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: UTI
Preexisting Conditions: Diabetes, COPD, Hypertension, Gastroesophageal reflux Disease, Obesity, CHF
Allergies: Sulfa Antibiotics
Diagnostic Lab Data: 5/1 COVID test negative
CDC Split Type:

Write-up: Acute respiratory distress, SOB, sats 70%; patient intubated approximately 12 hours after vaccine; extubated on 5/3.


VAERS ID: 1285118 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / -

Administered by: Public       Purchased by: ?
Symptoms: Chills, Headache, Injection site pain, Lymphadenopathy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shot made me very sick
Other Medications: Ammoxicillin and Clavulanate Potassium Tablets
Current Illness: Ear infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen and sore gland under the right arm. Fever. Cold chills. Headache. Body aches. Pain in the area of the shot.


VAERS ID: 1285213 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-02-28
Onset:2021-05-01
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram abnormal, Hysterectomy, Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Uterine and fallopian tube tumours of unspecified malignancy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: OMEPRAZOLE 40 mg as needed, DIVIGEL, 1 mg (ESTRADIOL GEL), PROGESTERONE 100 mg, ALPRAZOLAM . 5 mg all daily.
Current Illness: None
Preexisting Conditions: Gerd
Allergies: Latex
Diagnostic Lab Data: CT scan was completed on 4/16/21 to rule out cancer spread and revealed possible blood clot. On 4/19/21, ED confirmed blood clot.
CDC Split Type:

Write-up: On 2/28/21, had first COVID Shot. On 3/16/21 had Hysterectomy. On 3/30/21 had second COVID shot. On 4/19/21, was diagnosed with blood clot. The doctor reported that it was not the norm for someone my age and with my good health to get a blood clot after a hysterectomy.


VAERS ID: 1285227 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypotension, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Hypotension-Medium


VAERS ID: 1285244 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-01
Onset:2021-05-01
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / -

Administered by: Public       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (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: Shingles


VAERS ID: 1285291 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-29
Onset:2021-05-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Bell's palsy, Drooling, Eyelid function disorder, Facial paralysis, Headache, Hypoaesthesia oral, Mastication disorder
SMQs:, Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), 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), Ocular motility disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: metformin, aspirin, lisinipril
Current Illness:
Preexisting Conditions: diabetic, cholesterol
Allergies: none
Diagnostic Lab Data: emergency room on 5/2/2021. Dr. diagnosis was bells palsy
CDC Split Type:

Write-up: paralysis on left one side of the face, difficulty in closing eyelids and smiling, drooling, difficulty in chewing numbness of tongue, Headache


VAERS ID: 1285305 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metformin, atorvastatin, Escitalopram, glipizide, multivitamin, Zyrtec
Current Illness:
Preexisting Conditions: diabetes, anxiety, asthma,
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt says the next day after taking the vax her right arm has become sore and red from the elbow up to the shoulder. The arm has a lump around the injection site and is warm to the touch. As of today 5/4/21 the redness is gone but it is still warm and sore. Pt has been taking Tylenol but has not helped any. Pt will call her PCP for medical advice.


VAERS ID: 1285323 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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: Frozen shoulder - left arm 2014; right arm 2016
Other Medications: Leothyronine, Levothyroxin, Xaralto
Current Illness: None
Preexisting Conditions: Thyroid, blood clots, mild tinnitus left ear, migraines
Allergies: Avelox, Cipro, penecillin, shellfish
Diagnostic Lab Data:
CDC Split Type:

Write-up: 30-50% increase in left ear tinnitus


VAERS ID: 1285328 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-09
Onset:2021-05-01
   Days after vaccination:53
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary normal, COVID-19, Chest discomfort, Dyspnoea, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cholecalciferol (Vitamin D3) 75 MCG (3000 UT) TABS DAILY VITE (THERAGRAN) per tablet divalproex (DEPAKOTE) 250 MG EC tablet divalproex (DEPAKOTE) 250 MG EC tablet rosuvastatin (CRESTOR) 10 MG tablet tamsulosin (FLOMAX) 0.4 MG CAPS
Current Illness: Undergoing radiation and hormone treatment for prostate cancer Contusion With Intact Skin Surface Of The Right Forearm
Preexisting Conditions: Anxiety ? Benign prostatic hyperplasia without lower urinary tract symptoms ? Carpal Tunnel Syndrome ? Cervical Disc Degeneration ? Cervical Radiculopathy ? Esophageal Reflux ? Hyperlipidemia, acquired ? Hypogonadism ? Nephrolithiasis ? Osteoporosis ? Plantar Fasciitis ? Secondary Polycythemia ? Seizure Disorder ? Sleep Apnea ? Tension-type Headache ? Vitamin D Deficiency ? Elevated liver enzymes ? Nausea & vomiting ? Fever ? Viral gastroenteritis ? AKI (acute kidney injury) ? Paroxysmal A-fib ? Nonintractable generalized idiopathic epilepsy with status epilepticus ? Prostate cancer ? Chest pain
Allergies: GI Upset: Ciprofloxacin, codeine Itching: hydrocodone/acetaminophen; oxycodone/acetaminophen Hives: omeprazole Restless: sulfa antibiotics
Diagnostic Lab Data: 5/1/21 COVID-19 PCR: positive 5/2/21: CT angiogram chest: Minimal streaky bibasilar subsegmental atelectasis. No evidence of pulmonary embolism.
CDC Split Type:

