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

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



Case Details (Reverse Sorted by Onset Date)

This is page 184 out of 6,611

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VAERS ID: 1512521 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-11
Onset:2021-07-28
   Days after vaccination:78
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 mg oral tablet ferrous sulfate (FERATAB) 325 mg (65 mg iron) oral tablet ibuprofen 600 mg oral tablet INCASSIA 0.35 mg oral tablet lansoprazole (PREVACID) 30 mg oral delayed release caps
Current Illness:
Preexisting Conditions: ADD (attention deficit disorder) Bipolar 2 disorder COVID-19 Depression Mild intermittent asthma NSVD Urinary retention
Allergies: Pcn [Penicillins] Tamiflu [Oseltamivir]
Diagnostic Lab Data:
CDC Split Type:

Write-up: POSITIVE COVID RESULT 7/28/21


VAERS ID: 1512545 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Pruritus
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received second dose of Moderna and had an itchy mouth/jaw area for about five minutes until it subsided


VAERS ID: 1512550 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-28
Onset:2021-07-28
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 2 - / UN

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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 2.5 mg oral tablet aspirin 81 mg oral enteric coated tablet atorvastatin (LIPITOR) 20 mg oral tablet cephalexin (KEFLEX) 500 mg oral capsule fluticasone (FLONASE) 50 mcg/actuation nasal spray
Current Illness:
Preexisting Conditions: Anemia CAD CKD Chronic diastolic heart failure Type II DM HTN
Allergies: Engerix-B (Hepatitis B)Vaccine [Hepatitis B Virus Vaccine,Recb] Ace Inhibitors
Diagnostic Lab Data:
CDC Split Type:

Write-up: POSITIVE COVID TEST 7/28/21


VAERS ID: 1512557 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW973 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia oral
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

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

Write-up: Patient''s tongue began to "tingle".


VAERS ID: 1512564 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 RA / IM

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

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

Write-up: Patient said he did not have a Covid vaccine before, but when we were logging the dose into our state''s IIS it showed he did get a dose of Pfizer on 6/19/21.


VAERS ID: 1512574 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2020-01-05
Onset:2021-07-28
   Days after vaccination:570
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 1 RA / 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: Circulatory Hypertension Gestational Endocrine/Metabolic Nodule Thyroid Other Anxiety
Allergies: NKA
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE
CDC Split Type:

Write-up: unknown


VAERS ID: 1512579 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-08
Onset:2021-07-28
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: naproxen sodium (ALEVE) 220 mg oral capsule
Current Illness:
Preexisting Conditions: Acute meniscal tear of left knee Kidney stone Malignant neoplasm of connective and other soft tissue Allergic rhinitis HTN
Allergies: Animal Dander (Nic)
Diagnostic Lab Data:
CDC Split Type:

Write-up: POSITIVE COVID TEST 7/28/21


VAERS ID: 1512582 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Erythema, Feeling hot, Flushing
SMQs:, Anaphylactic reaction (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: -Mobic -Robaxin -Zyrtec
Current Illness: None
Preexisting Conditions: Hypertriglyceridemia Prediabetes Fatty Liver Allergic rhinitis Elevated liver function Eczema Insomnia
Allergies: Erythromycin Penicillin Trazodone
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient is a 43 year old female who has completed a 45-minute observation period with the following signs and symptoms of an adverse reaction: other - Chest tightness and skin redness. Per patient, she had a "bad" reaction to flu vaccine and had to be sent to ED. Patient c/o feeling warm, appears flushed. Given cold pack. Lung sounds, clear. No audible wheezing. No visible rash or hives noted. Denies SOB, No tongue or lip swelling noted, no difficulty swallowing. Patient speaks in full sentences. Allergies Allergen Reactions ? Erythromycin Base Skin Rash and/or Hives and Asthma and/or Shortness of Breath ? Pcn Class [Penicillins Class] Skin Rash and/or Hives and Asthma and/or Shortness of Breath Anaphylaxis ? Trazodone And Phenylpiperazines Palpitations with 50 mg at bedtime Pfizer-BioNTech COVID-19 vaccine # 1 in series administered. o Action(s) taken: Another drug administered - benadryl 25mg PO and Recommended transfer to higher level of care, risk and benefits explained to patient, patient declined o Allergy to COVID-19 vaccine documented in Allergies activity: No, will discuss with clinician o Patient advised to discuss second dose considerations with a clinician o sent home stable. Refused to go to ED or urgent care Vitals: 07/28/21 1642 07/28/21 1700 07/28/21 1715 BP: (!) 164/80 (!) 148/68 134/76 Pulse: 80 78 72 Resp: 18 18 18 SpO2: 100% 100% 100%


VAERS ID: 1512598 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Pruritus
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: palpitations and dyspnea after first Pfizer vaccine
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: lavender, mango
Diagnostic Lab Data:
CDC Split Type:

Write-up: itching on arms and neck


VAERS ID: 1512605 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-22
Onset:2021-07-28
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / UNK RA / 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: acetaminophen (TYLENOL) 325 mg oral tablet acetaminophen (TYLENOL) 500 mg oral tablet ALPRAZolam (XANAX) 0.5 mg oral tablet amoxicillin (AMOXIL) 500 mg oral capsule atorvastatin (LIPITOR) 80 mg oral tablet
Current Illness:
Preexisting Conditions: Angina pectoris Arthritis Bleeding disorder Cancer CHF DVT Hypertension Asthma MI MRSA Renal disease Seizures TIA Acute respiratory failure CAD Hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: POSITIVE COVID TEST 7/28/21


VAERS ID: 1512611 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Headache, Mobility decreased, Muscle spasms, Pain in extremity, Peripheral swelling, Pyrexia, Vomiting
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: About 11 p.m. on July 28th I started vomiting, having stomach cramps ,back cramps ,headache ache ,and fever and I felt like I was smothering. My arm is so swollen and painful to the point where I have to use my other arm to lift it.


VAERS ID: 1512616 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (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), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient came in to receive her 1st dose of the Covid vaccine. At 6:25 the vaccine was administered and at 6:33 the patient passed out. After a few seconds she came to. Emergency personnel were called to the scene. They arrived at 6:41 and checked her out and gave her the clear to go home.


VAERS ID: 1512626 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-22
Onset:2021-07-28
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: **MEDICAL CANNABIS - NOTIFICATION** by N/A route as directed. NMHC does not allow the continuation of Medical Cannabis while hospitalized. This entry is for notification only. ACETAMINOPHEN (TYLENOL ARTHRITIS PAIN) 650 MG ORAL TBSR
Current Illness:
Preexisting Conditions: Brain tumor (HCC) ? Essential hypertension ? Fibromyalgia ? GERD (gastroesophageal reflux disease) ? Hypercholesteremia ? Mild intermittent asthma ? Neuropathy ? Osteoporosis ? Rheumatoid arthritis(714.0) (HCC) ? Seizure (HCC)
Allergies: Ciprofloxacin Diarrhea ? Latex Rash ? Lorazepam Anxiety and Other Paradoxical reaction.
Diagnostic Lab Data:
CDC Split Type:

Write-up: POSITIVE COVID TEST 7/28/21


VAERS ID: 1512637 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / IM

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

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

Write-up: Patient stated that injection site is red and swollen, and has been since she got the vaccine.


