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From the 10/15/2021 release of VAERS data:

Found 800,916 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 19 out of 8,010

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VAERS ID: 1776748 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Electrocardiogram abnormal, Fatigue, Myalgia, Pyrexia, Ventricular extrasystoles
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (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: EKG done-Trigeminal PVCS. will be following up with a provider
CDC Split Type:

Write-up: Fever, fatigue, severe muscle aches for 2 days. 2 days after vaccine, became short of breath and felt chest tightness,.


VAERS ID: 1776752 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 - / IM

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

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

Write-up: Patient came in for a routine follow up with PCP, she wanted the 3rd Covid vaccine (booster), I asked patient what vaccine she got for the first 2 doses and she stated that it was Pfizer so I asked to pull a vial to get vaccine prepped (since we have to wait 15 min). I asked patient for her covid card she told me she lost it so I told her I will get her a new one. when I finished checking her in I went to grab vaccine then came back to administer vaccine for patient while she waited for provider to come in for visit after that I left the room to get her vaccine card ready that''s when I realized when I went to patient''s immunization record that she in fact got Moderna series instead of the Pfizer series. Patient was advised of mistake and discussed any questions with PCP


VAERS ID: 1776758 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-04
Onset:2021-10-08
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Breakthrough positive covid testing 10/8/2021
CDC Split Type:

Write-up: Breakthrough positive covid testing 10/8/2021


VAERS ID: 1776760 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / UN

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Headache, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: Multivitamin, generic Keppra
Current Illness:
Preexisting Conditions: Hypothyroidism, seizure disorder (I take medication.)
Allergies: Seasonal allergies, penicillin
Diagnostic Lab Data: I haven''t had any tests or labs since my vaccine on Friday. I''m trying to contact my hcp but they''re not available and since I''m not insured want to avoid going to an ER.
CDC Split Type:

Write-up: Headache on and off since Friday, tingling in left arm (Friday about 1-2 hours after shot) right foot right hand (on Saturday-brief) sore left shoulder after shot but didn''t last, some very very mild chest pain that doesn''t last on Friday evening Saturday morning and Monday early afternoon.


VAERS ID: 1776775 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blister, Eye pruritus, Eyelid rash, Ophthalmic herpes zoster, Vision blurred
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Periorbital and eyelid disorders (narrow), Ocular infections (narrow), Hypersensitivity (broad), Hypoglycaemia (broad), Opportunistic infections (narrow)

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

Write-up: 10/7-2nd Moderna vaccine 10/8- Itching around left eye 10/9- Rash appeared around left eye 10/10- Rash turned into grouped vesicles around left eye 10/11- blurry vision in the left eye. Patient was evaluated in urgent care and sent ophthalmology for emergency evaluation. Treatment for herpes zoster opthalmicus initiated ( Valaciclovir, dexamethasone eye solution)


VAERS ID: 1776777 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-22
Onset:2021-10-08
   Days after vaccination:259
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Encephalopathy
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Inpatient admission to hospital with symptoms thought to be consistent with "COVID encephalopathy"


VAERS ID: 1776804 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-25
Onset:2021-10-08
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 RA / IM

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

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

Write-up: breakthrough covid case


VAERS ID: 1776813 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
SMQs:, Medication errors (broad)

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

Write-up: PATIENT RECEIVED A PFIZER DOSE AS THE SECOND DOSE, BUT HAD MODERNA AS THE FIRST DOSE. NO ADVERSE REACTION IS KNOWN


VAERS ID: 1776843 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939901 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: Lisinopril
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe chest pain that lasted (on scale of 1-10 = 8) lasted for 36 hrs then slowely diminished. Still painful 4 days later - no breathing issues Significant joint pain (on scale of 1-10 = 7) lasted for 24 hours


