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From the 7/23/2021 release of VAERS data:

Found 506,830 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 19 out of 5,069

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VAERS ID: 1483784 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-07-09
Onset:2021-07-15
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 LA / IM

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

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

Write-up: Patient had red rash that spread out all throughout his upper arm. Dark red in the center. Started occurring 6 days after the vaccine and necessitated an ER visit on Sunday


VAERS ID: 1483818 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Injection site rash, Periorbital swelling, Pyrexia
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Starting the night of the vaccine the patient started to feels chills, then the next morning she had a fever of 101 degrees which lasted for a day. She also is experiencing a rash at the injection site and swelling under her eyes that still persists from the day after the vaccine to now 3 days later.


VAERS ID: 1483872 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-09
Onset:2021-07-15
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site pruritus, 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: N/a
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness, itching and hard bump in injection site


VAERS ID: 1483880 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-07-13
Onset:2021-07-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none known
Preexisting Conditions: hashimoto''s disease
Allergies: penicillin, codeine
Diagnostic Lab Data: Physical examination on 7-17-21
CDC Split Type:

Write-up: The patient developed mild swelling and redness developing over 2 days extending from below the injection site down approximately 4-6 inches. She went to urgent care for evaluation. The provider ruled out allergic-type reaction, recommended topical Benadryl cream and redness and swelling went down within 24 hours.


VAERS ID: 1484011 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-07-08
Onset:2021-07-15
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Injection site erythema, Injection site rash, Injection site swelling, Pain in extremity, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None other than mild allergic asthma.
Allergies: Sulfa antibiotic, ash tree pollen, both types of dust mites. Sulfa antibiotic causes anaphylaxis. And bee venom allergy.
Diagnostic Lab Data: None but I have photos of the rash on day 8 and day 9
CDC Split Type:

Write-up: On day 8 after receiving the first jab, began to experience tiny itchy bumps all around the inj site. Approximately 3 inches wide. I had only severe arm pain for the 8 days prior. On day 9 after the itchy rash occurred, I began to get swelling 4 inches wide/long around injection site and the skin turned hot pink. I?m currently on day 9, today.


VAERS ID: 1484027 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Arthralgia, Back pain, Fatigue, Gastrooesophageal reflux disease, Immediate post-injection reaction, Malaise, Musculoskeletal chest pain, Myalgia, Nausea, Pyrexia, Shock
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (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: H1N1
Other Medications: Zyrtec, Soliqua, Metformin, Prozac, Zubsolv, Simvastatin, Metoprolol, Estradiol, Progesterone, Lidocaine, Ibuprofen, multi vitamin, potassium, magnesium, B-12, Biotin, Lecithin, Milk Thistle, Tumeric, Fiber capsule, Trilligy Ellipta, Flonas
Current Illness: None
Preexisting Conditions: Arthritis for 30 years, degenerative disc disease, arrhythmia, anaphylaxis
Allergies: Penicillin, Levaquin, melons, avacados, shell fish, morphine, cucumber
Diagnostic Lab Data: Answe to next question: Mostly recovered. Still some abdominal pain.
CDC Split Type:

Write-up: Within 5 seconds of injection I immediately experienced a triggered fight/flight reaction with perspiration that turned into the feeling of shock, within an additional 5 seconds. Full event lasted less than 1 minute. Then, I began feeling acid reflux which intermittently continued through the next 24 hours. The reflux lessened within 36 hours. Pain began in upper abdomen under lowest ribs, also mid back, on both sides all the way around my upper torso . This has continued to date. Otherwise, I experienced similar commonly reported side effects such as joint pain, fatigue, malaise, muscle pain, nausea and a slight, short fever occurred within 3 hours of the time of injection, lasting through the first 48 hours.


VAERS ID: 1484032 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-07-01
Onset:2021-07-15
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, 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: Levothyroxine, Gabapentin, Clonazepam
Current Illness: none indicated
Preexisting Conditions: not indicated on form
Allergies: Meperidine, Propoxyphene
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported itching beginning at injection site and spreading around to various spots 2 weeks after her vaccine. I checked with her 2 days later to see if it resolved and it had.


VAERS ID: 1484076 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-04
Onset:2021-07-15
   Days after vaccination:72
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Aortic thrombosis, Arterial thrombosis, Cardiac operation, Computerised tomogram thorax abnormal, Thromboembolectomy, Vascular operation
SMQs:, Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: CT scan of the chest that reports the following: filling defect that extends from the mid aortic arch into the right brachiocephalic artery is consistent with the thrombus. There is a filling defect at the origin of the left carotid artery. There is no obvious left ventricular clot. There is a defect in the anterior aorta at the diaphragm.
CDC Split Type:

Write-up: This is not confirmed diagnosis however, part of the immediate differential diagnosis includes possible vaccine related thrombosis. Currently being worked up in the hospital for New - Onset aortic arch thrombus with thromboembolectomy to left arm. Patient has no previous history of blood clots, no family history of blood clots and the location of blood clot is in a very unusual location. Patient developed sudden onset symptoms of left arm arterial thrombosis that required immediate surgical embolectomy to restore blood flow to left arm. CT scan noted large aortic arch thrombosis and transferred to Hospital for escalation of care, cardiac surgery and vascular surgery evaluation. Hematology team consulted to begin workup for hypercoagulopathy.


VAERS ID: 1484077 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-13
Onset:2021-07-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Blood ethanol, C-reactive protein, Catheterisation cardiac, Chest X-ray, Chest discomfort, Chest pain, Differential white blood cell count, Echocardiogram, Electrocardiogram, Fibrin D dimer, Full blood count, Hepatitis viral test, Lipids, Metabolic function test, Red blood cell sedimentation rate, Scan with contrast, Troponin I
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: 1 tablet - Carditone /day. Usually taken at night for past 4 years. 1 - 1000 mcg Chromium Picolinate / day 1- 400 mg Magnesium Oxide / day
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CBC Jul 17, 2021 Lab BASIC METABOLIC PANEL Jul 17, 2021 Imaging Ct Angiogram Chest W WO Contrast Jul 16, 2021 Imaging CARDIAC CATHETERIZATION Jul 16, 2021 Lab D-DIMER,QUANTITATIVE Jul 16, 2021 Lab TROPONIN I Jul 16, 2021 Lab ACUTE HEPATITIS PANEL Jul 16, 2021 Lab ETHANOL LEVEL Jul 16, 2021 Lab LIPID PANEL Jul 16, 2021 Imaging TRANSTHORACIC ECHO (TTE) COMPLETE 16, 2021 Imaging XR Chest 1 View Jul 16, 2021 Lab COMPREHENSIVE METABOLIC PANEL Jul 16, 2021 Lab TROPONIN I Jul 16, 2021 Lab CBC W/ AUTO DIFFERENTIAL Jul 16, 2021 Lab SEDIMENTATION RATE, AUTOMATED Jul 16, 2021 Lab C-REACTIVE PROTEIN Jul 16, 2021 Other type of result ECG 12-LEAD Jul 16, 2021
CDC Split Type:

Write-up: ? 7/13/21 1015AM 2nd COVID vaccine from Moderna received. ? 7/15/21 0200AM (times are approximate) o I started having chest pains in the middle of the night. Sitting or kneeling seemed to relieve some of the pain. It went away after 1500 mg Acetaminophen lasting approx. 3 hrs. ? 7/16/21 (times are approximate) o 0100-0500 Chest pain came back, same style of pressure. No breathing issues. 1500 mg Acetaminophen o 0900 Checked into ER. 7/17/21 Discharged from hospital 330PM


VAERS ID: 1484092 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-15
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Headache, Injection site pain, Musculoskeletal stiffness, Neck pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), 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: None
Current Illness: none
Preexisting Conditions: None
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Whole body joints pain for 2 days, Injecting site still in pain for 2 weeks now, Tingling whole body starting at 10th day , still ongoing, Left neck(injected at left arm) pain / stifness on and off, Light headache ongoing


VAERS ID: 1484101 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Arthralgia, Chills, Diarrhoea, Fatigue, Hyperhidrosis, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 5 mg Prednisone, 20 mg Lexapro
Current Illness:
Preexisting Conditions: Rheumatoid arthritis
Allergies: Penicillin, Bactrim
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills and sweats, upset stomach/diarrhea, muscle and joint pain, fatigue. I was not able to take Tylenol or aspirin because I am taking a steroid. Symptoms went away after about 36 hours.


VAERS ID: 1484112 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Lymphadenopathy, Myalgia, Pain in extremity, Peripheral swelling, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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:
CDC Split Type:

Write-up: Swollen lymph node under right arm. My entire arm was sore to my finger tip it felt as if my circulation was being cut off in my arm and it lasted about 48hrs. My under arm is still swollen and sore. I did have all the other side affects, fever, chills, dizzy, muscle aches and fatigue.


VAERS ID: 1484286 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 RA / SYR

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

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

Write-up: chills, headache


VAERS ID: 1484465 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 - / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT STARTED FEELING DIZZINESS AND LAID ON THE FLOOR AT HOME. PT STATES SHE FEELS MUCH BETTER AFTER LAYING ON THE FLOOR. PT HOME WITH MOTHER WITH STABLE CONDITION


VAERS ID: 1484473 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chills, Headache, Injection site pain, Myalgia, Pain, Pyrexia, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydroxychloroquine 200mg 2x daily Folic Acid Daily Vitamin
Current Illness: Lupus SLE
Preexisting Conditions: Lupus SLE
Allergies: Latex Benadryl Oyster
Diagnostic Lab Data: none
CDC Split Type:

Write-up: High fever of 103 Chills with severe shakes severe headache that lasted 3+ days where I could not get up body ache pain at injection site 3+ days back pain severe muscle pain


VAERS ID: 1484479 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Chest pain
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra
Current Illness: None
Preexisting Conditions: Seasonal allergies
Allergies: Food allergies: wheat, peanut, hazelnut, sesame, tuna, salmon, shrimp
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chest tightness 2 hrs after vaccine administered. 18 hrs and after chest pain exacerbated by light physical activity. Pain becomes sharp immediately after moderate physical activity such as brisk walk/jog. Same symptoms experienced when sick with assumed COVID-19 in October 2020


VAERS ID: 1484511 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-07-13
Onset:2021-07-15
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: levofloxacin, threonyl lactone, vitamin B12, vitamin D3, potassium, magnesium, fish oil, coQ-10, turmeric, probiotics, hair, nail, and skin supplement
Current Illness: none.
Preexisting Conditions: Postpartum stroke at age 32, breast cancer
Allergies: Codine, and hydrocodone
Diagnostic Lab Data: No.
CDC Split Type:

Write-up: About 2 days after vaccination, patient developed a red spot at the injection site. Over the last several days the redness and swelling has expanded to about an inch from the crease of the elbow, and is warm to the touch. Redness and swelling appears to be spreading at this time, 6 days after vaccination.


VAERS ID: 1484514 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-12
Onset:2021-07-15
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Malaise, 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: Lisinopril 10mg, Albuterol HFA, Betimol 0.5% ophthalmic solution, apirin 81mg
Current Illness: NA
Preexisting Conditions: Essential hypertension, carrier of hemochromatosis HFE gene mutation.
Allergies: NKA
Diagnostic Lab Data: Positive COVID-19 PCR test on 05/18/2021
CDC Split Type:

Write-up: Symptoms of COVID which developed on 07/15/2021,


VAERS ID: 1484564 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Nodule, Pruritus
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: I began to note a raised itchy bump on my forearm, very small and blister-like on the same day as my shot about 6 hours after the shot. It reminded me of poison ivy. Another bump appeared near the first. In the subsequent days, including today, new bumps have appeared on various parts of the Left side of my body (a cluster of bumps behind my left knee. Two bumps on the left side of my neck. Two bumps on my left underarm. Total of 6 bumps now on my left forearm (below inside of the elbow). Two bumps below my jaw.


VAERS ID: 1484623 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Feeling abnormal, Headache, Insomnia, Lymphadenopathy, Pain in extremity, Restless legs syndrome
SMQs:, Dementia (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Arm Pain 6pm, Headache the following 2 days all day long, brain fog the following day of vaccine, Diarrhea 4 days now, glands under arm (same with injection) swollen painful days 3 and 4 after vaccine, 2nd night had insomnia, days 3-4 had restless legs at bedtime.


VAERS ID: 1484669 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-07-12
Onset:2021-07-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dehydration, Diarrhoea, Muscle spasms, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Pseudomembranous colitis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin, fish oil, magnesium
Current Illness: None
Preexisting Conditions: Migraines, allergic asthma
Allergies: Penicillin, codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: 7/12/21 extremely painful arm lasting 2 days. 7/15/21 nausea, cramping, diarrhea lasting until 7/18/21 which caused dehydration. Still some nausea today.


VAERS ID: 1484675 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chest pain, Chills, Echocardiogram normal, Ejection fraction normal, Electrocardiogram normal, Nausea, Pain, Pleuritic pain, Troponin I increased, Vomiting
SMQs:, Acute pancreatitis (broad), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lamictal Testosterone (female -$g male transgender) Rizatriptan
Current Illness:
Preexisting Conditions: Seizure disorder Female to male transgender on hormone replacement therapy
Allergies: Procaine
Diagnostic Lab Data: Troponin I level: 3.95 (7/17 6:27 am), 9.15 (7/18 13:10), 7.50 (7/18 19:18) EKG (7/17): normal sinus rhythm, normal axis, normal intervals and no specific ST-T abnormality Echo (7/17): normal ejection fraction (55-60%), no wall motion abnormalities, no significant valvular abnormalities
CDC Split Type:

Write-up: After recieving second dose of Pfizer vaccine, patient developed pchest pain radiating to back the following day. Associated with nausea, vomiting, and chills. Chest pain was also pleuritic. Symptoms improving over the preceding days while in the hospital.


VAERS ID: 1484684 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-05
Onset:2021-07-15
   Days after vaccination:71
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Pain, Productive cough, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive, Sneezing
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (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: Xyzal 5 mg tablet 1 tab(s) orally once a day (in the evening) Premarin 0.3 mg tablet 1 tab(s) orally once a day
Current Illness: unknown
Preexisting Conditions: Fibroid uterus. Fiber cystic changes of breast. Depression. HPV+. Obstructive Sleep apnea.
Allergies: NKDA
Diagnostic Lab Data: COVID PCR tested on 7-16-2021. Result: positive
CDC Split Type:

Write-up: 1. fever, body aches/Pt states she has had phlegm in her throat X 1 month, with sneezing, states she has tried OTC sinus medication and it has not helped. She feels the mucus has now gone into her chest and started with fever and bodyaches yesterday Pt self reported completing PFIZER COVID vaccine series at the beginning of May. I was unable to pull vaccination information.