VAERS ID: 1512647 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-27
Onset:2021-07-28
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 RA / 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: rivastigmine (EXELON) 9.5 MG/24HR 24 hr patch aspirin (ASA) 81 MG EC tablet Glucos-Chondroit-Hyaluron-MSM (GLUCOSAMINE CHONDROITIN JOINT) TABS omeprazole 20 MG tablet senna-docusate (EASY-LAX PLUS) 8.6-50 MG tablet sildenafil (VIAG
Current Illness:
Preexisting Conditions: Benign prostatic hyperplasia Gastroesophageal reflux disease Herniated lumbar intervertebral disc Herpetic infection of penis Hyperlipidemia Inflammatory and toxic neuropathy Memory loss Parkinson disease Lewy body dementia without behavioral disturbance Abnormal MRI, cervical spine Seasonal allergic rhinitis Sleep disorder Anxiety Orthostatic hypotension Abdominal wall hernia
Allergies: Sulfa (Sulfonamide Antibiotics)
Diagnostic Lab Data:
CDC Split Type:

Write-up: POSITIVE COVD TEST 7/28/21


VAERS ID: 1512651 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (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), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: PATIENT GOT LIGHT HEADED AND PASSED OUT AFTER LEAVING THE PHARMACY AREA. PATIENT STATED HE HAD NOT EATEN OR DRANK ANYTHING PRIOR TO COMING IN TO RECEIVE THE VACCINATION. PATIENT WAS ALSO NERVOUS TO START WITH ABOUT RECEIVING THE VACCINE


VAERS ID: 1512654 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-27
Onset:2021-07-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004D21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Hypoaesthesia, Injection site erythema, Injection site mass, Injection site pain, Injection site pruritus, Injection site swelling, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (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), Arthritis (broad), Hypoglycaemia (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: Levothyroxine, propranolol , iron supplements
Current Illness: Cold, sinusitis
Preexisting Conditions: Hashimoto?s thyroiditis, pcos, endometriosis, chronic migraines, anemia
Allergies: Pineapple, onions, milk, gluten
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Numbness, pain in elbow, wrist and hand joints, severe shaking in arm of injection 15 minutes after injection, large, tender and itchy swollen mass on upper arm approximately one inch from injection site. Itchiness and pain started roughly an hour after injection, red bump about an inch and a half in diameter appeared 6 and a half hours after injection.


VAERS ID: 1512663 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Anthrax (3rd in series), .5cc, 2004, age 38, severe arm swelling (right arm)
Other Medications: None
Current Illness: None
Preexisting Conditions: Had MRSA in 2012.
Allergies: Penicillin, Ciprofloxacin, Poison Ivy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling at the injection site (3in), hot to the touch. Painful to the touch. Slightly pain when arm is in motion.


VAERS ID: 1512668 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-27
Onset:2021-07-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Induration, Influenza like illness, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Chills (couldn''t get warm even with blankets and sweaters), Body/Muscle Aches, fever, and flu like symptoms. Also soar lump under left arm, in armpit area (same arm vaccine was given)


VAERS ID: 1512690 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Dizziness, Tinnitus
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad)

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

Write-up: Severe ringing in ears, partial loss of hearing, dizziness, loss of balance


VAERS ID: 1512693 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-21
Onset:2021-07-28
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness unilateral, Dyschromatopsia
SMQs:, Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad)

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

Write-up: Left eye doesn''t hurt or burn, but cannot see out of the eye suddenly. Can only see black, white, and grey.


VAERS ID: 1512696 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Immediate post-injection reaction
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: no medications listed
Current Illness: no illnesses
Preexisting Conditions: patient reports has metal rods in the left leg from previous injury
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient reported that left leg was numb for a while immediately after receiving injection. Pharmacist called patient again on Thursday, July 29 at which time reported no more problems that was experienced on 7/28/2021


VAERS ID: 1512700 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Extra 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: Megestrol 40mg BID, Nephro Vitamins 0.8mg daily, Cozaar 100mg daily, Phos Lo 667mg 2 capsules with meals, Norco 5/325mg 1 tablet q 4h PRN, Pantoprazole 40mg BID, Carvedilol 6.25mg BID, Renvela 800mg 2 tablets with meals, Alprazolam 0.5mg 1
Current Illness: Acute MI 7/23/21
Preexisting Conditions: End Stage Renal Disease with dialysis 3x week; HTN; CAD; Diabetes; Chronic Pain
Allergies: Minoxidil
Diagnostic Lab Data: no tests ordered at this time
CDC Split Type:

Write-up: This nurse was notified by Pharmacy at 12:15pm 7/29/21 that this was elder''s 3rd vaccine when they were entering in . On admission, elder notified staff she was not vaccinated. No adverse effects noted at this time. APRN/PCP were notified


VAERS ID: 1512710 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Limb discomfort, Musculoskeletal discomfort, Pruritus
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Anemia "When i get sick very bad cold" ? Edema ? Elevated cholesterol ? Fatty liver ? GERD (gastroesophageal reflux disease) ? Headache(784.0) ? Hypertension ? Irregular menstrual bleeding ? Lower back pain ? Obesity ? Obstructive sleep apnea ? PONV (postoperative nausea and vomiting) ? Preeclampsia with 11 year old child ? Renal calculi calcium oxalate and apatite
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: ~20 mins (0852) after receiving the 1st dose of Pfizer vaccine, complained of itchiness on her back, legs. She denied swelling of throat/tongue, difficulty of breathing. BP 190/93, O2 sat=96. 25 mg. Benadryl given x1 at 0853. 20 minutes later, verbalized persistent itchiness on her back and left foot. A second dose of Benadryl 25 mg. given at 0913. 10 minutes later, verbalized she''s "feeling good". Patient advised to get clearance from her PCP regarding the second dose of the Pfizer vaccine.


VAERS ID: 1512712 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Cold sweat, Dizziness, Pallor, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: SUBJECTIVE: Pt. is a 15 year old male here vaccinated at our community vaccine event at high school last evening and received the Pfizer vaccine Approx 10 min after receiving the vaccine the patient reported: weakness and lighheadedness At approx 10 min post vaccination he was still sitting in the chair he was vaccinated in. When I came to him he was clamy and pale and felt weak and lightheaded. He also c/o of feeling tremulous This Hx of was obtained by pt and pt''s mother who was with pt at the vaccine event. Pt was feeling anxious but well prior to the vaccine. He last ate approx 5 hrs prior to vaccine and had hamburger and root beer. He had no significant activity during the day prior to the event. He did wake up approx 4 hrs earlier then his usual time on day of event because of school orientation he had that day. Pt and mom denied any prior hx of similar reactions after vaccines Pt reported it "feels like just got a shot" No nausea, itching or resp distress No PMHx -Per pt. has been on IEP for adhd No current medications NKDA SocHx: pt denied any recent drug or etoh use Sudden onset of symptoms/signs: yes Rapid progression of symptoms/signs: Rapid progression that quickly improved OBJECTIVE: General appearance: pale and clammy Skin:no rashes Resp: CTA bilat CV: RRR Vitals Vaccine given at 5:58 pm 6:05 pm BP 87/50, P 83, pox 98%- pt was given water 6:08 pm BP 134/84, - coloring in face improved and pt began to feel better- pt was alert and oriented x 3 at this point 6:13pm BP 130/66- pt was given granola bar and 2nd bottle of water BS: 118 DISPOSITION: After sitting in chair for approx 35 min, drinking two bottles of water and two granola bars pt was feeling better, appeared better with normal coloring and not clamy and had normal vitals signs. He and his mom felt comfortable going home to rest. I reviewed warning signs with mom to call or go to ED for I called the next day (7/29) and spoke with his mom and she stated pt was doing better after eating dinner and was feeling well this. She plans to call pt''s pediatrician to coordinate his 2nd dose in their office or affiliated clinic.