VAERS ID: 1776847 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, Arthralgia, Blood test normal, Chest X-ray normal, Cold sweat, Diarrhoea, Dizziness, Fall, Hand fracture, Hyperhidrosis, Loss of consciousness, Nausea, Sensory disturbance, Slow response to stimuli, X-ray limb abnormal
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Osteonecrosis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: : Livalo 2mg 1/day(cholesterol) Ramipril 10 mg 2/day(blood pressure) Levothyroxin 100mcg 1/day(low thyroid) HCTZ 25 mg 1/day (blood pressure) Meloxicam 15mg 1/day(arthritis) Generic Boniva 150 mg 1/mo.(osteoporosis) Zy
Current Illness: none
Preexisting Conditions: high cholesterol, high blood pressure, osteoporosis, osteo-arthritis
Allergies: Marcaine?passed out, breathing problems during Cesarean section Sulfa?severe headache EES?constant hunger pains Norflex?feelings of impending doom Tequin, Levaquin?headache Previcid?bowel movement urgency Lipitor, Pravachol, Crestor?joint, skin pain
Diagnostic Lab Data: 10/08/2021 Bloodwork, chest x-ray, finger x-ray at the hospital. All were normal except I had a non-displaced fracture of my left index finger: no treatment for fracture, except ice and if I felt like I needed to splint it. 10/10/2021 I noticed I had soreness over my left hip replacement, probably from the fall off the commode.
CDC Split Type:

Write-up: My husband fell in the bathroom about 4am. I popped out of bed to see what happened. Within 2 minutes I got extremely dizzy and sick to my stomach. I broke out in a cold sweat; I sweat through all my night clothes. I sat on the commode to use the bathroom. I put my head between my knees to try to control the dizziness. Next thing I know I am lying on the floor. I got back up; I was still dizzy. I had to put my head down on the vanity. It took several minutes before the dizziness and queazy stomach backed off. At some point I had to use the bathroom again, at which time I had diarrhea. My husband said he saw me fall off commode. He said my name several times before I responded. I asked my husband (what had happened to him. He said he got dizzy; next thing he knew he was on the floor in extreme pain in his shoulder, arm and ribs. It took us probably another 15 min. to figure out how to get him off the floor. I cannot lift him as he is twice my size. He was finally able to do work his way up off the floor. We got back to the bed. I dozed a couple of hours before getting up at 7. We went to the Hospital ER for treatment about 10am. I continued to have that slight head rush feeling on and off for the next 3 days.


VAERS ID: 1776857 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-11
Onset:2021-10-08
   Days after vaccination:270
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/8/21 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1776960 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Kansas  
Vaccinated:2021-05-28
Onset:2021-10-08
   Days after vaccination:133
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Breast mass
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol, apap, asa, amolodipine, buspar, duloxitine, ellipta, topamax, sumatriptan, propranolol, oxycodone, zofran, metformin, latuda, levothyroxine, ibu, lasix, gabapentin
Current Illness: anxiety, migraines, asthma, gerd, copd, ckd 2, arthritis, obesity
Preexisting Conditions: Anxiety Arthritis of hip Asthma Atypical mole Bilateral knee pain Chronic GERD Chronic leg pain CKD (chronic kidney disease), stage III Constipation COPD without exacerbation Depression Depression External hemorrhoids High blood pressure Hypothyroidism, adult Kidney stones Migraine Mouth dryness Osteoarthritis Pain and swelling of left lower leg Perforation of tympanic membrane, unspecified Prediabetes PTSD (post-traumatic stress disorder) Schizoaffective disorder Severe recurrent major depressive disorder with psychotic features Tobacco user Tremor of both hands Historical Arthralgia of the lower leg Arthritis Beta lactam resistant bacterial infection Bronchitis Cellulitis of breast Chest pain Depression Hearing loss Kidney stones Methicillin resistant Staphylococcus aureus PTSD Thyroid disease
Allergies: effexor, norco, flexaril, mirtazapine
Diagnostic Lab Data: physical exam
CDC Split Type:

Write-up: breast lump


VAERS ID: 1776977 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient called stating that she had gotten her first dose of Pfizer Covid-19 vaccine on 10/07/21. She noticed redness, itchiness, and swelling at the injection site, and It was also warm to the touch the following day 10/08/21 . Patient informed that there was no rash anywhere on the body, and there was no difficulty breathing.