VAERS ID: 1484690 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-01-12
Onset:2021-07-15
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Influenza, Influenza virus test positive, 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: Based on lab report, patient became symptomatic with chills on 7/15/2021 starting at 05:00. Influenza/COVID-19 Nucleic Acid Amplification Test performed on 7/17/21 at 15:15. Test came back positive. Case investigation interview completed at time of written note, isolation period advised and public health preventative measures have been advised. Case appears to be safe and with family at home.


VAERS ID: 1484699 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Myalgia, Nausea, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: headache, nausea, body aches, myalgias


VAERS ID: 1484765 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-08
Onset:2021-07-15
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: COVID positive PCR after being vaccinated.


VAERS ID: 1484830 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 1 LA / IM

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

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

Write-up: The recipient is 16yo and received Moderna, which is only approved for 18 and over.


VAERS ID: 1484847 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-15
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021CZ1A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Autoimmune thyroiditis, Breast pain, Breast swelling, Condition aggravated, Hypothyroidism, Sleep disorder
SMQs:, Angioedema (broad), Hypothyroidism (narrow), Hyperthyroidism (broad), Lipodystrophy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Hypothyroid and hashimotos but I manage it through diet.
Allergies: Aspirin. Gluten intolerant.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 1. Painful, enlarged, swollen breasts 2 weeks after 2nd dose. It has been lasting for several days and is still occurring. It hurts to wear a bra. I have to seek help with anti inflammatory medication, acupuncture, and breast massage. 2. Also, I feel my immune system ramped up which is exacerbating my adrenal-thyroid condition and making it difficult to calm down and fall asleep at night.


VAERS ID: 1484865 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site discolouration, Injection site erythema, Injection site hypersensitivity, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (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: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Received vaccine at 3:30 pm on 7/15/21. By 4:00 pm, my son had complaints of sensitivity and soreness. Morning of 7/16/21, he woke with a significantly swollen arm with raised red area and extreme sensitivity. I took pictures due to the significance. Measurements 3" x 3", warm to the touch. Color, dark purple. By Day 3 - 7/18/21, the color faded to a blue bruise, size remains the same, still warm to the touch. Day 4 - 7/19/21, color is fading, but can still see the area affected on his right harm. Since it has been 4 days, we went back to pharmacy today 7/19/21 at 1:00 pm, to show them his arm, and the pictures I took. They referred to this as COVID arm, and immediately recommended I register with VSAFE to track his progress. *Note: VSAFE does not allow any registration for people born after 2005. So, I am tracking information here at VAERS


VAERS ID: 1484868 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-10
Onset:2021-07-15
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Fatigue, SARS-CoV-2 test positive
SMQs:, Taste and smell disorders (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Positive Covid Test received 7/18/2021 in. Symptoms are mild, but fatigue is very bothersome and no taste or smell.
CDC Split Type:

Write-up: Got Covid barely a month after receiving the vaccine


VAERS ID: 1484877 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C214 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Erythema
SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Asthma, mitral valve prolapse but no longer needed to have EKGs as it has seemed to have corrected itself as I?ve gotten older
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizzy, lightheaded, hard to breathe, both arms turned bright red Lasted 2 min or so and symptoms started to dwindle on their own


VAERS ID: 1484883 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-18
Onset:2021-07-15
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Myalgia, Nasal congestion, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Taste and smell disorders (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (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: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose 01/28/2021pfizer,Lot#EN5318 2nd dose: 02/18/21,Pfizer,Lot# EL9266 Diagnosed covid positive:07/15/21 Exposure:Community esposure Symptoms:cough, fatigue,muscle aches,loss of smell/taste, nasal congestion.


VAERS ID: 1484884 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-22
Onset:2021-07-15
   Days after vaccination:84
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / UNK LA / 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? 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: your coronavirus nasal swab came back positive for SARS-CoV-2, the virus that causes COVID-19. This means that you are actively infected and contagious to others. You must isolate at home to prevent spread of the virus.


VAERS ID: 1484885 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-18
Onset:2021-07-15
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Exposure to SARS-CoV-2, Fatigue, Myalgia, Nasal congestion, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Taste and smell disorders (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (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: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose 01/28/2021pfizer,Lot#EN5318 2nd dose: 02/18/21,Pfizer,Lot# EL9266 Diagnosed covid positive:07/15/21 Exposure:Community esposure Symptoms:cough, fatigue,muscle aches,loss of smell/taste, nasal congestion.


VAERS ID: 1484887 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-05
Onset:2021-07-15
   Days after vaccination:132
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Exposure to SARS-CoV-2, 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose 02/12/21pfizer,Lot#EM9810 2nd dose: 03/05/21,Pfizer,Lot# EN6202 Diagnosed covid positive:07/15/21 Exposure:Travel Symptoms:


VAERS ID: 1484892 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-29
Onset:2021-07-15
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Headache, Pyrexia, SARS-CoV-2 test positive
SMQs:, 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? 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: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose :01/08/21pfizer,Lot# 2nd dose: 01/29/21,Pfizer,Lot# Diagnosed covid positive:07/16/21 Exposure: Symptoms:Fever, head ache.


VAERS ID: 1484894 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-29
Onset:2021-07-15
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Chills, Cough, Fatigue, Headache, Myalgia, Rhinorrhoea, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Taste and smell disorders (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (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: Agency completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose 01/08/21pfizer,Lot# 2nd dose:01/29/21,Pfizer,Lot# Diagnosed covid positive:07/17/21 Exposure: Symptoms:cough, fatigue,muscle aches, loss of smell/taste,chills,runny nose,HA


VAERS ID: 1484956 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH QWO181 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? 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: Zoloft 50 mg QD
Current Illness: None
Preexisting Conditions: Depression Obesity
Allergies: NKDA
Diagnostic Lab Data: EKG 7/15/21
CDC Split Type:

Write-up: Chest pain, Bilat Arm Pain, Fever


VAERS ID: 1484992 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-07-01
Onset:2021-07-15
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Osteopenia after menopause ? Dementia without behavioral disturbance ? History of neck surgery ? Moderate major depression ? Gastroesophageal reflux disease ? Mild intermittent asthma without complication ? Morbid obesity with BMI of 40.0-44.9, adult ? Seasonal allergic rhinitis ? Fibromyalgia ? Spinal stenosis, cervical region ? Connective tissue and disc stenosis of intervertebral foramina of cervical region ? Vitamin D deficiency ? Type 2 diabetes mellitus ? Myalgia ? Essential (primary) hypertension ? Osteoarthritis ? Bilateral hand pain ? Cervicalgia ? Rheumatoid arthritis ? Neoplasm of unspecified behavior of brain ? Trigger finger
Allergies: Levaquin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted to the hospital with a pulmonary embolus