VAERS ID: 1512718 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

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

Write-up: day 49 to complete series


VAERS ID: 1512727 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-19
Onset:2021-07-28
   Days after vaccination:100
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21 / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Respiratory failure, 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), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Melatonin 5 mg Aspirin 81 mg Hydrocodone/acetaminophen 10-325 mg Nitroglycerin 0.4 mg SL Ranolazine 500 mg 12 hr tablet albuterol sulfate HFA inhaler fluticasone-umeclidin-vilant inhaler apixaban starter pack divaloproex 500 mg DR tablet tr
Current Illness: none
Preexisting Conditions: Anxiety ? Arthritis ? Bipolar 1 disorder (CMS/HCC) ? Congestive heart disease (CMS/HCC) ? Diabetes mellitus (CMS/HCC) ? Esophagitis, reflux ? History of transfusion ? Obstructive sleep apnea ? PONV (postoperative nausea and vomiting) ? Primary pulmonary hypertension (CMS/HCC) ? Pulmonary embolism on left (CMS/HCC)
Allergies: Corticosteroids and Penicillins
Diagnostic Lab Data: COVID -19 aptima panther NP/OP Swab = positive
CDC Split Type:

Write-up: COVID infection with respiratory failure


VAERS ID: 1512739 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Chills, Dizziness, Feeling hot, Flushing, Myalgia, Pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartin, Amlodipine
Current Illness: none
Preexisting Conditions: Being tested for asthma
Allergies: Seasonal allergies birch pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left arm muscle pain, Generalized pain to back, arms , and all over, dizziness, Yesterday after leaving the hospital I felt, hot (face flushed), then chills last night.


VAERS ID: 1512750 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-11
Onset:2021-07-28
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3022 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, SARS-CoV-2 test positive
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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ? acetaminophen (TYLENOL) tablet 650 mg, 650 mg, Oral, Q6H PRN, ? albuterol (PROVENTIL) nebulizer solution 0.083% 2.5 mg/3mL, 2.5 mg, Nebulization, Q6H PRN ? atorvastatin (LIPITOR) tablet 10 mg, 10 mg, Oral, Nightly, ? budesonide-form
Current Illness: head injury
Preexisting Conditions: Arthritis ? At risk for self-inflicted injury ? BPH (benign prostatic hyperplasia) ? Diabetes mellitus (CMS/HCC) ? Gallbladder disease ? GERD (gastroesophageal reflux disease) ? History of left below knee amputation (CMS/HCC) ? Hypertension ? Hypothyroidism ? Neuropathy ? PVD (peripheral vascular disease) (CMS/HCC) ? Umbilical hernia
Allergies: baclofen codeine ditropan latex penicillins sulfa antibiotics
Diagnostic Lab Data: COVID-19 PCR positive 7/28/21
CDC Split Type:

Write-up: COVID-19 infection with pneumonia


VAERS ID: 1512764 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-26
Onset:2021-07-28
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Erythema of eyelid, Eye swelling
SMQs:, Anaphylactic reaction (broad), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Breast cancer- Left Mastectomy Hypothyroidism HTN
Allergies: None
Diagnostic Lab Data: None
CDC Split Type: 21014

Write-up: Woke up on Wednesday 7/28/2021 with bilateral redness at eyelids. Noticed the right eye was more swollen than the left eye. Started taking OTC benadryl. States today 07/29/2021 that the redness has gone away and but there is swelling under the right eye. Pt states she was vaccinated in the right arm. No other problems to report.


VAERS ID: 1512800 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-26
Onset:2021-07-28
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dysmenorrhoea, Intermenstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dupixent injection 300mg every 2 weeks, Lo Loestrin birth control every night, albuterol inhaler PRN
Current Illness:
Preexisting Conditions: Asthma, allergies, eczema
Allergies: Aspirin, nsaids, nuts, fish
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough menstrual bleeding started Wednesday night. It stopped overnight, but restarted this morning. Very mild cramping and light bleeding.


VAERS ID: 1512803 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

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

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

Write-up: Patient and her guardian showed up at an off site clinic for the Pfizer vaccine. Another patient walked up asking questions about timing of observation. Patient was inadvertently given a Moderna vaccine instead of a Pfizer vaccine. Patient and her guardian were notified immediately of the mistake and advised that we would need to monitor. After 20 minutes of monitoring, the patient and her guardian advised the patient was feeling fine and that they would like to leave. Guardian instructed to follow up with the patient''s PCP.


VAERS ID: 1512808 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Confusional state, Dizziness, Dysphagia, Fatigue, Feeling abnormal, Headache, Hypoaesthesia, Loss of consciousness, Muscle tightness, Nausea, Paraesthesia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (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), Dystonia (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 (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (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: Birth control, adderall
Current Illness:
Preexisting Conditions:
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: chest tightness (within 10 minutes), trouble swallowing (within 10 minutes), dizzy (within 3 minutes), fuzziness leading to blacking out (within 5 minutes), thumb tingling/partial numbness (within 2 minutes), tightness in neck and jaw (within 10 minutes), headache (within 10 minutes), - nausea, extreme tiredness, confusion (all about 3 hours later)


VAERS ID: 1512815 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect product formulation administered, Product preparation 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: furosemide, ASA, budesonide-formoterol, Clopidogrel, heparin, magnesium chloride-calcium carbonate, metoprolol, atorvastatin, oxycodone
Current Illness: superimposed on CKD
Preexisting Conditions: CAD, PAD, COPD, HTN
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pharmacy staff drew up the 0.3 mL dose without first diluting the Pfizer suspension. The dose was administered at 0919 on 7/28/21. The error was not identified until pharmacy attempted to draw up a dose for another patient at 1300 on 7/28/21.


VAERS ID: 1512816 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Confusional state, Crying, Dyspnoea, Fall, Head injury, Headache, Hyperhidrosis, Hypotonia, Pallor, Presyncope
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (narrow), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Per witness, patient was sitting in the waiting room post vaccination w/ Pfizer vaccine. Patient''s mother got up and walked to counter to make 2nd dose appt. Patient started leaning over in chair and fell to the floor (witness reports patient bumped head). Per witness, mother ran to patient''s side. This writer heard someone call for help. This writer was in the back assisting with immunization clinic. Patient was observed lying on the floor w/ mother at her side. Patient appeared confused and was actively trying to sit upright. This writer and patient''s mother explained that she had experienced a vasovagal reaction after her COVID-19 vaccine. Patient was instructed to stay in lying position while vital signs were obtained. Patient was able to verbalize name, DOB, and place. Vital signs at 1040 (BP 98/55, HR 61, O2 98% on room air). Patient was diaphoretic and pale. Patient reported eating breakfast this morning. Patient was observed crying stating "I feel like I can''t breathe." This writer continued to monitor vital signs (BP 120/72, HR 77, O2 99% on room air). Staff placed several ice packs on patient. She complained of headache and told staff that her head hurt. Mother of patient requested EMS to be called. Staff called EMS. Vital signs at 1050 (BP 101/64, HR 92, O2 98% on room air). Patient reported feeling better and was able to move to sitting upright position on the floor. Patient appeared less diaphoretic and color was returning to normal. Patient was moved to wheelchair w/ assistance from staff. Patient was provided with water and crackers. EMS arrived to the facility at 1050. EMS evaluated patient, but patient declined to be transported. V/S stable. Patient reports history of passing out unrelated to vaccine administration. Staff explained that mother/patient need to inform staff w/ the 2nd dose of vasovagal hx, so patient can receive vaccine lying down. Staff provided mother w/ concussion education and explained what S/S would indicate a need to go to the ER. Patient was also encouraged to f/u with pediatrician. Patient was taken out to car via wheelchair by staff at 1100.