VAERS ID: 1776978 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-21
Onset:2021-10-08
   Days after vaccination:260
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/8 SARS/COV-2, NAAT positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1777014 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 1 LA / IM

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

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

Write-up: No symptoms reported


VAERS ID: 1777015 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chest discomfort, Chills, Lymph node pain, Lymphadenopathy, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: bentyl, multi vitamin, xanax, omeprazole
Current Illness: no
Preexisting Conditions: IBS
Allergies: gold, nickel, black pepper, bell pepper
Diagnostic Lab Data: none
CDC Split Type:

Write-up: developed a gulf ball size lymph node enlargement to the left underarm on Friday (same day of administration), low grade fever, body aches and chills. 2 days later developed sub clavicular lymph node enlargement that is painful to touch. Having chest pressure from the swelling in both underarm and chest lymph node


VAERS ID: 1777019 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Hypoaesthesia, Injection site hypoaesthesia, Swelling, Swelling face, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flu vaccine, I have gotten sick from the flu vaccine in the past
Other Medications: Advair, Levothyroxine, pantoprozale
Current Illness: none
Preexisting Conditions: asthma, acid reflux
Allergies: milk, internal iodine, kiwi
Diagnostic Lab Data: Blood work completed
CDC Split Type:

Write-up: Numbness spread from injection site to rest of arm down to fingers. Then about 50 minutes after injection, numbness spread to right side of face and neck, throat started closing. Took Benadryl as soon as the numbness and swelling started on face neck. I went to her and could not be seen within 20min waiting, left to ER. They took me right in and started steroid and antihistamine IV , I was discharged with rx for prednisone once the swelling went down and throat opened up. I had to take Benadryl every 4 hours after being discharged, some my throat would start swelling again. Prednisone prescription was picked up following morning.


VAERS ID: 1777046 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-04-20
Onset:2021-10-08
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac arrest, Echocardiogram, Hyperhidrosis, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Cephalexin
Diagnostic Lab Data: Heart sonogram 10/09/2021
CDC Split Type:

Write-up: Nausea, sweats, fainting, heart pause-stoppage-25 seconds


VAERS ID: 1777056 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Headache, Nausea, Somnolence
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: Atorvastatin, B-12, Bupropion HC XL, D-Mannose powder plus with Cranberry & Probiotics, Levothyroxine, LI Carbonate, Omeprazole, Quetiapine, Fumarate, Xarelto
Current Illness: Bacterial infection, yeast infection
Preexisting Conditions: Sleep Apnea, pacemaker, non-alcoholic cirrhosis of the liver, detached retina, provoked blood clots, cystitis, bacterial/yeast infection, collapsed lung, pneumonia in both lungs, removed gallbladder, overactive bladder, double vision
Allergies: Ambien, Amoxicillin, Sulfa Antibiotics, Sulfacetamide, Nickel
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache, deep sleep for 24 hours, nausea, diarrhea, fatigue and couldn''t function as normal.


VAERS ID: 1777066 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-30
Onset:2021-10-08
   Days after vaccination:251
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/9 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1777080 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-08
Onset:2021-10-08
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/10 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1777090 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-06
Onset:2021-10-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Erythema, Fatigue, Lymphadenopathy, Malaise, Swelling, Tenderness
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine .075 mg, Sertraline 25 mg., Preservision, Senior Multivit., Vit D, ASA 81 mg., Glucosamine/Chondroitin,
Current Illness: -None-
Preexisting Conditions: Hypothyroid
Allergies: Penicillin (50 yrs ago - not taken since)
Diagnostic Lab Data: -None-
CDC Split Type:

Write-up: Supraclavicular lymphadenopathy - moderate swelling, redness and tenderness above L clavicle, first noticed 48 hrs after vaccine. Also mild axillary tenderness on L side. No symptoms on R side, and no elevated temp. (Vaccine was in L arm) Also felt mild malaise and fatigue the previous day, 10/7, relieved with sleep. Took one Aleve tablet the evening of 10/8 for discomfort over L clavicle, with relief. Swelling gradually diminished over the next 2 days. Today 10/11 there is only slight swelling and mild tenderness there. Still have had no elevated temp.


VAERS ID: 1777091 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-21
Onset:2021-10-08
   Days after vaccination:260
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/10 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1777106 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-26
Onset:2021-10-08
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/10 Sars/Cov-2, NAAT, positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1777130 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Severe Headache, arm pain at the site of injection/ body aches, chills, fatigue


VAERS ID: 1777315 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

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

Write-up: Very sick, headache, nauseous, achy, diarrhea,


VAERS ID: 1777331 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / N/A 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? 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: During a Pfizer vaccine and flu shot clinic, the administering RPh administered a Pfizer booster shot to a patient who had Moderna as his primary COVID vaccination series. The first Moderna shot was on 2/19/21, and second shot on 3/19/21. Administering RPh felt like patient was pressuring him to administer quickly d/t longer wait times and did not look at patient''s consent form or CDC vaccine record card prior to administration. The error was noticed immediately after vaccination and patient was counseled on the error.


VAERS ID: 1777336 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: arm hurt then the nerve all up to my neck hurt, then chills started, fever, headache, body aches present as of today. chills ended this morning and fever. arm feel ok Sunday and neck


VAERS ID: 1777337 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoaesthesia, Impaired driving ability, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Tingling and numbness in bilateral legs the day of the vaccine while driving noticeable numbness and tingling while driving 3 days after receiving the vaccine today is the 3rd day


VAERS ID: 1777350 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Lymph node pain, Lymphadenopathy, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Very swollen sore lymph nodes in left armpit and side of breast. Muscle soreness throughout body.


VAERS ID: 1777351 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
SMQs:, Medication errors (broad)

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

Write-up: Patient had 2 doses of Pfizer already and received a dose of the Moderna. Patient is not having any adverse reactions.


VAERS ID: 1777352 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Posture abnormal
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Promptly after vaccination, the patient''s head dropped and body leaned away from the immunizer in the chair. The elbows and wrists were bent. Within seconds, the patient regained consciousness with no recollection of the incident. He was immediately aware of his location and recalled the administration. He was accompanied by his brother. They stated their father has history of fainting with vaccinations. The pharmacy moved them to an open area and provided cold water. The patient stated feeling much better and waited ~45 minutes to be monitored before leaving.


VAERS ID: 1777941 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Musculoskeletal stiffness, Neck pain, Pain, Tenderness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (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: Birth control
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme shoulder pain (felt like when I had shoulder surgery, which was on the other arm, but same effects). Could not lift arm due to extreme pain and stiffness in tendons, extremely tender to touch. The mobility is back after 3 days, but as if trying to regain motion in the joint (tenderness duller but existent). Shooting pulses down the neck through the shoulder that I am still encountering.