VAERS ID: 1485081 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Vermont  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cyanosis, Feeling cold, Nausea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad)

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

Write-up: ? At approximately 6:50PM vaccine was administered. ? Within 10 minutes of the dose being administered, patient began vomiting. ? At approximately 7:03PM, RN attempted to assess patients pulse. RN determined pulse to be approximately 100 BPM but was difficult to be confident as the pulse was indistinct. Another RN also attempted to collect a pulse and was not confident in a reading. Oxygenation and heart rate was attempted to be collected using a pulse oximeter. A reading could not be determined. Additionally, a temperature could not be collected using an infrared thermometer. Upon observation, the patient appeared pale and diaphoretic. He did not present or report difficulty breathing at any time. Patients skin was cool to the touch. Patient reported to his parents that he felt nauseous and cold. ? At approximately 7:08PM patient was offered juice. ? At approximately 7:10PM RN observed that nail bed began to become discolored, slightly blue. RN requested call 911. ? EMS onsite by 7:15PM. EMS vitals included, o BP 131/88 o HR 103 o Resp. 24 o O2 Sat 98% o Temp 98.4 ? Family declined glucose screen and transport to emergency department as patietn began to report feeling better. Patients color improved. ? EMS, family, and staff left scene at approximately 7:50PM. ? RN connected with patients father on 7/16/21. Father reported that patient was doing much better, slept through the night with no issues. Patient was still sleep when father left for work that morning, however, father looked in on him. Per fathher, his color appeared good and he was sleeping well. Father wondered what gauge needle was used for the procedure. He stated he thought is was long and perhaps a 1 ? ? size. RN assured it was a 1? needle as the type of set-up used was a complete set-up with a standard 1? needle.


VAERS ID: 1485137 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-07-12
Onset:2021-07-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 RA / IM

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

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

Write-up: injection site redness, area warmer, area firmer than surrounding


VAERS ID: 1485172 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blister, Oral mucosal blistering
SMQs:, Severe cutaneous adverse reactions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flonase
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Blisters on the hands, feet, and inside mouth. Doctor said they are seeing this in some people with the 2nd Pfizer shot. Told us it should disappear in 10 days maximum.


VAERS ID: 1485236 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: New York  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Emotional distress
SMQs:, Depression (excl suicide and self injury) (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: Distress


VAERS ID: 1485416 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Chills, Dizziness, Electrocardiogram, Electrocardiogram ambulatory, Feeling abnormal, Headache, Heart rate increased, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: coconut
Diagnostic Lab Data: 7/15/21 at ER i had EKG, heart monitoring, IV fluids, Tylenol via IV.
CDC Split Type:

Write-up: Apx 18 hours after the vaccine was administers my body was sore, aches/pains (my glutes and hamstrings felt like i did 1000 squats), my right arm was sore, i had a terrible headache, chills, & low grade fever. I did not feel right. i was monitoring my heart rate on my wrist band it was very elevated. my resting heart rate was between 120-150 bpm for nearly 12 hours. about 3:20 i started to feel dizzy, anxious, and my heart rate was continuing to claim. I contacted ED advise nurse at 3:21pm the hold time was till 3:42pm when i received a call back. reviewed my symptoms and was told a doctor would call me back about 7pm. When the doctor called, he advise i need to go into the ER for EKG and to verify if i had a blood clot.


VAERS ID: 1485628 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, C-reactive protein increased, Catheterisation cardiac, Chest pain, Computerised tomogram, Dyspnoea, Electrocardiogram abnormal, Gout, Headache, Inflammation, Myalgia, Pyrexia, Ultrasound chest, Ultrasound scan
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Multi Vitamins, Prescription Testosterone, Anastrozole
Current Illness: None
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data: Blood work, EKG, CT Scan, ultrasounds of chest and legs
CDC Split Type:

Write-up: Was having normal side effects including headache, fever, muscle aches which started about 6 hours after injections. Roughly 14-16 hours after the injection (8:30-9am) started getting chest pain and slight shortness of breath. Called my PCP and they told me to go to the ER as the chest pain is not normal. At the ER they did an EKG which came back abnormal and I was rushed into a procedure to check my heart including a catheter, ultrasound, and a few more I will provide below. Outcome after all the test was inflammation which I asked if it could have been in other areas of my body but doctor said it was my chest. My C-Reactive Protein level was double the normal level. They put me on 3 medications, Ibuprofen, one for Gout and Prilosec.


VAERS ID: 1485637 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-12
Onset:2021-07-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Possible Bell''s palsy To whom it may concern: I am an ED physician, I saw this patient for what appears to be Bell''s palsy. He had his pfizer covid vaccine 1 week ago, and sx started a few days after that. He does not recall when he had the vaccine exactly and could only give estimate dates. He also did not recall the location he got the vaccine when I saw him in the ED. Further information should be obtained through him as I only know the limited information he had provided me.


VAERS ID: 1485643 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-25
Onset:2021-07-15
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, Rosuvastatin 20mg, Quonol. OTC, D3, Nicotinimide, Saw Palmetto, diphenhydramine 25mg, Prilosec 20mg
Current Illness: None.
Preexisting Conditions: None
Allergies: Contrast Iodine
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Tinnitus. A white noise and slightly muffled effect. Hearing acuity doesn?t seem affected. (No hearing test administered)


VAERS ID: 1485984 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-07-12
Onset:2021-07-15
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Communication disorder, Dysarthria, Fatigue, Vertigo, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily: 500 mg trans-resvaratrol, 2.5 g fish oil
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fatigue, weakness for 7 days so far. Neurological symptoms began 2-3 days ago: unable to think of words, saying some things with slurred or mispronounced vowels, tried to scratch nose and stuck my finger in my eye, eyes aren''t focusing right or something like mild vertigo.


VAERS ID: 1485999 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Georgia  
Vaccinated:0000-00-00
Onset:2021-07-15
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       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? 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: USJNJFOC20210738457

Write-up: FELT THROAT TIGHTEN; This spontaneous report received from a parent concerned a male of unspecified age. 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 15-JUL-2021 11:30 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 15-JUL-2021, the subject experienced felt throat tighten. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from felt throat tighten on 15-JUL-2021. This report was non-serious.


VAERS ID: 1486580 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Itching at Injection Site-Mild, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild


VAERS ID: 1486584 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 3 LA / IM

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

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

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


VAERS ID: 1486875 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-18
Onset:2021-07-15
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: R56.9 - New onset seizure (CMS/HCC)


VAERS ID: 1486897 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       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: Moderna vaccine
Current Illness: not available
Preexisting Conditions:
Allergies: Not available
Diagnostic Lab Data: no adverse event
CDC Split Type:

Write-up: Patient came with her mother and informed us that she wants moderna vaccine for her son who is 12 years old. My technician typed the prescription as a first dose of moderna vaccine. techinformed me that the vaccine is ready to be injected. I gave the moderna vaccine to the patient and realised that and I spoke to the mother about it and the mother said it is approved by moderna for kids 12years and older and she insisted that, that is what she wants . I advise patient that pfizer vaccine is the only vaccine which is now approved for AUE, for now but patients mother said that is what she wants. There was no reported adverse event. I am reporting because modener has not recievev the AUE aproval from FDA. my recomendation is now as use as off label use


VAERS ID: 1486986 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-17
Onset:2021-07-15
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: 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: Zoloft, vitamin d3, potassium, magnesium, lecithin, coq10, L Theanine, probiotics
Current Illness: None
Preexisting Conditions: None
Allergies: Septra
Diagnostic Lab Data:
CDC Split Type:

Write-up: I take birth control that doesn?t have a period and I have started spotting. Everyday since it began.