VAERS ID: 1512869 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-22
Onset:2021-07-28
   Days after vaccination:128
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Intensive care, 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: Dialysis/renal disease, hypertension
Allergies: NKDA
Diagnostic Lab Data: Rapid Covid-19 antigen test.
CDC Split Type:

Write-up: pt vaccinated on 3/22/2021 tested positive for covid 19 on 7/28/2021 hospitalized in the icu on high flow oxygen.


VAERS ID: 1512880 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-27
Onset:2021-07-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO191 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Electric shock sensation, Fatigue, Headache, Injection site erythema, Injection site pain, Injection site swelling, Malaise, Myalgia, Pain, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Injection site pain, swelling and redness. Tiredness, headache. Muscle and joint pain, fever and feeling unwell. I also experienced shooting pain down left arm and what feels like electrical jolts throughout my body.


VAERS ID: 1512897 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-27
Onset:2021-07-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site reaction, Injection site swelling, Rash pruritic
SMQs:, Anaphylactic reaction (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt called this morning around 7/29, 11 AM. She woke up the previous night when she turned on her side while sleeping. She noticed that the shoulder where the vaccine was administered developed a bumpy rash. The site still had the band-aid on it. The rash was itchy, and she asked if it was ok to put anti-itch cream on it. I advised her to monitor the rash and to take hydrocortisone cream and benadryl if needed. I confirmed that the band-aid was not made of latex, so the band-aid allergy is not likely.


VAERS ID: 1512941 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-27
Onset:2021-07-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 RA / IM

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

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

Write-up: The patient reported swelling of her upper lip that began on 7/28/2021. It was more pronounced this morning.


VAERS ID: 1512952 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: No adverse event, Product preparation 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: Patient has had no adverse outcome to date. Diluent used in administering the vaccine was not the diluent shipped with the vaccine. The diluent was correct type, concentration (normal saline USP .09% ) , but was in a single use bottle, not intended for use with injection and used with one other patient previously.


VAERS ID: 1512992 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Headache, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shot. Headache, dizziness,significant site swelling. January 2021
Other Medications: HCTZ and Valsartan
Current Illness: None
Preexisting Conditions: HTN
Allergies: Codeine, Lisinopril,Steroids
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache within 15 minutes of vaccine given. Some nausea with next hour. Chest felt tight but no shortness of breath about one hour after vaccine given. Chest tightness gradual increase over the course of 4-5 hours. Took Benadryl 25 mg much later and after one hour chest loosen considerably.


VAERS ID: 1513004 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-01-11
Onset:2021-07-28
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 LA / IM

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

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

Write-up: Fully vaccinated and tested positive for Covid-19.


VAERS ID: 1513019 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-07
Onset:2021-07-28
   Days after vaccination:112
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

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

Write-up: Tested PCR positive for COVID 7/28/21. Symptom onset 7/25/21.


VAERS ID: 1513060 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939893 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: blood pressure and pulse ox 7/28/2021
CDC Split Type:

Write-up: Approximately 5 minutes after the vaccine was administered, patient notified me that she felt her throat tightening. I had her sit down. After 5 more minutes she condition had not improved. at that point I called 911 and the paamedics arrived at the pharmacy. Patient could speak and breath but reported that the tightening in her throat was still continuing. Her blood pressure was normal as well as her pulse-ox. she was brought to the hospital by ambulance.


VAERS ID: 1513063 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-30
Onset:2021-07-28
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cough, Exposure to SARS-CoV-2, Headache, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? No
Previous Vaccinations:
Other Medications: sertraline, 100 mg daily
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: I tested positive for COVID-19 on 07/29/21. I have similar symptoms to those I was exposed to: headache, fever, sore throat, cough.
CDC Split Type:

Write-up: I tested positive for COVID-19 on 07/29/21. I have similar symptoms to those I was exposed to: headache, fever, sore throat, cough.


VAERS ID: 1513069 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Fatigue, Injection site pain, Joint swelling, Loss of consciousness, Nausea, Night sweats, Pyrexia, Salivary hypersecretion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Fever, nausea, hyper salivation, fatigue, several episodes of blacking out/passing out/collapsing, inappetence, night sweats, pain at injection site, swollen joints. Not touched by Tylenol or Meloxicam


VAERS ID: 1513088 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Phobia of shots
Preexisting Conditions: Unknown
Allergies: Penicillin and erythromycin
Diagnostic Lab Data: None that I know of.
CDC Split Type:

Write-up: Patient received the shot, 10 minutes later her mother came to the pharmacy window saying her daughter couldn''t breathe. I went to speak to patient and patient said she "couldn''t breathe" then lost consciousness shortly thereafter. I injected her with an epipen in her left hip. She regained consciousness about 90 seconds later. Her lips were blue, she was pale, her pulse was strong, and heartbeat rapid. She expressed a phobia of shots before the shot and her mother said she has high anxiety about shots. Was taken away via ambulance.


VAERS ID: 1513097 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

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

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

Write-up: Vaccinated 11 yr old minor. No adverse outcome.


VAERS ID: 1513105 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-01-21
Onset:2021-07-28
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 AR / SYR

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? 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: Patient tested positive for COVID-19 while fully vaccinated.


VAERS ID: 1513108 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-26
Onset:2021-07-28
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, COVID-19 pneumonia, Computerised tomogram thorax abnormal, Diarrhoea, Dyspnoea, Fatigue, Gastrointestinal disorder, Nausea, Oxygen saturation decreased, Pulmonary congestion, Respiratory symptom, Vomiting, White blood cell count
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Prednisone taper 10 mg, Ruxolitinib (Jakafi) 15 mg po BID
Preexisting Conditions: Myelofibrosis, immunosuppression on chemotherapy Jakafi
Allergies: Penicillins
Diagnostic Lab Data: WBC: 32 k/mcl 7/28 and 53.4 K/mcl 7/29/2021. Sats 93% on room air. Started on 3 L NC sats improved to 98%. CT chest negative for PE, consistent with COVID pneumonia.
CDC Split Type:

Write-up: Patient hospitalized on medical floor. Nausea, intermittent abdominal pain, occasional diarrhea, fatigue and shortness of breath. Minimal respiratory symptoms, full feeling in lungs. Vomitting, 3X and diarrhea 2X day of admission. Received dexamethasone. Admitted to hospital to manage covid pneumonia with GI symptoms.


VAERS ID: 1513132 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-27
Onset:2021-07-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 RA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary mass, Chills, Lymphadenopathy, Pain, Pain in extremity, Pyrexia, Sleep disorder
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ibuprofen, anoro, gabapentin, dicyclomine, lisinopril/hctz, sumatriptan
Current Illness: no
Preexisting Conditions: emphysema, cervical spinal stenosis, bp, anxiety
Allergies: pcn
Diagnostic Lab Data: no
CDC Split Type:

Write-up: The patient woke up in the middle of the night following her injection with some arm pain. When she woke up the next morning (day after shot), her whole upper body was severely achy and sore and she had a fever of 100.7. The following day (today) she still had body aches and chills and a fever that reached 101.3, and she discovered a "golfball sized lump" under her arm. She had a telemedicine appt with her pcp who confirmed she had a swollen lymph node. He prescriber her ibuprofen 800mg.