VAERS ID: 1778510 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Confusional state, Depression, Feeling cold, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Malaise, Mental status changes, Neck pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (narrow), Arthritis (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: Inderal, Pravastatin, Lexapro, Nexium, Spironalactone, Zyrtec
Current Illness: Sinus infection, was given a Rocephin and Steroid shot 12 prior to Pfizer Covid-19 vaccine
Preexisting Conditions: Bronchitis, Asthma and Sinusitis
Allergies: Neomycin, Streptomycin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Took both the pfizer covid 19 vaccine and flu (fluzone) shot together on Friday, October 8, 2021. Both vaccines were given in my upper right arm. Starting from that Friday, the day one of vaccination throughout the Saturday and Sunday (the weekend after the shot) -Low grade fever, fever, chills, body aches; extremely painful, red, itchy and swollen injection site; overall feeling of being unwell, depressed and confused; pain shooting from the upper arm (injection site) up through the neck and back. Called the pharmacy on Saturday morning (the morning after the vaccine) and took Tylenol every 6 hrs and used ice pack as directed by the pharmacy. On the Monday following the vaccine still experiencing pain and more redness around the vaccine site, however mental and physical well-being has improved somewhat. This has not been a good experience for me. And if I would need another booster in the future, I will give it very much consideration. Also I would not take the booster and flu vaccine ever together again as I feel they may have made the adverse reactions somewhat worse.


VAERS ID: 1778512 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR - / UNK RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Chills, Confusional state, Depression, Inappropriate schedule of product administration, Injection site erythema, Injection site pain, Injection site pruritus, Malaise, Neck pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (narrow), Arthritis (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nexium, Zyrtec, Inderal, Spironalactone, Hair Skin and Nails Vitamins, Lexapro, Pravastatin
Current Illness: Sinus infection two weeks before and was given a Rocephin and Steroid Vaccine 12 days before my Covid Booster and Flu shot.
Preexisting Conditions: Asthma, Bronchitis, Arthritis, High Blood Pressure, Gastric Stomach
Allergies: Neomycin, streptomycin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Took both the pfizer covid 19 vaccine and flu (fluzone) shot together on Friday, October 8, 2021. Both vaccines were given in my upper right arm. Starting from that Friday, the day one of vaccination throughout the Saturday and Sunday (the weekend after the shot) -Low grade fever, fever, chills, body aches; extremely painful, red, itchy and swollen injection site; overall feeling of being unwell, depressed and confused; pain shooting from the upper arm (injection site) up through the neck and back. Called the pharmacy on Saturday morning (the morning after the vaccine) and took Tylenol every 6 hrs and used ice pack as directed by the pharmacy. On the Monday following the vaccine still experiencing pain and more redness around the vaccine site, however mental and physical well-being has improved somewhat. This has not been a good experience for me. And if I would need another booster in the future, I will give it very much consideration. Also I would not take the booster and flu vaccine ever together again as I feel they may have made the adverse reactions somewhat worse.


VAERS ID: 1778568 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Feeling abnormal, Headache, Injection site erythema, Injection site pruritus, Injection site swelling, Lethargy, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Site: Itching at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Systemic: Body Aches Generalized-Severe, Systemic: Chills-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Headache-Severe, Systemic: Nausea-Medium, Additional Details: patient presented on 10/11/21, 3 days following second covid shot given 10/8/21. He stated he felt awful all weekend, tired, achey, headache, nausea and today was the first day he felt well enough to get out of bed. But also today he had new symptom of redness, swelling and itching in right deltoid, in the general area of injection and below. Because he tated it was itching, I suggested bendadryl orally and to check in with his family dr


VAERS ID: 1778571 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-10-03
Onset:2021-10-08
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E211A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Back pain, Bowel movement irregularity, Chest pain, Dizziness, Dysuria, Erythema, Flank pain, Genitourinary symptom, Headache, Hypoaesthesia, Injection site erythema, Injection site rash, Injection site swelling, Injection site warmth, Lethargy, Nausea, Pyrexia, Skin swelling, Skin tightness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Injection administered at 12:30 on 10/03/21. Numbness down arm to finger tips. Resolved at 6 PM same evening. Injection site warm to touch. Low grade back pain began on Tuesday. Injection site still warm to touch. Large area of swelling began at injection site. Friday evening at 4:30 Pm began urinary symptoms. Pain upon urination. Severe flank pain on left. Bowels became explosive. Severe abdominal pain. Chest pain began approximately 8 PM 10/8. Midnight Friday- Saturday AM developed fever, severe dizziness, nausea, severe headache. Chest pain continued. Lethargy on Saturday 10/09. Sunday 10/10/21 the injections site became red and hot with a rash. Skin became tight and swollen. Redness remains to arm 10/12/21


VAERS ID: 1778581 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: 5 minutes after vaccination pt was in a chair and stated she did not feel well. Pt has vasovagal syncope. Blood pressure 97/57. Pt was extremely sweaty.


