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

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

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 184 out of 8,753

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VAERS ID: 1794748 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (broad)

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

Write-up: Bell''s Palsy


VAERS ID: 1794769 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthma, Blood test normal, Chest X-ray normal, Chest discomfort, Condition aggravated, Cough, Dyspnoea, Electrocardiogram normal, Gastrooesophageal reflux disease, Heart rate increased, Hypertension, Rash, Rash pruritic
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific dysfunction (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol inhaler as needed
Current Illness: none
Preexisting Conditions: asthma, gerd, prostatitis, hemorrhoids
Allergies: sulfites, aspirin, ciproflaxacin, bactrim
Diagnostic Lab Data: EKG, chest xray, blood tests, all normal. BP and heart rate were a little high when initally came to ER.
CDC Split Type:

Write-up: Chest tightness and shortness of breath within 20-30 mins of receiving shot on evening of 10/13/21. Itchy rash on arms, legs and chest within 2 hours, which got better after took benedryl. However, chest tightness, shortness of breath didn''t get much better even though took albuterol. Bad gerd that night. When tightness and shortness of breath and gerd didn''t improve by Saturday morning 10/15/21 and started coughing , I went to urgent care. They sent me in ambulance to the Hospital ER. There I received EKG, chest xray, blood tests, which were normal, and treatment for asthma and gerd. When my symptoms improved I was discharged. I still have some chest tightness, shortness of breath, gerd and cough today 10/18/21.


VAERS ID: 1794814 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Swollen lymph nodes near collarbone.


VAERS ID: 1794847 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-07
Onset:2021-10-13
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Dysstasia, Gait inability, Headache, Migraine, Pain, Urine analysis, Vomiting projectile
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dystonia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril HCTZ 10-12.5 Duloxetine HCL DR 80 MG Bupropion HCL XL 300MG Omega-3 Fish Oil 17.50mg
Current Illness: I felt good at the time of vaccination.
Preexisting Conditions: Chronic pain from 2 disc surgeries around 2003. Hypertension Depression
Allergies: None known.
Diagnostic Lab Data: Hospital ran bloodwork, urine sample and did a cat scan of head and neck
CDC Split Type:

Write-up: Headache started on the evening of October 13th (one week after 1st dose of Pfizer. Thursday morning turned headache into migraine that was so severe meds did not work. Had projectile throw up, which has never happened before. Had to be taken to hospital by ambulance as I could not walk or hold myself up. Was treated in the ER with a cocktail of drugs to ease my pain. Received prescriptions for Ibuprofen (800mg 3 x a day), Acetaminophen 1000mg 3 x daily and cyclobenzaprine.NE 10mg 3 x a day for 10 days.


VAERS ID: 1794865 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Unknown  
Location: Missouri  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Blood electrolytes normal, Blood glucose normal, Chest X-ray normal, Chest pain, Chills, Dyspnoea exertional, Electrocardiogram normal, Full blood count normal, Pain, Renal function test normal, Troponin normal, Urine analysis normal
SMQs:, Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zrytec; Flonase; Zaditor; Multi-vitamin; Junel Fe
Current Illness: None known
Preexisting Conditions: None Known
Allergies: None Known
Diagnostic Lab Data: See above: EKG, Chest x-ray and lab tests all completed on 10/13/21
CDC Split Type:

Write-up: Patient reported to the ED on 10/13/21 stating symptoms of weakness, chest pain, shortness of air with exertion, body aches and chills began that morning. No issues were reported on 10/12/21. EKG was normal. Chest x-ray was normal. Lab testing CBC, Troponin, electrolytes, renal values, urine specimen and glucose were all within normal limits. She was instructed to take OTC medication for symptoms and was dismissed from the ED that same day


VAERS ID: 1794935 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain
SMQs:

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

Write-up: Body Aches all over


VAERS ID: 1795031 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025621A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Ultrasound scan, Vaccine positive rechallenge
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: The first Covid shot brought the same reaction, but to a lesser degree.
Other Medications: Multivitamin, birth control pill, L-lysine, glucosamine
Current Illness: None
Preexisting Conditions: None
Allergies: Cipro
Diagnostic Lab Data: Blood test and ultrasound pending.
CDC Split Type:

Write-up: I woke up with extreme pain in my lymph nodes under my arm. As the day progressed it became more painful and swollen. 6 days later they are still painful and swollen, but have subsided slightly each day.


VAERS ID: 1795040 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-10
Onset:2021-10-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BN / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Nausea, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: probiotics, saw palmetto, magnesium citrate, tumeric, berberine, elderberry, levothyroxine, naltrexone, progesterone
Current Illness: unknown
Preexisting Conditions: PCOS, Hashimotos
Allergies: nkda
Diagnostic Lab Data:
CDC Split Type:

Write-up: nausea, bodys aches, diarrhea, vomiting Pt seen at clinic on 10/18 for persisting nausea given zofran


VAERS ID: 1795050 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-03
Onset:2021-10-13
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthma
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

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

Write-up: 81yr old female presents ambulatory with complaints of asthma. Patient was seen by provider in the clinic yesterday no medication changes made. Husband states he would like patient to be on Z-pak and Prednisone. Patient does not appear to be in distress, oxygen saturation above 90%. Patient has dementia and does not answer all questions. Has been using nebs and inhalers as ordered.


VAERS ID: 1795072 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-06
Onset:2021-10-13
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Confusional state, Exposure to toxic agent, Hypoaesthesia, Loss of consciousness, SARS-CoV-2 test positive, Vaccine breakthrough infection, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HLD, tinnitus, vertigo, meniere''s syndrome
Allergies: no known allergies
Diagnostic Lab Data: COVID test + 10/14/2021
CDC Split Type:

Write-up: Breakthrough COVID. First vaccine 3/16/2021. Pt reports he was sitting on a cardboard box containing toilet paper with his fabric mask on, playing with his phone, waiting to clock out of work. Then suddenly patient loses consciousness and next thing he knows he is on the floor near a spray bottle, which contained a strong chemical. Pt noted he was drenched with the chemical. He endorses the spray bottle, which was stored next to the box, to his knowledge was closed. Patient also reports he did not use the chemical that day. After he recovered his consciousness, he was confused and he could not feel his right hand in noted blurry vision, both which rsolved after he was in the ED.


VAERS ID: 1795088 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-26
Onset:2021-10-13
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood creatinine increased, Blood urea increased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chills, Dehydration, Dyspnoea, Headache, Hypomagnesaemia, Hypoxia, Laboratory test abnormal, Lung infiltration, Lymphopenia, Pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic leukopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Dehydration (narrow), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient reports being Covid + on 10/13/2021. Patient received Pfizer vaccine with 1st dose on 03/05/2021 and 2nd dose on 03/26/2021. Per ED Note: 62-year-old male presents to the emergency department with shortness of breath, body aches, and headache. He states that he tested positive for Covid infection on Wednesday. He also complains of fevers and chills. He denies any associated chest pain. He denies any lower extremity pain or swelling. He denies history of DVT/PE. He does state that he is a liver and kidney transplant patient. He does state that he received both Pfizer vaccine doses 62-year-old male presents to the emergency department with fever, shortness of breath, body aches, headache, and COVID-19 infection. The patient was found to be hypoxic on room air at 86%. He was placed on 2 L supplemental oxygen which improved his saturation into the upper 90s. A chest x-ray and laboratory analyses were ordered for further evaluation. The patient''s chest x-ray revealed bilateral infiltrates consistent with Covid pneumonia. His laboratory analyses revealed a lymphopenia in addition to hypomagnesemia. His magnesium was replaced with 2 g of IV magnesium sulfate. His BUN and creatinine were also slightly elevated consistent with dehydration. The patient will be admitted to the internal medicine service with infectious disease on consultation.


VAERS ID: 1795111 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Injection site bruising, Injection site haemorrhage, Injection site pain, Musculoskeletal stiffness, Neck pain, Pain, Pain in extremity
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Shot bled at time of injection (10:30am) Bruise appeared almost immediately. Shot was given high on the arm. Arm became stiff and pain developed early evening (6pm). Pain radiated across back of neck and down arm causing inability to use arm or sleep that night and the following day. Tylenol helped by the end of the second day pain subsided. Bruise is still very apparent today, day 7.