VAERS ID: 1513149 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / UNK LA / IM

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

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

Write-up: PATIENT HAS MIGRAINE SINCE GETTING VACCINE. PATIENT IS SUSCEPTIBLE TO MIGRAINES


VAERS ID: 1513157 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-27
Onset:2021-07-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Muscle spasms
SMQs:, Dystonia (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Muscle spasm. Feeling week


VAERS ID: 1513181 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-09
Onset:2021-07-28
   Days after vaccination:110
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Headache, Respiratory tract congestion, 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:
CDC Split Type:

Write-up: Tested positive for COVID on 07-29-2021 has very mild symptoms congestion and headache.


VAERS ID: 1513386 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-01-13
Onset:2021-07-28
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Conjunctivitis, Cough, Nasal congestion, Oropharyngeal pain, Respiratory viral panel, SARS-CoV-2 test positive, Streptococcus test negative
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Fatty liver
Allergies: NKA
Diagnostic Lab Data: Biofire Respiratory Panel with Covid-19: Covid-19 Positive on 7/28/2021. Tested for Strep on 7/28/21; results: Negative.
CDC Split Type:

Write-up: Diagnosed with Covid-19 on 07/28/2021. Patient reports having a dry cough, sore throat, conjunctivitis and stuffy nose since 7/24/2021. Pt received Monoclonal Antibodies on 7/29/2021. Reports being fully vaccinated with Covid-19 vaccine.


VAERS ID: 1513388 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-14
Onset:2021-07-28
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Back pain, Blood pressure fluctuation, Chest X-ray normal, Chest pain, Computerised tomogram normal, Confusional state, Malaise, Nausea, Pain, SARS-CoV-2 test negative, Scan with contrast normal, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (broad), Cardiomyopathy (broad), Arthritis (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Xyzal (allergies) and multivitamin
Current Illness: None
Preexisting Conditions: PCOS (managed), Interstitial Cystitis (managed)
Allergies: Levoquin, Bactrim, Nexium, Celexa
Diagnostic Lab Data: 7/28 - CT Scan with dye intravenously, chest xray, COVID test
CDC Split Type:

Write-up: Approximately 4 days after the vaccine, I started experiencing elevations and drops in my blood pressure. I take my health seriously and check it daily. I am always around 110/80 or 115/80. On Saturday, July 24th, I went to get fluids at a hydration clinic (for health, elective) and my blood pressure was 150/90. The nurse asked if I have always had blood pressure and I indicated never. Since then, it has spiked and dropped in the high 140''s to the low 109''s. The more severe issues started on July 26th. I woke up at 1am throwing up. I didn''t think much about it, but the entire next day, my chest hurt. I continued to monitor my blood pressure via a monitor. It was in the 130''s. I still didn''t feel well, but I thought maybe it was the result of something I ate, etc. On the morning of July 28th, I woke up with pain and radiating aches and stabbing pains/soreness in my back around my shoulder blades. It didn''t seem to let up. I continued to monitor my blood pressure via a home monitor. I watched it climb rapidly. When it went up to 141/90 and continued to climb along with me experiencing nausea and confusion, I knew it was becoming serious. I went to the emergency room and at arrival, my blood pressure was 223/117 so I was in a crisis and close to having a stroke. They had to immediately administer 20mg of Lisinopril which then brought it down to 117/85. I had a chest xray and a CT scan with dye. Thankfully, no damage that I was informed of, but I am still experiencing chest pain and issues with my blood pressure even after the emergency room putting me on lisinopril at home. Covid test was negative. It started to edge back up the next day. I do hope these symptoms are temporary and not permanent. These issues need to be taken seriously and the whole person looked at holistically. Please do not brush this off as a coincidence because more people get hurt and die from not being taken seriously. For me, this is a big deal. I eat well and exercise almost daily. Health is extremely important to me. As a result, I will not be getting the second dose. I''m worried it will kill me. I will likely need a cardiologist now and the medical bills from this one event will be astronomical (even with insurance).


VAERS ID: 1513391 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-27
Onset:2021-07-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blister
SMQs:, Severe cutaneous adverse reactions (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: Pt reported "blisters" on back after receiving vaccine the day prior 7/27/21. Pt was scheduled an urgent care visit with provider on 7/29/21


VAERS ID: 1513393 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-26
Onset:2021-07-28
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Headache, Pyrexia, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: PATIENT STATES HE HAD FEVER, FELT TIRED & A HEADACHE FOR THE FORST 48 HOURS. STARTING ON 7/28/2021 HE DEVELOPED HIVES ON HIS HANDS, FEET & BACK. AS OF TODAY 7/29/2021 THE RASH IS NOT SPREADING BUT IS BECOMING MORE DENSE.


VAERS ID: 1513403 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-27
Onset:2021-07-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: was hospitalized after 1st covid vaccine but it was determined not to be related to vaccine.
Other Medications: unknown
Current Illness: anemia
Preexisting Conditions: anemia , others unknown
Allergies: penicillin
Diagnostic Lab Data: in hospital. unknown.
CDC Split Type:

Write-up: Pt''s friend stopped by pharmacy 7/29/21 stating that she was hospitalized 7/28 , the day after receiving her 2nd Covid vaccine. Pt received 2 units of blood and is feeling much better. She has an ongoing history of anemia. Unsure if this was related to vaccine but reported due to timing of vaccine/ hospitalization.


VAERS ID: 1513443 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Dizziness, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

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

Write-up: During registration at , , informed that she might be pregnant and was not sure whether it was safe to get the Pfizer vaccine. explained to that she could still get the vaccine even if she was pregnant. But if she had any questions or concerns regarding the vaccine and her pregnancy, she should speak to her healthcare provider first. also told staff that was allergic to Penicillin and nuts. Staff explained to her that she could still get the vaccine, but she would have to sit for 30 minutes in the observation area so that staff could make sure she did not have any adverse reactions. decided to go forward with getting the vaccine. After getting the vaccine from , was directed to sit in the observation area for 30 minutes. During this time, , would periodically check on her to see how she was feeling, and each time said she felt fine. After her 30 minutes were over, told that she felt dizzy. asked if she could stay longer in the observation area as it was unsafe for her to stand up and walk. agreed. Staff offered her some candy and water to drink. After eating some candy, said she felt better. About 6 minutes later, said she was having trouble breathing and that it was getting worse. checked her oxygen level and it was 98. Staff explained to that her blood oxygen level was normal, but said she still couldn''t breathe. tried to do some breathing exercises with her. called EMS at 1:50 p.m. and then went outside and waited for them to arrive. then told staff that she was having chest pain and that it hurt. Staff continued to monitor until EMS arrived at 2:07 p.m. They assessed and then transported her to Hospital at 2:20 p.m. to have her further


VAERS ID: 1513449 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-27
Onset:2021-07-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C214 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse drug reaction, Chills, Fatigue, Insomnia, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: Gabapentin, Zoloft, Ibuprofen
Current Illness: N/A
Preexisting Conditions: Anxiety, Neuropathy
Allergies: Just Gadolinium contrast media
Diagnostic Lab Data:
CDC Split Type:

Write-up: "Moderna COVID19 Vaccine EUA" I rcvd vaccine around 7pm n about 12hrs after injection, 8/9 am, I started having terrible side effects. It reminded me of my symptoms when I had COVID back in February 2021. I was exhausted but couldnt sleep bc I had chills n a fever with the most awful body aches u can imagine. It really felt like days 4 n 5 of the actual virus! Totally dreading getting my 2nd dose now! Lol. But that only lasted until about 30 hrs after injection-around 12 am. The soreness in my arm started a few hours after injection but it was bearable and today its still sore but a lot better than yesterday. Just thought u should know in case it helps u understand this better!! Thanks for all u guys are doing!