VAERS ID: 1778775 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Paraesthesia, Pharyngeal swelling, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Diffuse body tingling, mild tongue and throat swelling.


VAERS ID: 1778830 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-01
Onset:2021-10-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Electrocardiogram, Headache, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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: celexa 20mg Drospirenone
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: at home mobile ecg test
CDC Split Type:

Write-up: severe daily headaches, episodes of sudden onset tachycardia possible SVT for less than 15 min.


VAERS ID: 1778840 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 RA / IM

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

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

Write-up: Patient is a health care worker and works in a facility. She was given a third dose of Pfizer too soon after her second dose was administered. Her second dose was administered on 7/17/2021 and the third dose was administered on 10/08/2021.


VAERS ID: 1778846 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-06
Onset:2021-10-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Body temperature decreased, Gait inability, Ligament sprain
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Tendinopathies and ligament 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: Cymbalta, Atorvastatin
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: On Friday October 8, 2021 had low grade temp and right sacroiliac area pain and unable to walk. As of Tuesday October 12, 2021 still have pain in the right sacroiliac area. No temp


VAERS ID: 1778851 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS - / 2 RA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Headache, Pain, Pyrexia, Urinary tract infection
SMQs:, 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: buproprion, vitamin D, magnesium, vitamin B
Current Illness: ankle ORIF surgery 9/18/2021
Preexisting Conditions:
Allergies: penicillan
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache, severe body aches, severe fatigue, fever, UTI


VAERS ID: 1778861 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure increased, Fatigue, Headache, Nausea, Vaccine positive rechallenge
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (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: EE developed similar symptoms after receiving initial Pfizer dose #1 vaccine. Symptoms lasted about one month.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache, exhaustion, nausea, elevated blood pressure. Received Naproxen and Zofran from primary care provider for symptoms.


VAERS ID: 1778873 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest X-ray normal, Chest pain, Chills, Dyspnoea, Electrocardiogram normal, Headache, Oropharyngeal pain, Pain
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Patient received her first Pfizer Covid vaccine on 10/8/21. Around 11 pm that evening she woke up with chills, body aches, a headache and a sore throat. The following day her body aches became more severe. She took Tylenol which helped with the pain. She did not check her temperature. On 10/9 she developed a substernal CP described as a burning in her chest which was constant at first and now comes and goes. She also has SOB at rest. She contacted the employee exposure line o 10/11 and was instructed to go to urgent care. At urgent care she had CXR and EKG was unremarkable. She was instructed to schedule a follow up with her cardiologist and follow up at urgent care on 10/15.


VAERS ID: 1778881 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 2 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: NONE
Allergies: NO KNOWN
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: LARGE WARM RED RASH ON LEFT ARM


VAERS ID: 1778907 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939901 / 2 RA / IM

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

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

Write-up: Patient apparently received the Pfizer vaccine on 9/31/2021 in Clinic. He is now in a Rehab facility where we went to vaccinate. He mentioned that he had received his first dose in Sept, 2021 but did not have his vaccination card nor did he remember which vaccine he received. Upon inquiry, he stated that "it was probably Moderna". So we went ahead and gave him the Moderna vaccine, which is the only vaccine we have. He did well with no immediate reaction noted during the 15 mins he waited. Later while entering his data in the website we realized the error and are reporting the same. Please let us know if patient will need a second Moderna dose or if he is considered fully vaccinated. Thank you.