VAERS ID: 1487037 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-11
Onset:2021-07-15
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 57 11/2020 flu shot
Other Medications: I take these daily. Zinc vit c probiotics magnesium. Linisopril 20 mgThe vitamins don''t make me sick
Current Illness: none
Preexisting Conditions: herniated disc in Lumbar vertebrae herniated c7 disc arthritis in spine and joints slight gout premature heartbeats high blood pressure
Allergies: codeine novacaine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: woke up nauseous 2nd daylater drank some coffee I small cup took vitamins threw up kept feeling nauseous from Thursday until Tuesday . At first after vaccine I felt hot then cold no chills.


VAERS ID: 1487081 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-26
Onset:2021-07-15
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20-2A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Exposure to SARS-CoV-2, Fatigue, Feeling cold, Headache, Myalgia, Oropharyngeal pain, Pain, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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: Hydroxyzine, metformin XR, Tri-Sprintec, nortriptyline, sertraline, spironolactone, sumatriptan.
Current Illness:
Preexisting Conditions: PCOS, depression, anxiety
Allergies: Latex
Diagnostic Lab Data: Novel Coronavirus PCR: SARS-COV-2 detected (7/15/2021)
CDC Split Type:

Write-up: Pt is 26 yo female employee at this institution. She is s/p Moderna COVID-19 full vaccination: first dose on 12/31/2020, second dose on 1/26/2021. Underwent voluntary COVID-19 rapid testing on 7/15 after experiencing symptoms including chills, new onset cough, fatigue, muscle/body aches, sore throat, headache, and congestion/runny nose. She reported possible exposure to someone else with COVID-19. PCR test resulted positive.


VAERS ID: 1487097 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-02
Onset:2021-07-15
   Days after vaccination:135
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Malaise, Rhinorrhoea, SARS-CoV-2 test positive, Sneezing
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Hypersensitivity (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none known
Allergies: unknown
Diagnostic Lab Data: positive rapid test 7/20/2021
CDC Split Type:

Write-up: Client was vaccinated for Covid with Moderna vaccines on March 2 and March 30, 2021. Client had Covid symtoms that started on 7/15/2021: runny nose, sneezing, cough, loss of taste and smell. Tested positive with rapid test on 7/20/2021. Reported because this is a case of Covid in a previously fully vaccinated person.


VAERS ID: 1487113 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-05
Onset:2021-07-15
   Days after vaccination:71
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / UNK RA / 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: 07/20/2021-Encounter For Preprocedural Laboratory Examination (COVID-19)


VAERS ID: 1487121 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-13
Onset:2021-07-15
   Days after vaccination:93
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036N21A / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Headache, Rhinorrhoea
SMQs:, Anaphylactic reaction (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: 7/15- Patient stated that their symptoms started on: 7/15 patient stated he had a headache, mild cough and runny nose. Today he feels better.


VAERS ID: 1487155 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-01-20
Onset:2021-07-15
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes COPD
Allergies:
Diagnostic Lab Data: Tested on 07/16/21 with the Antigen test at Hospital.
CDC Split Type:

Write-up: Patient contracted COVID-19 and was hospitalized on 07/16/21 after receiving the COVID-19 vaccinations.


VAERS ID: 1487195 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

Write-up: Vaccine was mixed with sterile water instead of sodium chloride. there were no know ADE.


VAERS ID: 1487233 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Scan
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Dehydration (broad)

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

Write-up: BP DROP 78/53 HR 36-37 WENT TO ER CARE 11:30 PM TIL 10:00 AM WAS TOLD HAD A STROKE TRANSFERRED TO ER 12 NOON TIL 7:30 PM DOCTOR TOLD HER NO STROKE RELEASED NEXT DAY BP REBOUND TO 170/101 HR 73 STILL RUNNING HIGH 7/20/2021 TOLD TO CHECK WITH CARDIOLOGIST


VAERS ID: 1487281 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-07-01
Onset:2021-07-15
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest pain, Computerised tomogram, Costochondritis, Dyspnoea, Electrocardiogram, Fatigue, Headache, Hypokinesia, Lymphadenopathy, Nausea, T-lymphocyte count increased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none/ sensitive to Demerol
Diagnostic Lab Data: Friday 7/16, in ER they gave him ECG, cat scan, full blood panels. The only abnormalities were elevated t-cell count, and some inflammation seen in chest cavity.
CDC Split Type:

Write-up: Sudden onset of severe headache, chest pain, difficulty breathing, fatigue and nausea, ~72 hours post vaccination. After 16 hours of bad symptoms that got worse, I took my husband to the ER, as he was having difficulty breathing and moving. (He is normally very fit, active and healthy). In hospital, they ran a battery of tests and found signs of inflammation in chest and lymph nodes. They gave him fluids, and intravenous pain meds (acetaminophen, Toradol), which helped slightly. Symptoms diminished slowly over next 24 hours, and he was feeling 90% better by Saturday afternoon.


VAERS ID: 1487295 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia, Peripheral swelling, Pruritus, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient began to experience pins and needles in upper lip and left cheek within 15 minutes of vaccination. Later that evening her chin, ears, and around her eyes developed hives and were very itchy. She also developed swelling under both arms the following day.


VAERS ID: 1487315 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Fatigue, Nausea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol sulfate HFA, ciclopirox 8%, gabapentin, lamotrigine, levetiracetam, mavyret, prazosin
Current Illness:
Preexisting Conditions: chronic hep c
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: shortness of breath , HA, fatigue, nausea and vomiting from date of vaccine until current per patient


VAERS ID: 1487380 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Burning sensation, Dizziness, Head discomfort, Hypoaesthesia, Nausea, Sleep disorder
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: DPT and Prevar admin. together as baby
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: As baby had a severe reaction to DPT and Prevar shots given at same time; high fever, shrill cry and afterwards at times a neurological
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Within 2-3 minutes post vaccine, dizziness, felt like I was going to faint, weak, nauseated, loss feeling both hands, burning pain pressure back of nape of neck which spread to overall head. Sat down right away, pharmacist (? tech ; administered vaccine) were both very attentive. Stayed there 30 minutes. My grandmother who is a nurse was right there with me. I live with my grandmother; and she checked my BP at home: 120/86, Apical pulse 88 regular; rechecked today 7-20-21 and it was 98/78, Apical pulse 72. That night and next one to two days some dizziness and diff. sleeping due to pressure sides of head which is slowly improving and no more dizziness.


VAERS ID: 1487443 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-07-09
Onset:2021-07-15
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AMLODIPINE, PIOGLITAZONE, TRIAMTERENE, METFORMIN
Current Illness: NONE PER PT
Preexisting Conditions: DMII, HTN
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: BELLS PALSY PER MD


VAERS ID: 1487461 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: New Chapter Brand Multi Vitamin for Women Over 40, includes herbal blends
Current Illness: None
Preexisting Conditions: Type 2 Diabetic
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Developed flu like or COVID like symptoms: headache; body aches, chills, felt feverish but did not show fever when temperature taken; extreme fatigue; dry cough. This has been happening for 5 days now.