VAERS ID: 1795135 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-11
Onset:2021-10-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Eye disorder, Vision blurred, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: My second pfizer vaccine was administered to me on Monday October 11th. On Wednesday October 13th I started to notice vision impairment issues with my right eye which got progressively and noticeably worse on Friday October 15th. The vision in my right eye seems to be deteriorating - noticeable vision loss compared to my left eye. My right eye is extremely blurry and has a yellowish tint.


VAERS ID: 1795166 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-03
Onset:2021-10-13
   Days after vaccination:252
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 RA / IM

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

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

Write-up: COVID - 8L HFNC- dex start 10/13 6mg IV q12h ( on chronic prednisone at home) Enoxaparin 100mg q12h afib PPI 40mg daily Remdesivir 10/14-10/17


VAERS ID: 1795186 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-09
Onset:2021-10-13
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Hypoaesthesia, Injection site pain
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Sexual dysfunction (broad)

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

Write-up: Numbness starting in left forearm, 50% of hand strength in lt hand loss, achy injection site, numbness rt forearm, bottom 2 digits of hand, neve ailment


VAERS ID: 1795201 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Face injury, Head injury, Headache, Myalgia, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen, atorvastatin, colchicine, ferrous sulfate, omeprazole, sertraline, ambien
Current Illness: None
Preexisting Conditions: Chronic back pain, anemia, GAD, HLD, obesity
Allergies: sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received pfizer booster vaccine and experienced chills, myalgias, nausea, and headache 2-3 hours following vaccine administration. Twelve hours following vaccine, pt had a witnessed syncopal episode lasting seconds. She hit her left maxilla as a result of syncope. She had resolution of symptoms two days following vaccine.


VAERS ID: 1795253 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-30
Onset:2021-10-13
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 3 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Autoimmune haemolytic anaemia, Bilirubin conjugated, Blood bilirubin, Blood lactate dehydrogenase increased, Coombs test positive, Haemoglobin decreased, Haptoglobin decreased, Reticulocyte count decreased, Transfusion
SMQs:, Haemolytic disorders (narrow), Haematopoietic erythropenia (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine
Current Illness: hypertension, obstructive sleep apnea
Preexisting Conditions: hypertension, obstructive sleep apnea
Allergies: none
Diagnostic Lab Data: hgb=4.6, +Coombs, Tbili=13, DBili=1.6, retic ct=0.48%, haptoglobin<9, LDH=578
CDC Split Type:

Write-up: severe autoimmune hemolytic anemia receiving prednisone, rituximab and transfusions still hospitalized


VAERS ID: 1795297 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-08
Onset:2021-10-13
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 8841 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan Cardizem Armour thyroid Metformin Xyzal Flonase Symbicort
Current Illness: None
Preexisting Conditions: Asthma, hypothyroidism, hypertension
Allergies: Advil
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe dizziness, sweating, vomiting upon waking. Symptoms lasted 36 hours- treated w OTC meclizine.


VAERS ID: 1795338 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-06
Onset:2021-10-13
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

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

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

Write-up: Patient tested positive for COVID on 10/13/2021 after receiving JNJ vaccine


VAERS ID: 1795387 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-10-05
Onset:2021-10-13
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 UN / IM
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. - / UNK UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Flank pain, Herpes zoster, Product administered to patient of inappropriate age, Pruritus, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: ASA 81mg daily Carboplatin 50mg/5ml IV Cetuximab 100mg/50ml IV Calcium 600mg daily Vitamin D3 2000units daily Ferrous sulfate 325mg daily Mag Ox-Vit D3-Tumeric 400mg BID Pravastatin 40mg daily Levothyroxine 100mcg daily metoprolol tartrate
Current Illness: none
Preexisting Conditions: Sinus malignant neopasm, Squamous cell carcinoma in SINUSES AND LUNG METASTASIS. Iron deficiency anemia, Hypertension, hyperlipidemia, Breast cancer s/p mastectomy,
Allergies: Bactrim DS
Diagnostic Lab Data: none, observed clinically
CDC Split Type:

Write-up: Patient developed shingles 8 days after receiving both influenza vaccine( Unknown which flu vaccine) IM and Pfizer COVID vaccine dose #3. She has flank pain, itching, and vescular rash to left flank. She has been rx valtrex and gabapentin.


VAERS ID: 1795475 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 3 RA / IM

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

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

Write-up: none . Vial sent with wrong Expiration date . expired 2 days after vaccine was administered


VAERS ID: 1795478 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Myalgia, Nasopharyngitis, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), 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: vitamin c, vitamin d3, melatonin, zinc gluconate, zofran
Current Illness: Pt tested positive for COVID-19 (PCR) 8/26/21 Pt was hospitalized on 9/5/21 for COVID-19 with Acute hypoxemic respiratory failure - discharge date 9/7/21
Preexisting Conditions: fibromyalgia, HTN, solitary kidney (organ donated to husband) , thyroid nodule,
Allergies: anesthesia, Compazine, narcotics, hay fever,
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received her second dose of Pfizer vaccine 10/13/21 08:00am and has had a fever(102-103.4-F), chills, myalgias, nausea, for over 24hrs. Fever is not responding to APAP, ASA or Motrin. She tried Zofran with minimal relief. Pt is not registered with system and is reporting adverse side effects to PCP office. Vaccine administered yesterday at pharmacy. Patient advised to go to ER due to lack of response to antipyretics and inability to tolerate oral hydration due to nausea. Should I complete a VAERS report? Patient declined suggestion to go to ER for evaluation. She reports the fever broke on Sat 10/16/21 and symptoms improved. She states she now has a cold.


VAERS ID: 1795485 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-30
Onset:2021-10-13
   Days after vaccination:75
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Ageusia, Asthenia, Body temperature increased, COVID-19, Chest discomfort, Condition aggravated, Cough, Dyspnoea, Dyspnoea exertional, Malaise, Myalgia, Nausea, Oedema peripheral, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Coronavirus Testing: 10/12/2021 Positive
CDC Split Type:

Write-up: Pt Admitted: 10/13/2021: Chief Complaint: pt tested covid + today. c/o cough for 1 wk with weakness. fever and SOB over the last day. cancer pt with HOG. History of Present Illness: patient is a 59 y/o female with hx of CAD, HTN, DMII, CKD 3, HLD, melanoma currently receiving chemotherapy through HOG who presented to the ED with cough and SOB. Patient reports she has felt unwell for a week with cough. She reports over the past day she has had SOB as well as low grade temperature to 99.8. She reports chest pressure associated with the SOB today. She reports myalgias and loss of taste. She reports nausea but denies diarrhea or vomiting. She denies sick contacts. She has received both doses of COVID-19 vaccination. She reports chronic LEE which has been worse recently. She denies any history of CHF, orthopnea. She reports she has had intermittent DOE over the past several months. She has an upcoming appointment with her Cardiologist due to this complaint. Today her symptoms worsened with increased weakness and so she presented to the ED. Discharge date: 10/17/2021


VAERS ID: 1795486 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 3 LA / IM

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

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

Write-up: NONE VIAL SENT WITH WRONG EXPIRATION DATE ON BAG NO DATE ON VIAL ITSELF


VAERS ID: 1795518 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-03
Onset:2021-10-13
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chest pain, Diarrhoea, Dyspnoea, Feeling abnormal, Fibrin D dimer, Headache, Hypophagia, Lung opacity, Productive cough, Pyrexia, SARS-CoV-2 test positive, Sputum discoloured, Troponin increased, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Home betamethasone dipropionate 0.05% topical cream, 1 Application, Topical, bid, 2 refills ciprofloxacin doxazosin 2 mg oral tablet, 1 Tablet(s), Oral, Daily, 3 refills latanoprost ophthalmic 0.005% solution, 1 Drop(s), Each Eye, At Be
Current Illness: cystitis
Preexisting Conditions: Anisocoria - R $g L Anxiety disorder Atrial Fibrillation Colon polyp Encounter for monitoring diuretic therapy Erectile dysfunction Heart failure Hypertension Moderate mitral regurgitation Obesity Osteoarthritis Osteoporosis Psoriasis Psoriatic arthritis Recurrent urinary tract infections Thoracic aortic aneurysm
Allergies: Allergies Bactrim (Rash) Contrast Dye (Pt says this made him hot w/ hives)
Diagnostic Lab Data: sx onset 10/13, positive test 10/13 D-dimer 0.33 trop 17 on admission
CDC Split Type:

Write-up: 10/16/2021 82yoM with pmh of A Fib (on warfarin), HTN, HFpEF (EF 59%), and psoriasis who presented to the ED due to shortness of breath. He tested positive for COVID on 10/13, the same day as symptom onset. Symptoms included cough productive of rust colored sputum, HA, and feeling "wheezy". He endorses feeling run down and very weak. His work of breathing became more difficult on 10/15 and he felt as though the wheezing was much worse, which prompted him to present to the ED for evaluation. Endorses subjective fevers, chest pain 2/2 coughing, diarrhea, HA, and decreased po intake. Denies nausea, vomiting, or abdominal pain. Is vaccinated against COVID. CXR 10/16: patchy left sided predominant opacities c/w COVID pna -No oxygen at baseline, now on 2L NC -SpO2 on RA 93-96%


VAERS ID: 1795560 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abortion spontaneous, Arrhythmia, Blood test, Chest discomfort, Chest pain, Electrocardiogram, Exposure during pregnancy, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (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: Zyrtec 4 tablets daily, Montelukast 1 tablet daily, Prednisone as needed
Current Illness: None
Preexisting Conditions: Idiopathic angioedema
Allergies: None
Diagnostic Lab Data: Blood test to confirm miscarriage was completed on 10/15/2021. EKG completed on 10/18/2021. Echocardiogram was ordered for 10/19/2021 for further testing of heart condition.
CDC Split Type:

Write-up: 1st dose of Moderna Covid-19 vaccine was received 09/14/2021. Abnormal heart rhythm with palpitations began on 10/5/21. Symptoms returned intermittently for one week. Second dose of Moderna Covid-19 Vaccine was received on 10/12/2021. Abnormal heart rhythm, palpitations, chest pain and tightness returned on 10/13/21 and persisted daily for one week. Pregnancy (5 weeks) was confirmed on 10/11/2021. Miscarriage of pregnancy occurred on 10/14/2021, 2 days after 2nd dose of Moderna Covid Vaccine.


VAERS ID: 1795565 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sprintec, turmeric, valacyclovir, vitamin D 50,000 IU, glucosamine
Current Illness: None
Preexisting Conditions: None
Allergies: Peas, lentils
Diagnostic Lab Data:
CDC Split Type:

Write-up: I skip my periods with my birth control. Normally that particular week I would have a period, but since I take my pack continuously I do not. A few hours after the vaccine, I started spotting. For my regular spotting, the blood color is normally dark brown. After the vaccine, the amount of spotting has continued to change every day and the color has changed from dark brown to bright red (as if I was on my actual period). This is unacceptable and more women need to know this. I would not have got vaccine if this was a listed side effect. It has been 6 days with this odd bleeding behavior!


VAERS ID: 1796187 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dry mouth, Dry throat, Dysphagia
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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: The client received the 1st Pfizer COVID vaccine (Lot # FF8839 Exp 10/9/21) on 09/22/21. The client reported to RN that within 1
Other Medications: None
Current Illness: Unknown
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 2:08PM the client stated it was "hard to swallow." Vitals obtained at 2:09PM were as follows: BP 158/98, HR 106, O2 98%. RN offered the client Benadryl IM. The client agreed. RN responded for additional support. The client reported that her "mouth is dry, and it''s hard to swallow." The client consented to receive Benadryl IM. RN administered Benadryl 50mg IM (Lot# 020020 exp 02/2022) in the left deltoid at 2:12 PM. The client denied any shortness of breath or dizziness. Reported that her throat was very dry. Repeat vitals obtained at 2:15PM were as follows: O2 95%, HR 98%. The client stated she began to feel saliva in her throat and reported "struggling less to swallow." At 2:18PM the client requested water and stated her throat felt better. RN advised the client to take only a small sip of water. The client reported being able to swallow the small sip of water without difficulty. Blood pressure obtained at 2:19PM was 136/86. At 2:21PM the client reported "a little bit of dryness, the saliva is back." Repeat vitals obtained at 2:24PM were as follows: BP 140/96, HR 96, O2 95%. The client reported "normal dryness" of her mouth and throat. Repeat vitals obtained at 2:30PM were as follows: BP 142/88, HR 96, O2 96%. The client reported that the dryness continued to feel normal and the client denied any other symptoms. RN provided education regarding s/s of anaphylaxis, when to seek EMS, and to follow up with a doctor regarding her blood pressure. The client voiced understanding of this education. Repeat vitals obtained at 2:40PM were as follows: BP 142/88, HR 96, O2 95%. The client denied any current symptoms and stated that the dryness felt normal. The client stated her mother was outside and was going to drive the client home. The client stood up from the anti-gravity chair and ambulated unassisted with a steady gait out of the observation area at 2:42PM.


VAERS ID: 1796348 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-08
Onset:2021-10-13
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstrual disorder
SMQs:

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

Write-up: I am premenopausal and have not had a regular cycle for 2.5 years. My last menstrual cycle was late July and as it has been going, I wasn''t due for another cycle until November or later. However after my 1st shot in September, I started bleeding after 4 days of receiving the vaccine. After my 2nd dose on October 8th, I again started bleeding after 5 days. I haven''t had a consecutive menstrual cycle in years, and to have 2 cycles in a matter of 3 weeks is concerning to me.


VAERS ID: 1797117 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-10-13
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Chills, Feeling hot, Flushing, Headache, Medication error, Muscle spasms, Nasal congestion, Pain
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Hypersensitivity (broad), 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: Abstains from alcohol; Cramps in legs; Kidney failure (kidney failure was on dialysis.); Shingles (Had shingles about a month ago. Have a tiny bit of a rash and a little bit of itching still remaining); Smoker (Vape trying to quit).
Preexisting Conditions: Medical History/Concurrent Conditions: Automobile accident; Coma; Dialysis (kidney failure was on dialysis.); Diarrhea, Clostridioides difficile (Twice); Head injury; Infection; Knee fracture; Wrist surgery; Comments: The patient had history of drug abuse or illicit drug usage (had a substance abuse problem and has been clean for several years).
Allergies:
Diagnostic Lab Data: Test Name: Body temperature; Result Unstructured Data: One degree above normal.
CDC Split Type: USJNJFOC20211029002

Write-up: BODY ACHES; CRAMPING IN LEGS; FEEL HOT; FACIAL FLUSHING; STUFFY NOSE; BAD CHILLS (DREAMING THAT WAS STUCK IN SNOW) / FREEZING AND SHAKING BAD AND UNCONTROLLABLY (FELT LIKE A TRUCK RAN OVER); HEADACHE; POTENTIAL MEDICATION ERROR (ADMINISTRATION OF FIRST DOSE OF MODERNA VACCINE BEFORE JANSSEN VACCINE); This spontaneous report received from a patient concerned a 40 year old male. The patient''s height, and weight were not reported. The patient''s past medical history included: Clostridioides difficile, muscle eating infection in right arm, left wrist surgery, dialysis, coma, hit by a car, head injury, and shattered knee, and concurrent conditions included: shingles, kidney failure, non alcohol user, smoker, and Charlie horses, and other pre-existing medical conditions included: The patient had history of drug abuse or illicit drug usage (had a substance abuse problem and has been clean for several years). The patient experienced drug allergy when treated with haloperidol for drug used for unknown indication. 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 13-OCT-2021 18:00 for prophylactic vaccination. The batch number was not reported and has been requested. Concomitant medications included miRNA 1273 for prophylactic vaccination. On 13-OCT-2021, the patient experienced potential medication error (administration of first dose of Moderna vaccine before Janssen vaccine). On 14-OCT-2021, the patient experienced body aches. On 14-OCT-2021, the patient experienced cramping in legs. On 14-OCT-2021, the patient experienced feel hot. On 14-OCT-2021, the patient experienced facial flushing. On 14-OCT-2021, the patient experienced stuffy nose. On 14-OCT-2021, the patient experienced bad chills (dreaming that was stuck in snow) / freezing and shaking bad and uncontrollably (felt like a truck ran over). On 14-OCT-2021, the patient experienced headache. Laboratory data (dates unspecified) included: Body temperature (NR: not provided) One degree above normal. Treatment medications (dates unspecified) included: paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from bad chills (dreaming that was stuck in snow) / freezing and shaking bad and uncontrollably (felt like a truck ran over), and cramping in legs, had not recovered from body aches, headache, feel hot, facial flushing, and stuffy nose, and the outcome of potential medication error (administration of first dose of moderna vaccine before janssen vaccine) was not reported. This report was non-serious.