VAERS ID: 1513625 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Loss of consciousness, Nausea, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Patient passed out in the chair (in the waiting room), while waiting the 15 minutes. He leaned over in the chair and his girlfriend noticed. He came to quite quickly. He was pale and sweating. He felt nauseated but never vomited. He stated he hadn''t eaten in over 6 hours. He had been working outside in the heat and hadn''t had much water, so those may have been contributing factors. He stayed in the waiting area for 30 minutes and felt completely fine when he left the store.


VAERS ID: 1513639 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood pressure increased, Dizziness, Malaise, Paraesthesia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypertension (narrow), Vestibular disorders (broad), Hypersensitivity (broad)

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

Write-up: Patient was given the Covid 19 Pfizer shot. Per protocol she was in the waiting room for the 15 minutes but was not feeling well. Conscious but was feeling light headed and dizzy. Came over and mentioned about her condition and wanted her vitals to be checked, brought her back to the immunization room and took her blood pressure was around 140/90 was high and requested me to call 911. Had an intern stay in the room with her had the EMT take a look and they brought her to the ER. At the hospital she felt more dizzy light headed and weak and started noticing tinglyness and tightening of the throat at that time they started her on prednisolone and Benadryl, after which she started feeling better and normal. Had her under observation till 5 pm and let her go home. Did prescribe her to take Benadryl for the next two days. Was not able to contact her yesterday. But did speak to her to find out about her condition, which she is feeling much better. She did notice similar symptoms in the morning so she did take Benadryl. Did contact her doctor listed on VAR form and updated them. The ER also requested the patient to contact the CDC for further information.


VAERS ID: 1513647 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-27
Onset:2021-07-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C12A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: I am not aware of tests that can be run but will be contacting my primary care physician
CDC Split Type:

Write-up: Significant Tinnitus like I''ve never experienced. Extremely loud and very concerning. Sounds like a deafening number of cicadas. The sound can be masked by external sounds at times but when it would otherwise be quiet the ringing becomes overwhelming.


VAERS ID: 1513880 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B211A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest discomfort, Dyspnoea, Rash, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: flu vaccine
Other Medications: Symbicort, Lisinopril, Zyrtec, garlic, calcium, Vit D, omega 3, multivitamin
Current Illness: none
Preexisting Conditions: asthma, diabetes, osteoporosis
Allergies: Penicillin, sulfa, iodine, wheat, rye, barley, sorghum, shellfish, citrus
Diagnostic Lab Data: Blood test to check histamine level. No results as of this report.
CDC Split Type:

Write-up: In 45 minutes I had a rash on my chest, back, and neck. Chest tightness, some shortness of breath. First O2 reading was 94%. They gave me Benadryl, 50 mg prednisone, and a breathing treatment. This got it under control. They also drew blood to check levels of histamine. (No results yet). A few hours later I had some more breathing difficulties. 6 hrs after the shot I had hives. Benadryl helped with all of that.


VAERS ID: 1513898 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-29
Onset:2021-07-28
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Lung opacity, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Interstitial lung disease (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: vitamin D, Lopressor, Prozac, Spiriva, wixela, Remeron, ProAir, singulair, Nitrostat, docusate
Current Illness: Seen in ED for left knee pain
Preexisting Conditions: hronic hypoxemic resp failure on 2L NC at home, asthma with COPD overlap, SSS s/p pacemaker, h/o stroke, dysarthria
Allergies: codeine, coffee, erythromycin, iohexol, levofloxacin, Lipitor, midodrine, naloxone, PCN, phenobarb, pravastatin, procaine, propohexane, tetracycline.
Diagnostic Lab Data: cxr shows bilateral opacities oxygen requirement increased from 2L to 6L
CDC Split Type:

Write-up: Patient admitted to hospital for covid 7/28, has worsening in baseline oxygen requirement.


VAERS ID: 1513904 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-22
Onset:2021-07-28
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Cough, Gait inability, Joint swelling, Laryngitis, Loss of personal independence in daily activities, Oropharyngeal pain
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lantus Novalog MetForman Ozempic Lyrica Vitamin C over-the-counter
Current Illness: None
Preexisting Conditions: Diabetic CMT
Allergies: Sulfa
Diagnostic Lab Data: None so far
CDC Split Type:

Write-up: July 28 2021 woke up with slight cough , sore throat, also had some knee pain July 29 woke up 4;30 am With Excruciating knee pain and swollen knee , could not walk . My husband and son In law had to help me get up Also had sore throat and laryngitis Not sure if the above is related to my second shot 7/22/21 or not


VAERS ID: 1514050 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Emotional distress, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: PATIENT CALLED PHARMACY TO REPORT FACIAL SWELLING. WAS ADVISED TO TAKE A COUPLE BENADRYL AND GO TO THE EMERGENCY ROOM. HE WAS UPSET AND ACCUSED US OF MAKING HIM TAKE THE VACCINE AND CLAIMED THAT WE SHOULD BE ABLE TO FIX HIS ADVERSE REACTION WITHOUT HIM HAVING TO VISIT THE ER OR COME BACK TO THE PHARMACY. HE CLAIMED THAT HE TOOK 3 BENADRYL AND THAT HE WILL WAIT TO SEE HOW HE FEELS.


VAERS ID: 1514426 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Oregon  
Vaccinated:0000-00-00
Onset:2021-07-28
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210760314

Write-up: DOSE WITHDRAWN TWO DAYS AGO WAS GIVEN TO A PATIENT TODAY; This spontaneous report received from a pharmacist concerned a 61 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 28-JUL-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 28-JUL-2021, the subject experienced dose withdrawn two days ago was given to a patient today. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of dose withdrawn two days ago was given to a patient today was not reported. This report was non-serious.


VAERS ID: 1514429 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Oregon  
Vaccinated:0000-00-00
Onset:2021-07-28
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210760340

Write-up: INCORRECT PRODUCT STORAGE; OUT OF SPECIFICATION PRODUCT USE; This spontaneous report received from a health care professional concerned a 61 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 203A21A, expiry: 07-AUG-2021) dose was not reported, administered on 28-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 28-JUL-2021, the subject experienced out of specification product use. On an unspecified date, the subject experienced incorrect product storage. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the out of specification product use and incorrect product storage was not reported. This report was non-serious.


VAERS ID: 1514433 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-07-28
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Anosmia
SMQs:, Taste and smell disorders (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210760371

Write-up: VERY WEAK SENSE OF SMELL AND JUST THAT NIGHT COULD NOT SMELL ANYMORE; This spontaneous report received from a patient via a company representative concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: unknown) dose was not reported, administered on 27-JUL-2021 13:30 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 28-JUL-2021, the subject experienced very weak sense of smell and just that night could not smell anymore. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of very weak sense of smell and just that night could not smell anymore was not reported. This report was non-serious.