Write-up: Patient diagnosed with COVID-19 even though he was vaccinated -- he states vaccine on 3/9 (registered in system) and 3/30 (this dose was not registered in system). Patient reports that today (5/1/21) heaviness in his chest and felt as if he could not get a deep breath. He initially was worried that he was experiencing a heart attack therefore presented to the emergency department. Because of the shortness of breath Covid swab was done and resulted to be positive. Initial EKG and 2 sets of trop''s are negative. Remdesivir x 2 doses, no steroids, Pt with room air SPO2 of 98% at rest/awake/sitting in chair. Pt w ambulatory SPO2 of 96% .


VAERS ID: 1285329 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Fatigue, Hypoaesthesia, Hypoaesthesia oral, Injection site rash, Injection site vesicles, Myalgia, Nausea, Paraesthesia, Paraesthesia oral, Pyrexia, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 50 mg 1x per day
Current Illness:
Preexisting Conditions: EDS (Ehlers Danlos Syndrome)
Allergies: Sulfa
Diagnostic Lab Data: None needed
CDC Split Type:

Write-up: White blister rash that started at injection site then spread quickly over back, chest, other arm, legs. Light headedness, and tingling and numbness in lips and face. Was given Benadryl 25mg and 2 Tylenol. The rash and numb feeling persisted for 3-4 hours. Several hours later symptoms were followed with a fever and nausea. These symptoms remedied within 24 hours and she was just tired and sore.


VAERS ID: 1285353 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-23
Onset:2021-05-01
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 LA / SYR

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

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

Write-up: Red rash on the tops of both of thighs; the pattern resembled a net or web. It did not hurt or itch or burn, and no other symptoms. Occurred after sitting outside for 2 hours for lunch in the sun (but legs were covered by pants, so not a sunburn). The rash faded slightly and then intensified again over the course of the day/night. The next day it was gone and it has not yet returned. Appeared 8 days after my 2nd vaccine shot (Pfizer).


VAERS ID: 1285364 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-12
Onset:2021-05-01
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 RA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Appendicectomy, Appendicitis
SMQs:

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Farxiga, Januvia, Glimepiride
Current Illness: DM type 2
Preexisting Conditions: DM type 2
Allergies: PCN, Aleve, N Saids
Diagnostic Lab Data: Acute appendicitis
CDC Split Type:

Write-up: Last shot was 4/12/21. On 5/1/21 I was rushed to emergency with acute appendicitis and it was removed 5/2/21. Released home 5/3/21 Horrible experience at 70 years old! Still suffering!


VAERS ID: 1285376 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-01
Onset:2021-05-01
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Induration, Pain, Pain in extremity, Paraesthesia, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), 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: Venlafaxine 150 MG 1 daily
Current Illness: None
Preexisting Conditions: None
Allergies: Medical adhesive
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pain, redness, hardness, itching, swelling, welting, tingling and aching on left arm that has continued to spread after Benedryl. Still continuing after 36 hours.


VAERS ID: 1285396 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Headache, Injection site erythema, Injection site swelling, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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: Iron, amitriptlin, buspirone, venlafaxine, bupropion xl, cetirizine, loratdine, meloxicam
Current Illness: None
Preexisting Conditions: Obesity, asthma, depression, & anxiety
Allergies: Penicillin?s
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, body aches, fever, raised red bump on injection site


VAERS ID: 1285406 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 LA / IM

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

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

Write-up: unauthorized age group no symptoms reported- individual was contacted 5/3/2021


VAERS ID: 1285407 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

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

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

Write-up: Vaccinator administered vaccine to patient, however as she injected vaccine, the needle "popped" apart and disconnected from the syringe, causing the vaccine to splash all over the vaccinator''s glove, and down patient''s arm. It was estimated that the patient received less than half of the vaccine. Consulted Pharmacy team and utilized CDC COVID-19 Administration Errors and Deviations Table to determine a repeat dose needed to be administered. Patient and patient''s mother were informed of all details and decisions, and were in agreement of recommended actions before administration of repeat dose. Patient tolerated well.


VAERS ID: 1285427 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Decreased appetite, Fatigue, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: All symptoms started about 18 hours after second dose. Chills, lasting 3-4 hours Extreme fatigue, lasting for entire day, 16 hours Arm pain at vaccine site Loss of appetite for16 hours


VAERS ID: 1285455 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Headache, Injection site pain, Injection site reaction, Injection site warmth, Myalgia, Nausea, Pyrexia, Rash erythematous, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: in 12 hours began to feel headache, nausea fever of 100 to 101.8 for 2 days straight. Chills so bad my hands were shaking and muscle aches so bad it woke me from sleep. Slept almost 40+ hours in 2 days. on 2nd day got COVID Arm the red rash about 2 inches from the injection site - was 3inches by 4inhes in size and that was hot and tender to the touch. 3 day only had the headache and nausea and all symptons gone by 4th day.