VAERS ID: 1797126 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Missouri  
Vaccinated:0000-00-00
Onset:2021-10-13
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Patient had no known drug allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211031599

Write-up: STORAGE OF VACCINE OUTSIDE OF THE RECOMMENDED STORAGE CONDITIONS; ADMINISTRATION OF VACCINE STORED OUTSIDE OF THE RECOMMENDED STORAGE; This spontaneous report received from a health care professional concerned a 23 year old male. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: Patient had no known drug allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 211A21A expiry: 14-DEC-2021) dose was not reported, administered on 13-OCT-2021 for prophylactic vaccination. No concomitant medications were reported. On 13-OCT-2021, the patient experienced administration of vaccine stored outside of the recommended storage. On an unspecified date, the patient experienced storage of vaccine outside of the recommended storage conditions. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the administration of vaccine stored outside of the recommended storage and storage of vaccine outside of the recommended storage conditions was not reported. This report was non-serious.


VAERS ID: 1797664 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-10-08
Onset:2021-10-13
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, Rash, 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: Prilosec 20mg 1x/day
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Flax Seeds
Diagnostic Lab Data:
CDC Split Type:

Write-up: Stomach rash, hive like rash on lower left stomach area. Has lasted at least the last 6 or so days, got slightly worse lately but hydrocortisone cream helps with the itch.


VAERS ID: 1797669 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-27
Onset:2021-10-13
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Hypertension
Allergies: Unknown
Diagnostic Lab Data: PCR test administered on 10/15/2021 at the Hospital.
CDC Split Type:

Write-up: Patient contracted COVID-19


VAERS ID: 1797678 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-11
Onset:2021-10-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Gait inability, Hemiparesis, Transient ischaemic attack, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic 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), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: TIA, inability to walk, transfer, unresponsive for approx 2 minutes with right side weakness.


VAERS ID: 1797719 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-11
Onset:2021-10-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 4696 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymph node pain, Lymphadenopathy, Pruritus, Skin lesion
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ditalizem , Crestor, Claritin, singularity, lexapro, vitamin d , asa,,cozaar
Current Illness: None
Preexisting Conditions: Hypertension hypercholesterolemia, anxiety allergic rhinitis
Allergies: None
Diagnostic Lab Data: 5 by 3 cm supraclavicular left node node enlargement and tenderness. Lacy generalized pruritic raised linear and annular lesions on left side of face left clavicular region bilateral hips left buttocks and left perineal region
CDC Split Type:

Write-up: 5 by 3 mm supraclavicular


VAERS ID: 1797723 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-10-06
Onset:2021-10-13
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Ear pain, Facial paralysis, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Amlodipine, Synthroid, and Effexor
Current Illness: None
Preexisting Conditions: Hypertension, Anxiety, Hypothyroidism, PCOS
Allergies: None
Diagnostic Lab Data: N/A Clinic Appointment scheduled for 11/1
CDC Split Type:

Write-up: I received the 2nd dose on 10/6/21. On 10/13/21 I developed pain in my left ear. I thought I was getting an ear infection. By 10/15/21, my left eye had drooped and the pain was a feeling of "pins and needles." This presentation was similar to my diagnosis of bells palsy with associated neuropathy in 2017. My face had recovered from the episode in 2017 but it seems I am back to looking like a stroke victim at 33!


VAERS ID: 1797755 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-23
Onset:2021-10-13
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Autoimmune Disease Hypertension High Cholesterol
Allergies: Unknown
Diagnostic Lab Data: PCR Test administered on 10/15/2021 at the
CDC Split Type:

Write-up: Patient Contracted COVID-19


VAERS ID: 1797819 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-27
Onset:2021-10-13
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Blood magnesium decreased, Blood test, Colitis, Computerised tomogram abnormal, Diarrhoea, Dizziness, Loss of consciousness, Skin laceration
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Ischaemic colitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune 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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metformin 1000mg daily, Rosuvastatin 40MG, Baby Aspirin, Multivitamin
Current Illness: n/a
Preexisting Conditions: Diabetes type 2, High cholesterol, coronary artery disease
Allergies: N/a
Diagnostic Lab Data: Blood test - 10/13/2021 - magnesium low; CT scan - 10/13/2021 - colitis
CDC Split Type: vsafe

Write-up: I woke up at 3AM with severe abdominal pain and got very lightheaded. I also had diarrhea. Next thing I knew I was on the floor in the bathroom waking up with a bleeding laceration from my scalp. I was taken to the hospital and monitored for about two days. Mostly they gave me a lot of fluid, and an antibiotic as well even though I was tested for infection and I did not have one.


VAERS ID: 1797891 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 RA / SYR
UNK: VACCINE NOT SPECIFIED (OTHER) / UNKNOWN MANUFACTURER - / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased
SMQs:, Neuroleptic malignant 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: flonase, zyrtec, stool softener,
Current Illness: none
Preexisting Conditions: MS
Allergies: penicillin
Diagnostic Lab Data: none that i''m aware of.
CDC Split Type: vsafe

Write-up: I had a spike in temperature 100.4. I went to ER , They gave me ibuprofen . it was about 3 am when my temp went down.


VAERS ID: 1797900 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Impaired work ability, Mobility decreased, Muscular weakness, Pain in extremity, Peripheral swelling, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Reports received first dose of Moderna COVID vaccine on 10/12/21 in left arm. That night began to have trouble sleeping and pain in left arm. The next day left shoulder began to swell, per patient not at injection site but the whole shoulder. Pain began to radiate down left arm and he felt his arm becoming weaker. Patient denies taking any medication for symptoms as doesn''t like meds. Called out of work past 2 days as feels can''t use his left arm to full potential. Today, patient reports the swelling has resolved, the pain is very diminished, but still having some weakness that per patient is slowly improving. Patient reports that he does not feel safe receiving second dose of vaccine in arm as feels it will cause more damage to his shoulders, inquiring if possible to get in gluteal area. Patient denies any incident of fever, chills, shortness of breath, rash. Denies need to seek medical care for issues.


VAERS ID: 1797906 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-08
Onset:2021-10-13
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest X-ray, Dyspnoea
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: severe short of breath - cxr with concern for covid change, hospitalized. fully vaccinated pt


VAERS ID: 1797981 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-15
Onset:2021-10-13
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       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: Allergy medication
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Have Shingles on right side of face.