VAERS ID: 1487775 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-10
Onset:2021-07-15
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling cold, Feeling hot, Flushing, Malaise, Motion sickness, Nausea, Nervousness, Piloerection
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (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: Became allergic to naproxen after malaria vaccine
Other Medications: LDN T3-T4 Citalopram
Current Illness: None
Preexisting Conditions: Asthma anxiety Hashimoto Thyroiditis
Allergies: Naproxen
Diagnostic Lab Data:
CDC Split Type:

Write-up: I felt perfectly fine until day 5 Ever since I feel very dizzy like motion sickness and nauseous most of the time. I am very nervous this will never go away. I get hot and flushed and then that goes away and I''m chilled with goosebumps. I feel ill most of the day


VAERS ID: 1488504 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-05-07
Onset:2021-07-15
   Days after vaccination:69
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Nasal congestion, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: tested positive for COVID on 7/19/2021
CDC Split Type:

Write-up: patient developed sore throat and nasal congestion on 7/15/2021. She tested positive for COVID on 7/19/2021


VAERS ID: 1489549 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Connecticut  
Vaccinated:0000-00-00
Onset:2021-07-15
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 180978 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Fatigue, Hypersomnia, Injection site pain
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (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: Blood pressure high
Preexisting Conditions: Comments: Patient had no known drug allergies. Patient was taking multivitamins and multivitamins for the eye.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210738491

Write-up: STAY ASLEEP / REST LONGER; INJECTION SITE ARM PAIN; FEELING TIRED; LOSS OF ENERGY; This spontaneous report received from a patient concerned a 74 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included high blood pressure, and other pre-existing medical conditions included patient had no known drug allergies. patient was taking multivitamins and multivitamins for the eye. The patient was previously treated with lisinopril for high blood pressure, and amlodipine for high blood pressure. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 180978 expiry: UNKNOWN) dose was not reported, administered on 27-MAR-2021 for prophylactic vaccination. No concomitant medications were reported. On 15-JUL-2021, the subject experienced stay asleep / rest longer. On 15-JUL-2021, the subject experienced injection site arm pain. On 15-JUL-2021, the subject experienced feeling tired. On 15-JUL-2021, the subject experienced loss of energy. Treatment medications (dates unspecified) included: menthol/methyl salicylate. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from injection site arm pain on 16-JUL-2021, and the outcome of feeling tired, loss of energy and stay asleep / rest longer was not reported. This report was non-serious.


VAERS ID: 1489556 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Missouri  
Vaccinated:0000-00-00
Onset:2021-07-15
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (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:
Current Illness: Back pain
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210738787

Write-up: MUSCLE SORENESS WHICH WAS WORSE IN HIS SIDES AND BACK; FATIGUE; This spontaneous report received from a patient concerned a 65 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included back pain. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 14-JUL-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 15-JUL-2021, the subject experienced muscle soreness which was worse in his sides and back. On 15-JUL-2021, the subject experienced fatigue. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from fatigue, and had not recovered from muscle soreness which was worse in his sides and back. This report was non-serious.


VAERS ID: 1489626 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / UNK RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Postmenopausal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BOTOX; PROPRANOLOL
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: post menopausal bleeding 3 hours and 45 minutes later; This spontaneous case was reported by a patient and describes the occurrence of POSTMENOPAUSAL HAEMORRHAGE (post menopausal bleeding 3 hours and 45 minutes later) in a 51-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 027B21A) for COVID-19 vaccination. Concomitant products included BOTULINUM TOXIN TYPE A (BOTOX) and PROPRANOLOL for Migraine. On 15-Jul-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 15-Jul-2021, the patient experienced POSTMENOPAUSAL HAEMORRHAGE (post menopausal bleeding 3 hours and 45 minutes later) (seriousness criterion medically significant). At the time of the report, POSTMENOPAUSAL HAEMORRHAGE (post menopausal bleeding 3 hours and 45 minutes later) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No medical treatment was reported. Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. Further information has been requested.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. Further information has been requested


VAERS ID: 1490253 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Injection site bruising, Injection site induration, Injection site nodule, Injection site pruritus, Injection site rash, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: herbal supplements for Rheumatoid Arthritis, various prescription medications
Current Illness: none
Preexisting Conditions: "colon issues" Rheumatoid Arthritis, cataracts
Allergies: unknown
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Nausea the evening of 7/15/2021. Took Nausea Medicine says she has a prescription due to "colon issues" 7/16-7/19 had nausea with intermittent vomiting. On 7/16/21, patient notices hard knot near injection site on left arm. Approximately 2 inches in length, 1.5-1 inch wide. Patient describes as football shape. Patient developed generalized rash at injection area on 7/17/21 with bruising. Patient reports that later the site become itchy. Called Pharmacy who administered vaccinations, advised to take benadry and tylenol continue to monitor. Advised patient to speak with PCP if injection site reaction does not resolve within 7-10 days after vaccination. Patient already has phone call in to PCP.


VAERS ID: 1490256 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1490338 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-31
Onset:2021-07-15
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Hypoxia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID positive by PCR on 7/15/2021
CDC Split Type:

Write-up: The patient tested positive for COVID on 7/15/2021 after being exposed to family member(s) that were also positive. He came to the hospital on 7/19/2021 with symptoms of shortness of breath, hypoxia, and dyspnea.


VAERS ID: 1490467 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 RA / IM

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

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

Write-up: Administered the vaccine to patient under 18 years old


VAERS ID: 1490473 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 RA / IM

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

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

Write-up: Itchy hives developed on both hands ~24 hours after injection. Most bumps are on his hands and wrist with a few on his elbows.


VAERS ID: 1490479 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

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

Write-up: Exhaustion, sore arm


VAERS ID: 1490526 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Aphonia, Arthralgia, Chest discomfort, Dyspnoea, Headache, Influenza like illness, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Influenza shots, noted similar side effects
Other Medications: Hydrochlorothiazide
Current Illness: N/A
Preexisting Conditions: HBP
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states that after receiving the Phizer 1st dose 07/14/2021, started to experience symptoms 07/15/2021 loss of voice, tightness in the chest, loss of taste, shortness of breath, fever (99.8), joint pain, and headache. Still experiencing continuous headache struggling with flu-like symptoms. Consulted with Pharmacists regarding still experiencing symptoms and was told to make a VAERS report. No primary visit noted.