VAERS ID: 1285514 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 10808978 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Laboratory test, Migraine
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Shortness of breath, heaviness of chest, migraine, felt like couldn''t breathe


VAERS ID: 1285588 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Pain, Pain in jaw, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Osteonecrosis (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 Claritin Nasacort
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I experienced sudden onset of fever, chills, severe body aches, severe headache, jaw pain, head pain, and fatigue. Fever and chills lasted 6 hours. Body aches and fatigue lasted 24 hours. Headache lasted 72 hours. I took Tylenol for all of the symptoms.


VAERS ID: 1285590 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-14
Onset:2021-05-01
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Pleural effusion
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shortness of breath Pleural effusion


VAERS ID: 1285617 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-05-01
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebral infarction
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cerebral infarction


VAERS ID: 1285656 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 1 RA / IM

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

Write-up: for 18 y.o. woman who experienced a 10-15 second seizure in observation area. No trauma. Found to have low CBG, history of anemia. No seizure disorder. Alert and talking while waiting for transport.


VAERS ID: 1285861 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-01
Onset:2021-05-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013LZOA / 1 LA / IM

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

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

Write-up: Moderna vaccine given to 17 year old . I asked nurse if this was approved has my daughter is 17 and nurse stated yes Moderna is approved and that they have been giving to other teens


VAERS ID: 1285874 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-30
Onset:2021-05-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Dyspnoea, Echocardiogram, Endotracheal intubation, Respiratory arrest, Skin discolouration
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levothyroxine 50mcg daily; Flonase nasal spray; aspirin 325 mg daily; Prilosec 20mg BID; Zyrtec 10 mg daily
Current Illness: unknown
Preexisting Conditions: hypothyroidism, tetralogy of fallot, Qtc prolongation
Allergies: albuterol, latex
Diagnostic Lab Data: 5/1/21: patient intubated in ED, admitted to ICU, required vasopressors to maintain BP, echo cardiogram completed
CDC Split Type:

Write-up: After taking normal medications prior to bed became acutely short of breath, mother states patients face turned blue then respiratory arrested followed by cardiac arrest. CPR was performed for approximately 10 minutes before pulse returned.


VAERS ID: 1285923 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-21
Onset:2021-05-01
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amylase increased, Lipase increased, Pancreatitis
SMQs:, Acute pancreatitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Phenylephrine - chest pain Amoxicillin - unknown
Diagnostic Lab Data: Lipase significantly elevated 5/1,5/2,5/3,5/4, Amalyse elevated on 5/4
CDC Split Type:

Write-up: Pancreatitis


VAERS ID: 1285994 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-03-31
Onset:2021-05-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: No Adverse Reactions. Moderna was administered to patient while under the age. of 18. No adverse Side effects noted.


VAERS ID: 1286121 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-07
Onset:2021-05-01
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Cough, Dyspnoea, Fatigue, Hypoxia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (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? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amiodarone allopurinol aspirin Lasix Synthroid Metformin coumadin
Current Illness: No acute illness
Preexisting Conditions: Coronary artery disease ? Ischemic cardiomyopathy ? Hyperlipidemia ? Atrial fibrillation (HCC) ? ICD (implantable cardioverter-defibrillator), dual, in situ ? Obesity, unspecified obesity severity, unspecified obesity type ? Amiodarone-induced hyperthyroidism ? Goiter ? Acute respiratory failure with hypoxia (HCC)
Allergies: Atorvastatin Carvedilol Chlorzoxazone lisinopril PCN Rosuvastatin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is a 71 y.o. male with past medical history of a-fib on coumadin, ischemic cardiomyopathy s/p ICD, CAD s/p BM stent 2005, and CKD III who initially presented to urgent care per family recommendations d/t persistent cough, SOB and fatigue. CXR was obtained with findings concerning for viral pneumonia vs CHF, rapid COVID was negative at that time with recommendations to come to ED for further evaluation and treatment. Patient subsequently tested + COVID 19 in ED and was hypoxic with ambulation


VAERS ID: 1286171 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-25
Onset:2021-05-01
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute myocardial infarction, Catheterisation cardiac abnormal, Chest pain, Coronary arterial stent insertion, Deep vein thrombosis, Intracardiac thrombus, Synovial cyst, Ultrasound Doppler abnormal
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: 5/2/21 0040: Left heart catheterization found proximal thrombotic left circumflex lesion 5/3/21 1457: Lower extremity bilateral venous duplex ultrasound found a chronic right gastrocnemius deep vein thrombosis and left Baker''s cyst
CDC Split Type:

Write-up: This patient was admitted on 5/1/21 with chest pain. He was found to have an inferior STEMI with a thrombotic lesion in the proximal circumflex artery that was stented. He was also found to have a chronic right gastrocnemius deep vein thrombosis on a lower extremity ultrasound on 5/3/21. He is currently undergoing a hypercoagulable workup. There is potential concern that the thromboses may have been related to his COVID vaccine, as he received the second dose on 4/25/21.


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