VAERS ID: 1798020 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-04
Onset:2021-10-13
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Condition aggravated, Contusion, Diarrhoea, Ecchymosis, Erythema, Full blood count normal, Metabolic function test, Muscular weakness, Paraesthesia, Phlebitis, Serum ferritin normal, Swelling, Ultrasound scan normal
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna COVID #1- noted above
Other Medications: none
Current Illness: Reaction to Moderna COVID vaccine #1- 9/6/21- significant left axillary tenderness x 6 days, left arm and leg paresthesia/heaviness
Preexisting Conditions: mild pre-diabetes- new diagnosis, A1c 5.8, no meds. BMI 33-35
Allergies: Niacin- flushing; zinc- GI distress
Diagnostic Lab Data: Negative right arm venous ultrasound on 10/15 for DVT or superficial clots. Normal CBC, ferritin, and CMP on 10/18.
CDC Split Type:

Write-up: Dx with phlebitis of the right arm, starting on morning 10/13, starting with dark line and pulling sensation in ventral right arm. 10/14 noted tenderness at elbow, then progression of lines past elbow to forearm that eve. Sought virtual care on 10/14 AM. Started on 325mg aspirin and 400mg ibuprofen TID, heat, and compression as helpful. No hand or arm edema noted. Follow up on 10/18, bruising resolving, more on forearm, mild localized swelling near ecchymosis. Subjective arm fatigue. Normal radial pulses and cap refill. Plan to continue aspirin for full 7 days, monitor for resolution as symptoms seem to be improving. Continue to keep differential open if other sx occur. Did have stomach pain and 1 episode of diarrhea 10/14- assume food related d/t also in family member. Also stomach pain only 10/16- suspect NSAID related. d/c ibuprofen 10/17. None since. Context -2nd Moderna on 10/4 and flu shot on 9/29 in the right arm. No hx of prior DVT, prior clotting event, or phlebitis.


VAERS ID: 1798029 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-09
Onset:2021-10-13
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: SARS-CoV-2 test negative, Vaccine positive rechallenge
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: 200mg spironolactone + daily vitamins
Current Illness: None
Preexisting Conditions: None
Allergies: Kale/walnuts
Diagnostic Lab Data: Covid test 10/1/2021- negative - prescribed antibiotics and inhaler Urgent care visit 10/13/2021- prescribed steroid shot, oral steroids, antibiotics, inhaler
CDC Split Type:

Write-up: Ongoing facial symptoms carried over from first dose of vaccine (blisters, sensitive swollen face , swollen eye and flaking skin in patches) most recently had a resting heart rate of 100-117 along with severely swollen left eye and re-emergence of mouth sores. (10/13/21) this caused me to seek medical attention once again. Had already finished one dose of antibiotics. Currently received a steroid shot, taking oral steroids, and another round of antibiotics. I am also an avid exerciser, but can no longer exercise without an inhaler. This is only recently.


VAERS ID: 1798155 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Cold sweat, Fatigue, Headache, Impaired work ability
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Effexor Wellbutrin Vitamin B Vitamin D
Current Illness:
Preexisting Conditions:
Allergies: Tylenol
Diagnostic Lab Data: What?s the point? My pcp is so provaccine that it?s automatically ?unrelated?.
CDC Split Type:

Write-up: Day after shot I was cold but sweating, had a headache and severe fatigue. 10/18/21 I missed work because I have all that again AND this awful abdominal pain unlike anything I have ever felt before. Today 10/19/21 it is still here and headache worse.


VAERS ID: 1798223 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: multi vitamins, zyrtec,,pravastatin,clonazepam,melatonin, dexilant, fish oil, icaps ,vt d-3
Current Illness: no
Preexisting Conditions: cholesterol,anxiety
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: its been one week. My arm is still swollen , painful, red/blue( bruised like) and I feel a hard spot in the center


VAERS ID: 1798242 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-13
Onset:2021-10-13
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chest X-ray normal, Gastrointestinal disorder, Inflammatory marker increased, Lung infiltration, Positive airway pressure therapy, Pyrexia, SARS-CoV-2 test, Streptococcus test negative
SMQs:, Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: 10/18/21 ID physician Dr. note: "Pneumonia due to COVID-19 in vaccinated host- Pfizer in March and April of 2021; with fever and GI symptoms on admit, was stable on RA; rapid strep negative. Cxray normal - -$gnow w/ rapid progression since am, bilat infiltrates and markedly increased O2 req''s covid hs PCR with cycle number 20 covid inflammatory labs elevated. Started on remdesivir D3/5; dexamethasone D4/10 anticipated; s/p TCZ x1 10/17; remains on BIPAP. S/p ceftriaxone 10/14-10/15".


VAERS ID: 1798308 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 2 UN / IM

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? 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: Patient presented the day after vaccine administration, with "hives".


VAERS ID: 1798362 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fall, Head injury, Hypotension, Loss of consciousness, Nausea
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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: PATIENT PASSED OUT BRIEFLY AND FELL SHORTLY AFTER VACCINATION. SHE HIT HER FOREHEAD AND WAS FEELING DIZZY AND NAUSEOUS FOR A LITTLE WHILE. HER BOYFRIEND CALLED THE AMBULANCE AND PARAMEDICS ARRIVED SHORTLY AFTER. THEY CHECKED HER VITALS AND FOUND HER BLOOD PAS A LITTLE LOW. THEY MONITORED AND OBSERVED HER FOR A LITTLE WHILE AND DETERMINED THAT SHE WAS OK. PATIENT LEFT THE PHARMACY AFTER RESTING.


VAERS ID: 1798474 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Influenza like illness, Injection site erythema, Injection site induration, Injection site mass, Injection site pain, Injection site rash, Injection site swelling, Injection site warmth, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Effects 150mg, losartin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 24 hours after vaccine (booster) fever,aches,shivering, you like symptoms, swelling and pain at injection side, fatigue, 48hrs after flu like symptoms gone, still having fatigue, large,hard,swollen,feverish knot at injection site, 7 days later severe,bumpy rash at injection site,still very red.


VAERS ID: 1798930 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immunodeficiency, Vaccination 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: Advair Diskus 500/50 1Q12h, montelukast 10mg 1hs, proair HFA prn
Current Illness: none
Preexisting Conditions: Asthma and seasonal allergies
Allergies: NKA
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Vaccine administration error - booster dose given before 6 month minimum. 1st dose 3/31/21, 2nd dose 4/21/21, and booster 10/13/2021. Pt did not have card with her at time of immunization and no record found on state database or store record service. Pt confirmed and signed waiver stating was greater than 6 months, so pharmacist administered based on patient verbal histroy. But upon return to have us fill out COVID card it had not been a full 6 months.


VAERS ID: 1799145 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-11
Onset:2021-10-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (broad)

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

Write-up: Diagnosed with Herpes Zooster (Shingles) as a result of reaction with second dose of Pfizer vaccine.


VAERS ID: 1800584 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-11
Onset:2021-10-13
   Days after vaccination:124
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, SARS-CoV-2 test negative, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin 20 mg po daily Aspirin 81 mg po daily DuoNeb dail Apixiban 5 mg po BID Finasteride 5 mg po daily Nitrofurantoin 100 mg po daily Prednisone 10 mg po daily KCl 20 meq po daily TMP/SMX 800 mg po daily
Current Illness:
Preexisting Conditions: CAD, Congestive Heart Failure, COPD, Dyslipidemia, HTN, Myocardial Infarction; Chronic respiratory failure, 02 dependent 5L OSA- uses bipap, AAA, Atrial fibrillation, CVA. Appendectomy, Other Placement of Stent in Coronary Artery, Cardiac Catheterization; TURP; AAA Repair Tonsillectomy. Smoking Status Former Smoker.
Allergies: Pantoprazole and penicillins
Diagnostic Lab Data: SARS-CoV-19 ANtigen 10/13/2021 (-) SARS-CoV-2 PCR 10/19/2021 (+)
CDC Split Type:

Write-up: Admitted for acute on chronic respiratory failure.


VAERS ID: 1800895 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Influenza like illness, Joint contracture, Loss of consciousness, Mobility decreased, Muscle spasms, Myalgia, Paraesthesia
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Flu like symptoms that led to passing out for approximately two minutes. After coming to my arms cramped and then my hands became contracted like lobster claws. I could move my arms and had some sensation in my fingers, but it mostly felt like pins and needles and I couldn''t move my hands. It took 20 minutes of actively prying my hands against things to flatten them out. Anytime I tried to lift or use my hands they tried to claw up again. That lasted for six hours. I had muscle pain in my hands and arms that was severe for two days and is still mild over a week later now.