VAERS ID: 1514439 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:0000-00-00
Onset:2021-07-28
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Product administration error, Product container issue
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: USJNJFOC20210760865

Write-up: TWO BROKEN VIALS; POTENTIAL ADMINISTRATION ERROR FROM ONE CRACKED VIAL; This spontaneous report received from a physician concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 207A21A, and expiry: 04-AUG-2021) dose was not reported, administered on 28-JUL-2021 for prophylactic vaccination. No concomitant medications were reported. On 28-JUL-2021, the subject experienced two broken vials. On 28-JUL-2021, the subject experienced potential administration error from one cracked vial. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the two broken vials and potential administration error from one cracked vial was not reported. This report was non-serious.


VAERS ID: 1514441 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-07-28
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Dyspnoea, Headache, Pain, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210761158

Write-up: VOMITING; FELT LIKE COULD NOT BREATHE; PAIN IN LOWER BACK; PAIN IN ENTIRE BODY; HEADACHE; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: not reported) dose was not reported, administered on 27-JUL-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 28-JUL-2021, the subject experienced vomiting. On 28-JUL-2021, the subject experienced felt like could not breathe. On 28-JUL-2021, the subject experienced pain in lower back. On 28-JUL-2021, the subject experienced pain in entire body. On 28-JUL-2021, the subject experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from vomiting, felt like could not breathe, pain in lower back, and headache, and the outcome of pain in entire body was not reported. This report was non-serious.


VAERS ID: 1514443 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-07-28
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache, Illness, Product administered to patient of inappropriate age, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic 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? 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: USJNJFOC20210761985

Write-up: REALLY SICK; FEVER; HEADACHE; VACCINE ADMINISTERED TO PERSON WHOSE AGE IS 17; This spontaneous report received from a parent concerned a 17 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 28-JUL-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 28-JUL-2021, the subject experienced vaccine administered to person whose age is 17. On 29-JUL-2021, the subject experienced really sick. On 29-JUL-2021, the subject experienced fever. On 29-JUL-2021, the subject experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from fever, headache, and really sick, and the outcome of vaccine administered to person whose age is 17 was not reported. This report was non-serious.


VAERS ID: 1514552 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-04-06
Onset:2021-07-28
   Days after vaccination:113
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: positive COVID test on 7/28/2021
CDC Split Type:

Write-up: patient had a COVID test for pre travel purposes on 7/28/2021, which came back positive


VAERS ID: 1514842 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Medium


VAERS ID: 1514849 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-25
Onset:2021-07-28
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Diaphragmalgia, Musculoskeletal chest pain, Pain, Painful respiration
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: Lipitor, Xarelto, Zoloft, Gabapentin, Vitamin B, Protonix
Current Illness: None
Preexisting Conditions: Depression, high cholesterol, DVT, PE, Gerd
Allergies: None
Diagnostic Lab Data: None, haven?t gone to be checked.
CDC Split Type:

Write-up: Sharp Pain in shoulder blade and Rib Area under Arm Pit on the same side as vaccine was injected. Pain is worse with movement and deep breaths as diaphragm expands.


VAERS ID: 1514856 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Flushing, Hyperhidrosis, Loss of consciousness, Presyncope, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Flushed / Sweating-Mild, Systemic: Seizure-Mild, Additional Details: Patient stated he suffered from vasovagal syndrome but had not had an episode in 6 years. He felt that it was more anxiety over the shot. He did not experience any difficulty breathing. passed out for about 15 to 20 seconds, regained conciousness, sat on the ground upright, then laid down. monitored for an hour.


VAERS ID: 1514864 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-07-21
Onset:2021-07-28
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Injection site erythema, Injection site pruritus, Injection site warmth, Pain in extremity, Paraesthesia oral, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Centrum fresh & fruity 50+ chewable Calcium Citrates Petites 400 mg + 12.5 mcg D3 Ed-a-hist 4mg
Current Illness: I had a sinus infection 2 weeks prior, was still taking Ed-a-hist for post nasal drip. I had a thoracic spinal fusion T2-12 on 5/10/21. My neurosurgeon approved of me taking the vaccine.
Preexisting Conditions: Post nasal drip for over 6 months.
Allergies: Allergic to penicillin Anaphylactic reaction to IVP dye
Diagnostic Lab Data: Have not been to doctor about it.
CDC Split Type:

Write-up: After 30 minutes waiting, I had hives on face and on way home tongue felt prickly. I was instruct by pharmacist to take Benadryl once got home. Exactly a week later 7/28/21, I started itching uncontrollably on arm at site of injection. Next morning, 7/29/21 it was a red circle on my arm and it was hot to touch and itched. Went to work and 8.5 hours later, entire arm and shoulder was hurting and achy. Today, 7/30/21, arm, shoulder pain with itch. Still warm to touch from red area / raised.


VAERS ID: 1514990 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-13
Onset:2021-07-28
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 2 LA / IM

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

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

Write-up: Patient had positive COVID test on 7/28/2021


VAERS ID: 1514999 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Electrocardiogram normal
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient left the facility with no signs or symptoms of adverse reaction after completing the 15-minute observation period. Patient and his mother came back into the facility approximately 10 minuets after leaving, at this time the patient complained of chest pain/pressure. Vital signs were taken and an EKG was performed, all results came back within normal limits. Patient was monitored for an additional 30 minuets and was feeling better. Patient then left the facility.


VAERS ID: 1515002 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Blood Glucose 91, BP 100/52, O2 99, HR 56. BP 133/60, HR 67, R 16, O2 99.
CDC Split Type:

Write-up: Client was vaccinated and went to the observation area, while there he complained of lightheadedness. Client placed in wheelchair and taken to private area in reconstitution section where his vitals were taken. While in chair he was offered a bottle of water and asked if he wanted to lay down; he did in supine position. Vitals repeated while he was lying down. Client was asked if he had eaten and hydrated and he replied that he had not. He was asked by EMS if he was feeling better and wanted to be taken to an ER. Client stated he would stay here until he felt better and refused to be transported. Client left the area at 12:30 walking on his own.


VAERS ID: 1515014 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-27
Onset:2021-07-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Fatigue, Feeling cold, Injection site erythema, Petechiae, Postmenopausal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: steraline
Current Illness: RSD for 10 years
Preexisting Conditions: RSD for 10 years
Allergies: all cillans, seafood, arbutoral
Diagnostic Lab Data: waiting to hear back from doctor and had an online consultation which is where I learned of the term peticia below in line 21 i can not answer as this is not completely done and waiting for responses back worried if I should or should not get next shot and why I am bleeding when i have not for 5 years
CDC Split Type:

Write-up: day of vaccine exhaustion in evening next day more tired and cold with what I was told was peticia / broken blood vesicles on left arm. (Not a rash but lots of red dots on left arm where injection was given). I am a woman who has completed menopause and has not had a period for 5 years and had heavy chunks of blood come out like a period 2 days after the shot with uncomfortable feelings in my stomach. I have also been cold to the point where I am staying under a heating blanket wearing a fleece jacket as well.


VAERS ID: 1515016 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-07-22
Onset:2021-07-28
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Induration, Pain, Rhinorrhoea
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zytec
Current Illness: Seasonal allergies
Preexisting Conditions:
Allergies: Penecillin
Diagnostic Lab Data: No test has been done at this time he doctor said I had to contact this office first because they do not have a lot of information on side effects on teenagers and to call them back once I got a response from you.
CDC Split Type:

Write-up: A inner lump has form in his left shoulder blade straight back from the injection site. He is saying it is painful and it hurts all the time. He also had a runny nose but that since has stopped.