VAERS ID: 1778916 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Erythema, Oedema peripheral
SMQs:, Cardiac failure (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Plavix. Optivar. Pulmicort .lamictal, albuterol
Current Illness: None
Preexisting Conditions: Asthma Brain aneurysms
Allergies: Tramadol
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Left arm erythema edema localized x 4 days. Started next day. Improving. Pt has taken benadryl and it improved.


VAERS ID: 1778938 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-16
Onset:2021-10-08
   Days after vaccination:234
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Bradycardia, COVID-19, Condition aggravated, Cough, Exposure to SARS-CoV-2, Heart rate decreased, Respiratory tract congestion, SARS-CoV-2 test positive, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: celecoxib, Cholecalciferoll, gabapentin, lisinopril, methylPREDNISolone, Multiple Vitamins-Minerals, nitroGLYCerin, potassium chloride, simvastatin, tamsulosin, vitamin B-12
Current Illness: n/a
Preexisting Conditions: Gastritis, Essential hypertension, Dyslipidemia, Erectile dysfunction, Obesity, Hyperglycemia, Chronic kidney disease (CKD), Vitamin D deficiency, Long term current use of anticoagulant, Arthritis of knee, degenerative, Coronary artery disease involving native coronary artery of native heart without angina pectoris, S/P lumbar laminectomy, Hypercholesterolemia Low back pain, L4-L5 disc bulge, Edema of both legs, Syncope
Allergies: Niacin
Diagnostic Lab Data: SARS-CoV-2 (COVID-19).
CDC Split Type:

Write-up: 10/7 Pt to ED for syncopal episode at home this morning in the shower, cough and congestion x 1 week, exposure to COVID pt approx 3 wks ago, COVID + diag. 10/9-10 patient''s heart rate keeps going brady below 40 bpm


VAERS ID: 1778982 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-13
Onset:2021-10-08
   Days after vaccination:209
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Positive airway pressure therapy, Posture abnormal, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Covid + on 10/08/2021. Hospitalized Per ED Note: 77-year-old female with a past medical history of COPD and hypertension presents to the emergency department for shortness of breath. Patient was brought in by EMS from home. Per EMS, they found patient sitting in a chair and slouched over. She was 66% on 4 L nasal cannula. Patient does wear 2 L at home at baseline. Patient was started on CPAP in route and was given a DuoNeb treatment. On arrival, patient is awake and alert and states that she has felt short of breath for the past 2 or 3 days and worsened today. She denies fever, chills, cough, nausea, vomiting, chest pain, abdominal pain and urinary symptoms. Patient states she has never been intubated or required BiPAP for her COPD.


VAERS ID: 1778994 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-22
Onset:2021-10-08
   Days after vaccination:228
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Covid + from Assisted Living. Hospitalized Per ED Note: History of Present Illness This is an 87-year-old gentleman This is an 85-year-old gentleman with a history of hypertension dyslipidemia atrial fibrillation and intracerebral bleed that was transferred to this facility for inpatient medical management after being found to be Covid positive in assisted living. Patient has been vaccinated. Patient currently denies any chest pain shortness of breath lightheadedness dizziness patient denies any fever chills diarrhea loss of taste or smell


VAERS ID: 1779009 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 182809 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Fatigue, Gait disturbance, Heart rate increased, Myalgia, Pyrexia, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Symptoms after 6 hrs., Severe Body Shaking (difficult walking unassisted), High Fever (102?F), Severe pain in lower back and joints, elevated heart rate (100 bbm, normal is 50 bbm) Symptoms after 10 hrs., High Fever (103.6?F), Severe pain in lower back and joints, elevated heart rate (100 bbm, normal is 50 bbm) Symptoms after 12 hrs., High Fever (101-102?F), Severe pain in lower back and joints, elevated heart rate (100 bbm, normal is 50 bbm) Symptoms after 30 hrs., Minor to no fever, General muscle soreness and fatigue. Symptoms after 48 hrs., No fever, General muscle soreness and fatigue.