VAERS ID: 1490572 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 2 LA / IM

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

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

Write-up: Moderna administered to a 12 yr old


VAERS ID: 1490583 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 2 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood glucose normal, Blood lactic acid, Blood magnesium normal, Body temperature increased, Chills, Dehydration, Differential white blood cell count, Electrocardiogram T wave abnormal, Full blood count, Influenza virus test negative, Lipase normal, Lymphocyte percentage decreased, Mean cell volume increased, Metabolic function test, Nausea, Neutrophil count increased, Neutrophil percentage increased, QRS axis abnormal, Red blood cell count decreased, SARS-CoV-2 test negative, Sinus tachycardia, Urine analysis normal, Vomiting, White blood cell count increased
SMQs:, Acute pancreatitis (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Other ischaemic heart disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow), Hypokalaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: Covid-19, unsure of issues
Other Medications: tamoxifen, oxybutynin chlorideXL, telmisaratan-hydrochlorithiazide, setraline
Current Illness:
Preexisting Conditions: Mitral Valve prolapse, hypertension, hyperlipidemia, malignancy (mastectomy with reconstructive augmentation), urge incontinence.
Allergies: Iodine, Penicillin, Latex, Natural Rubber
Diagnostic Lab Data: Physical exam 7/15 All 7/15 Lactic Acid 3.1 (HH) Magnesium 1.6 (L) Comprehensive metabolic panel - Glucose 136 (H) other values within range Lipase 56 CBC with Automated DIFF WBC 16.5 (H) RBC 3.89 (L) MCV 101.3 (H) Neutrophils 80 (H) Lymphocytes 15 (L) ABS Neutrophils 13.2 (H) All others within ref range EKG, 12 Lead Initial VR 121 AR 121 PR Interval 162 QRS 74 Q-T Interval 314 QTC Calculated 446 P Axis52 R Axis-27 T Axis66 sinus tachycardia corderline left axis deviation abnormal r wave progrssion borderline t abnormalities Covid, influenza, negative urinalysis normal
CDC Split Type:

Write-up: A few hours after receiving 2nd Covid vaccine patient began feeling nauseated then started vomiting. She denies blood in the emesis. She also endorses feeling "chilled to the bone." Triage temp is 103.1. Patient denies chest pain, shortness of breath, cough, numbness, tingling, falls, headache, abdominal pain, diarrhea, constipation, changes in diet, recent travel. No dysuria, hematuria, rashes, bruising or bleeding. She states she has had at least 6 or 7 episodes of emesis and is on her fourth emesis bag in the ER. She states she feels very dehydrated and week. I was informed that the patient was admitted and was under the care of a hospitalist who I could not reach.


VAERS ID: 1490675 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007D21A / 1 LA / IM

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

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

Write-up: Moderna vaccine vial must be discarded 12 hours since first puncture. Although the vial was kept in the refrigerator, patient received a dose from a punctured vials that was first opened past the 12 hour mark.


VAERS ID: 1490775 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

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

Write-up: Describe the adverse events, treatment, and outcomes?: enter: ?Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.?


VAERS ID: 1490796 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Full blood count, Inflammatory marker test, Metabolic function test, Myalgia, Peripheral swelling, Polyarthritis
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Systemic lupus erythematosus (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Arthritis (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Normal inflammatory markers, CBC, BMP.
CDC Split Type:

Write-up: Patient developed ipsilateral arm swelling which progressed to polyarthritis on the elbow and wrist. Within a few days, similar symptoms developed on the ipsilateral leg including knee and ankle. Also with arthralgias and myalgia in this distribution. No real improvement with ibuprofen. Was admitted to hospital for these symptoms and arthritis resolved with NSAIDs, but still with significant arthralgias. No fevers throughout, but on NSAIDs.


VAERS ID: 1490828 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / UNK - / IM

Administered by: Work       Purchased by: ?
Symptoms: Lip pruritus, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swelling, itching lips, upper back and scalp. History of anaphylactic reaction to medications. Patient was given one dose of epinephrine, responded well and was transported to the ED for further observation.


VAERS ID: 1490998 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 - / -

Administered by: Pharmacy       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:

Write-up: Received vaccine not stored according to manufacturer recommendations


VAERS ID: 1491002 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New York  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate increased, Hypoaesthesia, Malaise, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Dehydration (broad)

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

Write-up: About 9pm on July 15, 2021, my daughter started to feel a tingling sensation on her face. Between 9:30pm-10:30pm she gradually begin to have mild to severe numbness in her face, legs, chest and arms and her heart was beating rapidly. She told us she feels that she?s going to die. We took her to the emergency room where heart rate rose as high as 175bpm and the numbness got worse


VAERS ID: 1491661 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Head discomfort, Headache, Migraine, Nausea, Pain, Polymenorrhoea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Developed body aches, tiredness, fever, and headache. But the headache never went away, it?s more of a migraine. The headache and throbbing lessens but there is still some underlying pressure in my head and then it hurts again accompanied by nausea, and I haven?t suffered from migraines. The migraines seem to be lessening now. Also, I had just finished my period the week I got the shot and it restarted my period when I got the symptoms.


VAERS ID: 1492076 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-07
Onset:2021-07-15
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / N/A LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Chest X-ray, Chest pain, Dyspnoea, Headache, Palpitations, Tinnitus
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Dyshidrotic eczema. Seasonal Allergies
Allergies: None
Diagnostic Lab Data: On 07/19/2021 I had some tests done but nothing was found. Frontal and lateral radiographs of the chest did not find anything notable. Heart rate has some palpitations but is mostly normal. Blood tests didn''t find anything.
CDC Split Type:

Write-up: Day 2 after getting the vaccine I went to the hospital over headache, tinnitus, chest pain and breathing problems. The pain never went away but it slowly got worse over time. 5-6 weeks and I am severely suffering from chest pain and shortness of breath. Airways feels very tight. Went to the doctors and got perscribed prednisone and an inhaler. I''ve never needed or used an inhaler before. I''ve never had breathing problems other than nasal congestion during flu season. Neither the prednisone or the inhaler help at all. The prednisone and inhaler do not help the breathing even a tiny bit and this is after using them for all 5 days that they were perscribed. Breathing never feels satisfying. I am constantly breathing deep breaths through the mouth for air but it never feels like I''m getting enough air. Whether it be stress, allergic reactions, or exercise, I have never had breathing problems like this before and I have not done anything else that could have brought these problems on.


VAERS ID: 1492079 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Confusional state, Disturbance in attention, Dysphemia, Feeling hot, Hypoaesthesia, Nausea, Pain, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (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: Cozaar 100mg, 2000 iu vitamin D, iron, sodium bicarbonate 2 pills
Current Illness:
Preexisting Conditions: Stage 4 kidney disease, hypothyroidism, hypertension
Allergies: Lisinopril - dry cough
Diagnostic Lab Data: No
CDC Split Type:

Write-up: Started feeling hot about 19 hours later 07/15/21 around 2:30pm, then both forearms and hands felt tingly/numb sensation on and off for about 7 hours. Started feeling confusion in the brain with stuttering lightly, trouble concentrating, inside brain kept feeling not as aware around 4:30PM for 2 hours, then started feeling like throwing up lightly around 6:30PM on and off for 3 hours, body ached all over starting at 8:30PM for about 4 hours towards end of night. I took 2 aspirin and 4 Tylenol around 10:00PM, then felt better at 3:30am.


VAERS ID: 1493590 (history)  
Form: Version 2.0  
Age: 100.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-03-11
Onset:2021-07-15
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 - / 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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 PCR Positive 07/15/2021
CDC Split Type:

Write-up: Patient fully vaccinated with Pfizer x 2 doses. Developed COVID-19 and hospitalized at Medical Center for same.