VAERS ID: 1800902 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-20
Onset:2021-10-13
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Amnesia, Fatigue, Feeling abnormal, Haemorrhage, Immediate post-injection reaction, Lethargy, Lymphadenopathy, Menstruation irregular, Muscle spasms, Pain in extremity, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Fertility disorders (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Hashimotos, IBS
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediately following vaccine: sore arm, swollen lymph nodes in arm pit, fever, fatigue/lethargy. Symptoms lased 2 days. 3 weeks following vaccine: irregular menstrual cycle. Bleeding lasting 7 days. Cramps lasting 9 days and potentially longer. Patients periods were 3 days with little to no cramping prior to getting the vaccine. Also experiencing brain fog and short term memory loss since 10/5/2021.


VAERS ID: 1800929 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-07
Onset:2021-10-13
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2584 / 3 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily medications
Current Illness: 12 hour cold
Preexisting Conditions: Hypothyroidism; Hypertension
Allergies: IV contrast
Diagnostic Lab Data: COVID test; Flu test.
CDC Split Type: vsafe

Write-up: Break through of COVID virus after receiving all three dose of the COVID vaccine. I had the antibodies infusion.


VAERS ID: 1800991 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Cough, Eyelid pain, Periorbital swelling, Rash, Rash papular
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: The day I received the first dose 10/13/21 I developed a rash/raised skin on my upper right thigh which is still present on 10/20/21. The following days i developed chest tightness and a dry cough intermittently. On 10/18/21 i felt pain under my right eyelid which worsened at night into a visible puffing and swelling under my right eye. By 10/20/21 this area worsened and is extremely swollen/puffy causing problems with vision. Going to see Dr. at 14:00 hrs. on 10/20/21.


VAERS ID: 1801052 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-05-27
Onset:2021-10-13
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, COVID-19, COVID-19 pneumonia, Hypotension, SARS-CoV-2 test positive, Septic shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Neuroleptic malignant 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 (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: type 2 diabets, hyperlippidemia, dementia
Allergies: no known medication allergies
Diagnostic Lab Data: 10/12/21 COVID-19 ANTIGEN TESTING DONE AT HOLSTON HELTH AND REHABILITATION CENTER = POSITIVE
CDC Split Type:

Write-up: 10/13/21 PATIENT SEEN IN THE ER WITH KONWN COVID 19 ILLNESS. REPORTEDLY RECEIVED REGENERON AND DECADRON TREATMENT. PATIENT WITH LOW BP . ADMITTED TO INPATIENT HOSPITAL WITH COVID 19 PNEUMONIA, ACUTE RESP FAILURE DUE TO COVID 19, SPETIC SHOCK, ACUTE KIDNEY INJURY.10/19/21 PATIENT AND FAMILY WOULD LIKE TO NOT HAVE ANY FURTHER INTERVENTION AND WOULD LIKE TO TRNSITION BACK TO CONSERVATIVE TREATMENT MEASURES. ANY ADDITIONAL INFORMATION REGARDING THE OUTCOME SHOULD BE DIRECTED TO REHAB FACILITY. NOTE: NO VACCINE LOT NUMBER WAS ENTERED INTO THE DATABASE. so not able to provide that information .


VAERS ID: 1801055 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Headaches for two or three days


VAERS ID: 1801074 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. - / UNK - / -
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / UNK - / -
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature increased, Extra dose administered, Headache
SMQs:, Neuroleptic malignant syndrome (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Humalog, Lantis, Statin
Current Illness:
Preexisting Conditions: Type I diabetic
Allergies:
Diagnostic Lab Data: I had a Flu shot in the morning, and the pneumonia, Shringrix and 3rd Pfizer Covid shot in the afternoon.
CDC Split Type:

Write-up: Temperatures for three days over 103 degrees. Terrible headache on the first day


VAERS ID: 1801084 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Asthenia, Condition aggravated, Gait disturbance, Mental impairment, Speech disorder, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: Levothyroxin
Current Illness:
Preexisting Conditions: Familial tremors and anxiety caused by the tremors
Allergies: Penicillian
Diagnostic Lab Data: N/A.
CDC Split Type:

Write-up: Familial tremors typically only cause mild hand or leg shaking. Diagnosed with tremors and associated anxiety 5 years ago. After each vaccination shot, the tremors increased to the extent that walking and talking were difficult. Tremor-induced anxiety reduced ability to think. Severe tremors lasted about 12 hours followed by 18 hours of no energy. Normal tremors and energy returned 48 hours after injection. Did not seek medical help.


VAERS ID: 1801227 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-06
Onset:2021-10-13
   Days after vaccination:249
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID19 test 10/13/21
CDC Split Type:

Write-up: Positive COVID19 test 10/13/21


VAERS ID: 1801233 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-13
Onset:2021-10-13
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID-19 pneumonia


VAERS ID: 1801251 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Hypoaesthesia, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: headache, arm pain, finger tingling/numbness,


VAERS ID: 1801255 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Meloxicam Cyclobenzaprine
Current Illness: No known
Preexisting Conditions: Osteoarthritis, muscle pain, Bilateral occipital neuralgia
Allergies: No known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt presents with a fever up to 103.5 F., chills, body aches, joint pain, cough. These symptoms started the days after her booster. Treatment is Tylenol, Ibuprofen, hydration, rest and a short course of Prednisone.


VAERS ID: 1801260 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Chills, Confusional state, Diarrhoea, Dizziness, Dysphagia, Eye swelling, Fatigue, Headache, Hypoaesthesia, Incomplete course of vaccination, Injection site bruising, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Lethargy, Mouth swelling, Nausea, Pain, Paraesthesia, Pruritus, Rash, Swelling face, Swollen tongue, Tachycardia, Throat tightness, Tinnitus, Tremor
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Sexual dysfunction (broad)

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

Write-up: Site: Bruising at Injection Site-Severe, Site: Itching at Injection Site-Severe, Site: Pain at Injection Site-Severe, Site: Redness at Injection Site-Severe, Site: Swelling at Injection Site-Severe, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Mild, Systemic: Allergic: Itch (specify: facial area, extremeties)-Severe, Systemic: Allergic: Itch Generalized-Severe, Systemic: Allergic: Rash (specify: facial area, extremeties)-Severe, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Mild, Systemic: Body Aches Generalized-Medium, Systemic: Chills-Mild, Systemic: Confusion-Mild, Systemic: Diarrhea-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Exhaustion / Lethargy-Mild, Systemic: Headache-Mild, Systemic: Joint Pain-Medium, Systemic: Nausea-Medium, Systemic: Numbness (specify: facial area, extremities)-Medium, Systemic: Shakiness-Medium, Systemic: Tachycardia-Medium, Systemic: Tingling (specify: facial area, extemities)-Medium, Systemic: Tinnitus-Mild, Systemic: Weakness-Medium, Additional Details: Patient states doctor recommends not to receive second dose.


VAERS ID: 1801274 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / IM

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

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

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


VAERS ID: 1801318 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-15
Onset:2021-10-13
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain, Acute kidney injury, Blood lactate dehydrogenase increased, C-reactive protein increased, COVID-19, Chest X-ray abnormal, Cough, Decreased appetite, Fibrin D dimer, Headache, Hypoxia, Lung opacity, Nausea, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: DIabetes type 2, HTN, Hyperlipiemia, Obesity, Chronic kidney disease, Chronic obstructive pulmonary disease, Chronic back pain, Chronic anemia, Seizure, Arthritis
Allergies: ACE Inhibitors
Diagnostic Lab Data: Chest x ray: fine alveloar opacities ; CRP 3.4, LDH 304, D-dimer 0.51
CDC Split Type:

Write-up: Hospitalized for 3 days. Admitted with right-sided abdominal pain, and tested positive for COVID on admission. Reported nausea, decreased appetite, cough and headache. Hypoxic. Given Supplemental oxygen, albuterol inhaler prn, Vit C, D and Zinc. Remdesivir and decadron. Acute renal failure limit nephrotoxic drugs


VAERS ID: 1801367 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 RA / IM

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

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

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


VAERS ID: 1801464 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-10-08
Onset:2021-10-13
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood electrolytes normal, Dehydration, Generalised tonic-clonic seizure, Magnetic resonance imaging head normal, Pyrexia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin XR 150mg daily, fluoxetine 40mg daily, Mg Oxide 400mg daily; prn ibuprofen
Current Illness: None
Preexisting Conditions: Depression; seasonal allergies
Allergies: childhood rash to amoxicillin
Diagnostic Lab Data: Largely unremarkable electrolytes per what ED attending told me, MR brain noncontrast unremarkable. Discharged home with outpatient neurology f/u and plan for routine EEG.
CDC Split Type:

Write-up: First generalized tonic clonic seizure the morning of 10/13 while hiking; no prior h/o seizure. Febrile to ~102F on 10/9, low grade elevated temperature ~100F overnight preceding seizure. Suspect multifactorial (on wellbutrin, so lower seizure threshold; may have had some ongoing post vaccine fever as I had an impressive immune response symptom wise that contributed, +/- mild dehydraton/physical exertion). Waiting on EEG. Wanted to report just in case, even though I recognize it may have been coincidental.