VAERS ID: 1515017 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-26
Onset:2021-07-28
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / IM

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

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

Write-up: Breakthrough covid case after vaccination. Covid positive on 7/29/2021 by PCR testing


VAERS ID: 1515021 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 224CG / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, Wrong 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:

Write-up: Patient was given Pfizer Covid 19 dose in error, the patient had requested Tdap(Boostrix), and had previously received 2 doses of Moderna Covid vaccine. The Tdap was then given in the other(left) arm so the patient would know which vaccine was involved if any reaction occurred. The patient reports no ill effects so far on the next day.


VAERS ID: 1515031 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-07-27
Onset:2021-07-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Cold sweat, Pyrexia, Rash, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Pt reports "a rash on my forehead, weak, shakey, cold sweats, a fever of 101 that broke this morning around 0520"


VAERS ID: 1515032 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / UN

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Head discomfort, Headache, Hypoaesthesia, Hypotension, Impaired work ability, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad), Hypokalaemia (broad), Sexual dysfunction (broad)

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

Write-up: I experienced multiple adverse side effects: 1 pressure in my head 2 strong headache 3 pain in my left arm 4 numbness in my left arm 5 very low blood pressure 86/61 6 extreme weakness 6 today is the second day that I have to call in sick


VAERS ID: 1515037 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Disorientation, Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Client stated she fainted when had allergy shots "a years ago, aged approx late teens or early 20''s."
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 07/28/2021 At approx 10 min after injection at 1715, client stated she "was feeling dizzy and like she was going to faint." Approx 1716, client was talking w/RN and appeared to exhibit vasovagal s/sx''s, i.e. dizziness. Client stiffened for approx 2 -3 seconds, appeared to immediately faint in closed vehicle (drive up clinic) woke up after apprx 3 seconds, w/no loss of urination, stated she was slightly disoriented, and w/i 5 seconds oriented X4. Approx 1717, client was able to answer questions and stated "I feel so much better, back to normal. I have no medical conditions, no hx of seizures, and on no medications." Client later stated she had fainted in the past w/injections, stated she hadn''t drunk much water during day. Environmental temp was in 90''s, outdoors. At approx 1725 client was able to walk w/o difficulty or dizziness to restroom and continued to be monitored in observation until 30 min after time of injection. Client stated she felt normal and fine to drive. Client stated she was planning to go to store to pick up dinner for herself & daughter. RN advised client if she felt any s/sx?s as previously experienced to safely pull off road immediately. RN explained s/sx?s of allergic reaction to client and daughter and instructed client?s daughter to call 9-1-1 if client appears to have fainted, showing any signs as previous episode, any type allergic reaction, or in need of emergency medical care.


VAERS ID: 1515043 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-28
Onset:2021-07-28
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dizziness
SMQs:, Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

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

Write-up: Extreme, highly painful chest pain, dizziness


VAERS ID: 1515052 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-10
Onset:2021-07-28
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 - / IM

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

Write-up: pt is fully vaccinated and admitted for COVID 19


VAERS ID: 1515063 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Calcium Carbonate-vitamin D
Current Illness: None
Preexisting Conditions: Hypercholesterolemia
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Janssen vaccine vial punctured at 0833 and syringes drawn, BUD time 1433. Patient arrived at 1432 and was given injection at 1442, 9 minutes past BUD time. No adverse reaction or treatment necessary.


VAERS ID: 1515091 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Decreased appetite, Discomfort, Ear pain, Hallucination, auditory, Headache, Hot flush, Hyperacusis, Impaired work ability, Insomnia, Myalgia, Nausea, Pain, Photophobia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hearing impairment (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vyvanse 30mg once a day, Lexapro 10mg once a day, Rameltion 8mg at bedtime.
Current Illness: NA
Preexisting Conditions: Fibromyalgia, ADHD
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Headache started approximately 45 minutes after vaccine accompanied with hot flashes. When I got home from hospital the headache had become severe enough that I had to go into a dark room as I was having light and sound sensitivity. Approximately 4 hours after the vaccine I started feeling feverish, chills, aches, nausea. At 9pm that night I was in severe pain from the myalgias, the headache was severe. Took over the counter extra strength Tylenol. At midnight I could not get comfortable. I was having auditory hallucinations thinking that I heard a shout or noise that wasn''t there. Temp was never over 101. Started getting an earache at this point. I was awake for 30+ hours with symptoms. Decreased appetite the following day. I was unable to work for 1.5 days. Symptoms started to subside on 7/29 around the 30 hour mark. I was awoken this morning 7/30 at 4am with another of the headaches but I took tylenol and it went away. I had a moderate case of Covid back in December of 2020 and my symptoms after the vaccine mirrored those almost exactly in intensity.


VAERS ID: 1515096 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-27
Onset:2021-07-28
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 LA / IM

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

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

Write-up: COVID break-through case: Patient tested positive for COVID 07/28/2021; greater than 14 days following last COVID vaccine. Patient is symptomatic.


VAERS ID: 1515099 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-21
Onset:2021-07-28
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

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

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

Write-up: On day 8, patient reported a bright red, large, round irritated area on injection site. Also, complaining of itching and tenderness on that area. Patient had no issues except sore arm prior to the 8th day


VAERS ID: 1515138 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Dehydration, Electrocardiogram normal, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (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), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: unknown
Allergies: no known allergies to medications. unknown for food
Diagnostic Lab Data: Patient stated an EKG was performed in the ER and it was normal. He stated blood work was taken, and it was normal. He told me that he said that he was dehydrated and needed to drink plenty of fluid. They could not even get an IV in his arm because of the dehydration.
CDC Split Type:

Write-up: The patient walked out of the vaccination room and around to sit in clinic just outside the pharmacy. The patient then passed out. d emergency staff was called by other staff members as we attended to him. His wife stated after that he has a tendency to do this. We gave him juice as he was coming to. The staff took him to the emergency room at Medical Center.


VAERS ID: 1515141 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-27
Onset:2021-07-28
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure abnormal, Fatigue, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: B-12 .Silica,Calicum magnesium, fish oil probiotic Astaxthin DMAE glucosamine. All supplements
Current Illness: nothing
Preexisting Conditions: Nothing
Allergies: nothing
Diagnostic Lab Data:
CDC Split Type:

Write-up: Faint, nauseous, tired BP 143/102. My BP has always been good prior to the shot.


VAERS ID: 1515144 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / UNK RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Impaired work ability, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (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? 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: I received my vaccine yesterday and had complications after the vaccine and could not work today . I had swelling of the extremity all the way to finger tips with 8/10 pain . Which was unrelieved by ice and warm packs and taking Tylenol. I did contact my md last night as the pain was enough for me to question if I should be going to the emergency room. She believes it might have been an allergic reaction to the vaccine.


VAERS ID: 1515171 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-01
Onset:2021-07-28
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Cough, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SARS CoV-2 Coronavirus PCR Positive
CDC Split Type:

Write-up: Fever, Runny Nose, Cough


VAERS ID: 1515196 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-28
Onset:2021-07-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Cardiac flutter, Dyspnoea, Ear discomfort, Headache, Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (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 vitamin Percocet Gabapentin
Current Illness:
Preexisting Conditions:
Allergies: Zpack
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain in left outer thigh within 40min of the shot. A few hours later headache, then next day pain in my armpit area, heart flutters. Woke up this morning, pain is worse under arm, armpit area is all swollen, pain going down arm into my palm and fingers. Shortness of breath, clogged ears.


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