VAERS ID: 1493658 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired 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:

Write-up: Patient received vaccine that was stored improperly. Vaccine was moved from ultra-cold freezer to freezer on 6/17/21. According to guidance from Pfizer, vaccine stored in the freezer after day 17 is considered improperly stored, and the patient will need to be re-vaccinated.


VAERS ID: 1493664 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Anosmia, Balance disorder, Cough, Ear congestion, Headache, Influenza like illness, Injection site pain, Lacrimation increased, Malaise, Oropharyngeal pain, Productive cough, Pyrexia, Sluggishness, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Lacrimal disorders (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine - many years ago - back in the early 1990''s. Bad reaction and have never had a flu vaccine since.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Got vaccine by 5pm on Wednesday 7/14/2021, went to bed feeling fine, woke up the next morning feeling as sick as could be. I was feverish, sluggish, full of flu like symptoms (terrible sore throat/coughing/wheezing/headache/phlegm/ears blocked/ eyes watering/balance problems) My arm at the injection site was painful to the touch. I have had absolutely no taste or smell sensation at all. Today(07/22/2021) is day 8 of these symptoms and I am finally able to say that I may be over the hump(so to speak) of all this as I am starting to feel a little bit better. I am still coughing up phlegm, but not as bad.


VAERS ID: 1493704 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-07-08
Onset:2021-07-15
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site hypoaesthesia, Injection site pain, Injection site paraesthesia
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: patient states gets flu from flu vaccine for 6 months
Other Medications: amlodipine 5 mg daily aspirin 81 mg daily
Current Illness: none acute
Preexisting Conditions: fibromyalgia
Allergies: morphine/oxycodone/codeine penicillin and other antibiotics
Diagnostic Lab Data: none reported
CDC Split Type:

Write-up: About a week after her second shot in left arm, patient developed burning/numbness/tingling in right arm then in left arm. Patient reports that it is very painful. Patient states can''t tolerate any pain relievers and does not have a primary care provider to see, even though the pharmacist suggested it.


VAERS ID: 1493738 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-15
Onset:2021-07-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Deafness, Pyrexia, Shock
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None.
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2 mins after receiving the vaccination began to lose vision and hearing, fever. Went into shock and was admitted to the hospital.


VAERS ID: 1493742 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-13
Onset:2021-07-15
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Cough, Diarrhoea, Dyspnoea, Fatigue, Myalgia, Nausea, SARS-CoV-2 test positive, Vomiting
SMQs:, Rhabdomyolysis/myopathy (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), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CKD Stage IV, HTN, hyperparathyroidism, T2DM
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This case meets vaccine breakthrough criteria review with +COVID test $g14 days post vaccination series. Presented to ED with shortness of breath, myalgias, fatigue, nausea, abdominal pain, cough, vomiting, diarrhea


VAERS ID: 1493802 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-07-14
Onset:2021-07-15
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Contusion, Erythema, Induration, Neck pain, Pain in extremity, Skin warm
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ACETAMINOPHEN 325 MG ORAL TABLET 240 A 05-07 05-07 2 30 ALCOHOL PREP PAD 100 A 06-29 06-29R 11 30 BUPRENORPHINE-NALOXONE 8 MG-2 MG SUBLI E 06-01 06-01 0 30 90 CAPSAICIN 0.025% CREAM 60 A$g 05-18 05-18 5 15 HYDROXYZINE 25 MG ORAL TABLET 56 A
Current Illness:
Preexisting Conditions: alcohol abuse tobacco anxiety Type 2 DM asthma depression ptsd opioid abuse
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bruised, red, lump, warm to touch, sore/achy arm, neck hurts


VAERS ID: 1493858 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-01-25
Onset:2021-07-15
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL92601 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Melaena, Nausea, SARS-CoV-2 test positive, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Metorprolol, Synthroid, Omega 3, Zocor, multivitamin, vit. D, Prolia, CoEnzyme Q10,
Current Illness: COPD, GERD, hypothyroidism, pulmonary emphysema, dyslipidemia, diverticulosis, colon polyps, arthritis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COV pos. 7.15.21 on admission
CDC Split Type:

Write-up: Nausea, vomiting, black tarry stools,


VAERS ID: 1494112 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-08
Onset:2021-07-15
   Days after vaccination:68
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Brain natriuretic peptide increased, COVID-19, COVID-19 pneumonia, Lateral position, Pyrexia, SARS-CoV-2 test positive
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atorvastatin 20mg po q day, Bumetanide 0.5mg po qod, Carvedilol 25mg po bid, Famotidine 40mg po bid, Isosorbide Mononitrate SR 120mg po q am, Levothyroxine 100mcg po q day, Warfarin, Amlodipine 2.5mg po bid, Glipizide 2.5mg po q day, Hyd
Current Illness: Pt had fall on 6/10 and came in with head lacerations which were repaired with staples.
Preexisting Conditions: Cardiac Pacemaker, GERD, CAD, DM2, Hx of MI, pSVT, Erectile Dysfunction, Emphysema, Senile purpura, Atherosclerosis of Aorta, Hyperlipidemia, Bilat nonexudative age related macular degeneration, Hx of artery embolism, systolic Heart Failure, Constipation
Allergies: Ibuprofen - rash Lisinopril - Hyperkalemia Flomax - Stomach upset
Diagnostic Lab Data: CORONAVIR PAN 2019-NCOV, NAA, QL SARS-COV-2, QUALITATIVE, NAA (COVID-19), KP LAB Collected: 07/17/21 1109 Result status: Final Value: COVID DETECTEDAbnormal Comment: Nasopharynx/Oropharynx source.
CDC Split Type:

Write-up: 86 year old pleasant gentleman with a history of coronary artery disease (noted on MPS in 2003, unclear if prior intervention), hx of SSS with PPM, type 2 DM, ischemic CM with EF of 41%, chronic kidney disease with a baseline Cr 1.5 - 1.9, hx of popliteal artery embolism felt to cardioembolic in origin (in setting of cardiomyopathy) on lifelong coumadin, and chronic thrombocytopenia with baseline plts of 100s. He has been admitted for acute respiratory failure due to COVID pneumonia. There may also be a component of pulmonary edema given elevated BNP. Plan: 1. Acute Resp Failure/COVID-19 Disease - - Symptom onset on 07/15. COVID positive on 07/17. Last fever on 07/15 o Pt has been started on Remdesivir on 07/20. He is to have a 5 day course. o Continue decadron 6 mg daily - started on 07/20, will continue for 10 days o Trend LFT''s and chemistry daily as he is on remdesivir. Hold Remdesivir if ALT $g10xULN or CrCl<30 o Continue awake proning: 2 hrs prone, 1 hr left, 1 hr right and back to prone. Limit the hrs supine. Explained in detail to patient who understands and is agreeable. o May use MDIs as needed for bronchospasm o Check d-dimer, ferritin, ESR, and CRP every other day. If rising will need to consider CTA/LE doppler o Monitor I/O and make sure patient is net negative. Continue bumex home dose for now per patient request. Will increase tomorrow UOP not adequate. o Continue Coumadin for prophylaxis active bleeding o Nasal Cannula 3 liters. Goal SpO2 $g92%. Consider ICU evaluation if requiring $g40LPM and 60% FiO2 for SpO2 $g/= 90% o Pepcid for GI prophylaxis o Continue isolation in hospital per Regional/Local ID guidance.


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