VAERS ID: 1801562 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Systemic: Chest Tightness / Heaviness / Pain-Medium, Systemic: shortness of breath not allergy related-Medium


VAERS ID: 1801584 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Burning sensation, Dry skin, Lymphadenopathy, Pruritus, Tenderness
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Same day as injection experienced burning in hand of injected arm. Next day experienced swollen lymph under injected arm. Then same hand started intense itching, then peeled. Also if hand was bumped would bleed easily. Non injected arm - hand fine. 1 week later and hand feels tender and skin rough.


VAERS ID: 1801640 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear discomfort, Headache, Neck pain, Pain
SMQs:, Arthritis (broad)

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

Write-up: Body aches, neck pain, headache, clogged right ear


VAERS ID: 1801696 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Dyspnoea, Fatigue, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
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: Patient going to her primary provider.
CDC Split Type:

Write-up: Fever 101, fatigue, diahrrea and sob x 3 days.


VAERS ID: 1801703 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-10
Onset:2021-10-13
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1801705 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Head injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Anxiety, allergies
Allergies: Amoxicillin and tree nuts
Diagnostic Lab Data: EMT came and cleared me. Tried to take blood pressure and vitals.
CDC Split Type:

Write-up: I fainted when I got up to sit in the waiting room. I hit my head on the floor when I passed out. EMT arrived and cleared me to go home shortly after. Driven home by a friend.


VAERS ID: 1801711 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Chills, Dyspnoea exertional, Fatigue, Headache, Pain
SMQs:, Pulmonary hypertension (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuteral; aspirin 81 mg; azelastine; dehydroepiandrosterone DHEA 200 mg; finasteride 5 mg; fluticasone 220 mcg inhalation; fluticasone 50 mcg nasal spray; fluticasone-vilanterol 200 mcg inhalation; levocetirizine 5 mg; montelukast 10 mg;
Current Illness: Asthma, heart stent Jan 2019,
Preexisting Conditions: Asthma,
Allergies: Allergies to dust mites, cats, pollens; No other
Diagnostic Lab Data: None
CDC Split Type:

Write-up: first 24 hours 10/13 extreme fatigue, aches, headache, chills, weakness; seemed to recover next day 10/14; subsequently tiredness ;lack of energy; seem to get winded easily with little activity;


VAERS ID: 1801716 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, ProAir, Gabapentin, tamolosin, muliti-vitamin, omeprazole, amatriptyline, midodrine, mucinex, januvia, fludrocort, 5L of supplemental oxygen, stool softener, ipratropuim-albuterol, gas x, baclofen, trelegy, hydrocodone, miralax
Current Illness: N/A
Preexisting Conditions: Hx of stage 1 lung cancer, recent 3 month check up discovered abnormal spots during scans to the right lung, abdomen, and lymph nodes. Current dx of HTN, diabetes, COPD
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Client did not receive full dose of vaccination. The vial that the client received the booster dose from was inadvertently diluted a second time with saline after vial was used. local Department of Public Health notified and gave recommendation to report VAER, notify client, and give recommendation to client that client received some vaccine, but not full booster dose. Due to receiving a partial dose, no further doses are recommended. 10/20/2021, 1342, client notified and given all information with good understanding verbalized.


VAERS ID: 1801729 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-19
Onset:2021-10-13
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1801737 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amitriptyline, multi-vitamin, omeprazole, zyrtec, aspirin, ocybutin, baclofen, tamolosin, gabapentin, hydrocodone, zolpidem
Current Illness: N/A
Preexisting Conditions: back pain, acid reflux, difficulty sleeping
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Client did not receive full dose of vaccination. The vial that the client received the booster dose from was inadvertently diluted a second time with saline after vial was used. Department of Public Health notified and gave recommendation to report VAER, notify client, and give recommendation to client that client received some vaccine, but not full booster dose. Due to receiving a partial dose, no further doses are recommended. 10/20/2021, 1454, client notified and given all information with good understanding verbalized. Note: Client states received the influenza vaccine in early September 2021, does not remember exact date, unable to find in vaccination registry.


VAERS ID: 1801774 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-23
Onset:2021-10-13
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1801801 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-12
Onset:2021-10-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Timilol Digitek Paxil Diazepan Simvastatin Aspirin Vitimin D Fish Oil
Current Illness: none
Preexisting Conditions: controlled cholesterol controlled tacacardia controlled anxiety
Allergies: pennicilin sulphar
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: vomited violently for 8 hours diarrhea for 24 hours


VAERS ID: 1801827 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-04
Onset:2021-10-13
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1801996 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 212A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea exertional, Exposure during pregnancy
SMQs:, Pulmonary hypertension (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

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

Write-up: Moderate Shortness of breath upon minimal exertion such as walking at slow pace and having conversation. Vaccine recieved at 10 weeks pregnant estimated delivery date is 05/11/2022. Front line worker through pandemic, never tested positive or got sick. Mandated to get vaccine by employer even while in first trimester of pregnancy.


VAERS ID: 1803600 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: New York  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: patient given vaccine after the 30-day refrigeration date; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (patient given vaccine after the 30-day refrigeration date) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 014F21A) for COVID-19 vaccination. No Medical History information was reported. On 13-Oct-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (patient given vaccine after the 30-day refrigeration date). On 13-Oct-2021, EXPIRED PRODUCT ADMINISTERED (patient given vaccine after the 30-day refrigeration date) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment medications were reported. Most recent FOLLOW-UP information incorporated above includes: On 13-Oct-2021: Significant follow up received on 13 Oct 2021,Lot number added


VAERS ID: 1803602 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 2 LA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Medical history was not provided.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: This spontaneous case was reported by a nurse and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Second given at day 22) in a 29-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 011F21A) for COVID-19 vaccination. No Medical History information was reported. On 13-Oct-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Oct-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Second given at day 22). On 13-Oct-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Second given at day 22) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment information was provided.


VAERS ID: 1803623 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: This spontaneous case was reported by a health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Administration of expired dose) in a 23-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 047B21A) for COVID-19 vaccination. No Medical History information was reported. On 13-Oct-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Administration of expired dose). On 13-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Administration of expired dose) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were provided. No treatment information was provided by the reporter.


VAERS ID: 1803626 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: D.C.  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: 4 to 5 patients received shot past 30-day use by date; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a physician and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (4 to 5 patients received shot past 30-day use by date) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 019F21A) for COVID-19 vaccination. No Medical History information was reported. On 13-Oct-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (4 to 5 patients received shot past 30-day use by date). On 13-Oct-2021, EXPIRED PRODUCT ADMINISTERED (4 to 5 patients received shot past 30-day use by date) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. No Treatment was reported by reporter.


VAERS ID: 1803628 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered, Extra dose administered, Product temperature excursion issue
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Dose administered after 12 hours of vial puncture.; Dose administered after being more than 24 hours at room temperature; Extra dose administered; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Dose administered after 12 hours of vial puncture.), PRODUCT TEMPERATURE EXCURSION ISSUE (Dose administered after being more than 24 hours at room temperature) and EXTRA DOSE ADMINISTERED (Extra dose administered) in an 83-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 050E21A) for COVID-19 vaccination. No Medical History information was reported. On 13-Oct-2021 at 10:40 AM, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 13-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Dose administered after 12 hours of vial puncture.), PRODUCT TEMPERATURE EXCURSION ISSUE (Dose administered after being more than 24 hours at room temperature) and EXTRA DOSE ADMINISTERED (Extra dose administered). On 13-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Dose administered after 12 hours of vial puncture.), PRODUCT TEMPERATURE EXCURSION ISSUE (Dose administered after being more than 24 hours at room temperature) and EXTRA DOSE ADMINISTERED (Extra dose administered) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medication was not provided by the reporter. Treatment medication was not given. Reporter stated that Caller assumes the patient is immunocompromised but didn''t confirm it. This case was linked to MOD-2021-351411 (Patient Link).


VAERS ID: 1803632 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Expired dose administered; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired dose administered) in a 46-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 047B21A) for COVID-19 vaccination. No Medical History information was reported. On 13-Oct-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired dose administered). On 13-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Expired dose administered) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment medications were reported.


VAERS ID: 1803638 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B20A / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Gave a moderna vaccine that expired on 9/28 today; This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Gave a moderna vaccine that expired on 9/28 today) in a 45-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 036B20A) for COVID-19 vaccination. No Medical History information was reported. On 13-Oct-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Gave a moderna vaccine that expired on 9/28 today). On 13-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Gave a moderna vaccine that expired on 9/28 today) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. It was reported that the patient was observed for side effects for 35 minutes following administration. No concomitant medications were reported. No treatment medications were reported. Most recent FOLLOW-UP information incorporated above includes: On 13-Oct-2021: Patient age and gender added, suspect drug administration date, batch number updated.


VAERS ID: 1803649 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 LA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: This spontaneous case was reported by a health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Gave a Moderna 2nd dose and the vaccine expired yesterday) in a 39-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007C21A) for COVID-19 vaccination. No Medical History information was reported. On 13-Oct-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Gave a Moderna 2nd dose and the vaccine expired yesterday). On 13-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Gave a Moderna 2nd dose and the vaccine expired yesterday) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication information was provided. No treatment medication information was provided. It was reported that the vial was initially stored in the refrigerator on 08-Oct-2021 and did not undergo any temperature excursions. The reporter wasn''t sure if they had concomitant medications but saw that they marked "no medical history" on the form


VAERS ID: 1803651 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-01-29
Onset:2021-10-13
   Days after vaccination:257
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: dose expired 08Aug2021; Inappropriate schedule of vaccine; This spontaneous case was reported by a consumer and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (dose expired 08Aug2021) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Inappropriate schedule of vaccine) in a 72-year-old male patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) (batch nos. 022M20A and 007M20A) for COVID-19 vaccination. No Medical History information was reported. On 29-Jan-2021, the patient received first dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 26-Feb-2021, received second dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 13-Oct-2021, received third dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 13-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (dose expired 08Aug2021) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Inappropriate schedule of vaccine). On 13-Oct-2021, EXPIRED PRODUCT ADMINISTERED (dose expired 08Aug2021) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Inappropriate schedule of vaccine) had resolved. For mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Concomitant medications were provided by the reporter. No Treatment information was reported.


VAERS ID: 1803675 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered, Product temperature excursion issue
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Dose administered after 12 hours of vial puncture.; Dose administered after being more than 24 hours at room temperature; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Dose administered after 12 hours of vial puncture.) and PRODUCT TEMPERATURE EXCURSION ISSUE (Dose administered after being more than 24 hours at room temperature) in an 81-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 050E21A) for COVID-19 vaccination. No Medical History information was reported. On 13-Oct-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Dose administered after 12 hours of vial puncture.) and PRODUCT TEMPERATURE EXCURSION ISSUE (Dose administered after being more than 24 hours at room temperature). On 13-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Dose administered after 12 hours of vial puncture.) and PRODUCT TEMPERATURE EXCURSION ISSUE (Dose administered after being more than 24 hours at room temperature) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications information was reported. No treatment medications were provided. On11-Oct-2021, the vial was stored in the refrigerator. On 12-Oct-2021, at 8AM they were taken to room temperature, and on 12-Oct-2021 at 10AM the vial was punctured. After puncture, the vial was stored at room temperature, and 5 doses were drawn and administered on 13-Oct-2021, first dose was administered at 10:40 AM EST of 13-Oct-2021, and 5th dose administered at 1:06PM EST of 13-Oct-2021. Reporter stated that the total amount of time the vial was exposed to room temperature range was around 30 hours. Reporter assumed the patient was immunocompromised but didn''t confirm it,


VAERS ID: 1803678 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Dose administered after 12 hours of vial puncture/Dose administered after being more than 24 hours at room temperature; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Dose administered after 12 hours of vial puncture/Dose administered after being more than 24 hours at room temperature) in a 26-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 050E21A) for COVID-19 vaccination. No Medical History information was reported. On 13-Oct-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 13-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Dose administered after 12 hours of vial puncture/Dose administered after being more than 24 hours at room temperature). On 13-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Dose administered after 12 hours of vial puncture/Dose administered after being more than 24 hours at room temperature) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No Concomitant medications were provided No treatment medications were provided. The vial was exposed to room temperature range (8 degrees Celsius to 25 degrees Celsius/46 degree Fahrenheit to 77 degree Fahrenheit) for around 30 hours. On 12-Oct-2021 at 8 A.M, the vials were taken out of the fridge to room temperature. The vial did not undergo any temperature excursion.


VAERS ID: 1803806 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 1 LA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Administered an expired vaccine; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Administered an expired vaccine) in a 59-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 076C21A) for COVID-19 vaccination. No Medical History information was reported. On 13-Oct-2021 at 12:30 PM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 milliliter. On 13-Oct-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Administered an expired vaccine). On 13-Oct-2021, EXPIRED PRODUCT ADMINISTERED (Administered an expired vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No relevant concomitant medications was reported. Treatment information was not provided. Date the vial was initially stored in the refrigerator - 07-Oct-2021


VAERS ID: 1803809 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered, Product temperature excursion issue
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Dose administered after 12 hours of vial puncture; Dose administered after being more than 24 hours at room temperature; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Dose administered after 12 hours of vial puncture) and PRODUCT TEMPERATURE EXCURSION ISSUE (Dose administered after being more than 24 hours at room temperature) in a 30-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 050E21A) for COVID-19 vaccination. No Medical History information was reported. On 13-Oct-2021 at 12:27 PM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 13-Oct-2021 at 12:27 PM, the patient experienced EXPIRED PRODUCT ADMINISTERED (Dose administered after 12 hours of vial puncture) and PRODUCT TEMPERATURE EXCURSION ISSUE (Dose administered after being more than 24 hours at room temperature). On 13-Oct-2021 at 12:27 PM, EXPIRED PRODUCT ADMINISTERED (Dose administered after 12 hours of vial puncture) and PRODUCT TEMPERATURE EXCURSION ISSUE (Dose administered after being more than 24 hours at room temperature) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications were reported. This case is a report of the adverse events of patient 3. The vial was reported to be in the freezer prior to 11-Oct-2021. On 11-Oct-2021, the vial was stored in the refrigerator. On 12-Oct-2021 at 8:00 AM around 30 hours, they were taken out of the fridge to the room temperature. On 12-Oct-2021 at 10:00 AM, the vial was punctured. After puncture, the vial was stored at room temperature. Total amount of time the vial was exposed to temperature range (8 to 25 degree Celsius ( 46 to 77 degree Fahrenheit). This case was linked to MOD-2021-351075, MOD-2021-351200 , MOD-2021-352001 , MOD-2021-352549 (Patient Link).


VAERS ID: 1803840 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-11
Onset:2021-10-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Allergic: Rash Generalized-Mild


VAERS ID: 1803859 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 LA / IM

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

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

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


VAERS ID: 1803865 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-10-13
Onset:2021-10-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 LA / IM

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

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

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


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