VAERS ID: 1779019 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Impaired work ability, Pain
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

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

Write-up: Patient stated that she had some body aches and dizziness, alos stated that she was unable to work after getting shot at work.


VAERS ID: 1779021 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061EZ1A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram abnormal, Ischaemia, Left ventricular failure
SMQs:, Cardiac failure (narrow), Arrhythmia related investigations, signs and symptoms (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Blood pressure was 170/96 and the EKG was abnormal with Left Ventircal Overload vs. Ischemia.
CDC Split Type:

Write-up: Receive the shot on 10/7/2021 at 1 pm and on 10/8/2020 around 9 pm, I began experiencing chest pain. I went to urgent care where they did my vitals and an EKG. My blood pressure was 170/96 and the EKG was abnormal with Left Ventircal Overload vs. Ischemia. My heart rate is usually 110/65.


VAERS ID: 1779079 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-03-29
Onset:2021-10-08
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / UNK - / -

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

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

Write-up: Covid positive contact unknown


VAERS ID: 1779097 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Blood test normal, Computerised tomogram normal, Dizziness, Electrocardiogram normal, Fall, Musculoskeletal chest pain, Pain in extremity, X-ray normal
SMQs:, Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Saw Palmetto 450 mg whole herb. 1-2x/day Centrum Silver 1/day in AM Super B Complex B 1/day in PM Zyrtec (Aller-Zyr) 1/day in PM Vitamin D3 gummy 50 mcg 200 IU. 2/day at PM Probiotic Gummies 500 Million CFU Anti-Diarrheal PRN GlipiZIDE 10 M
Current Illness: none
Preexisting Conditions: Type 2 diabetes, high blood pressure, diabetic neuropathy, enlarged prostate
Allergies: none
Diagnostic Lab Data: 10/8/21 EKG, CAT scan, x-rays, blood work all came back normal. I was discharged with Rx''s for lidocaine patch and hydrocodone 5-325. No broken bones/dislocations.
CDC Split Type:

Write-up: I got up to use the bathroom about 4am. I got dizzy and the next thing I know I was on the floor in extreme pain in my left shoulder and arm. I was also hurting in my ribs. When my wife heard the fall, she rushed in to the bathroom to see what happened. She checked on me to see what was wrong. Within a minute or two she also got very dizzy and sick to her stomach. She sat down on the commode and put her head down between her knees. The next thing I know she is falling off the commode. I called to her several times before she answered. She finally got up but got dizzy again. I took several minutes before it began to wear off. We had to figure out how to get me off the floor as I am twice the size of my wife. I propped my foot against the door. I was finally able to get on one knee. There was no way I was going to use my left arm/shoulder. I was in too much pain. I was eventually able to get up on both knees and then to my feet. She helped me back to the bed. We both laid back down. That morning (~10am) we went to Hospital ER to get checked out. I was still in extreme pain. My wife seemed to be doing okay. She also filed an adverse reaction report.


VAERS ID: 1779119 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-01
Onset:2021-10-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Decreased appetite, Dysgeusia, Fatigue, Headache, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), 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: Metoprolol-50 mg. 2x/day Warfarin- 2.5 mg 4 days/week & 5 mg 3 days/week Ropinirole-2mg 1 hs Pantoprazole-40 1x/day Famotidine? 20 mg 2x/ day Potassium? 99 mg 1x/day Atorvastatin?10 mg 1x/day Areds 2 Eye Caps ?2x/day Bupropion-SR 100 mg 2x
Current Illness: Had a UTI 3 weeks prior to vaccination
Preexisting Conditions: Dx with mesenteric artery thrombosis in May 2019. Had a stent in SMA abut continued symptoms so had dual bypass of SMA & celiac arteries in Nov. 2019. Had 2 bouts of aFib post surgery but no further issues; also developed pancreatitis post surgery. Subsequently dx with Factor VIII blood clotting disorder.
Allergies: Supfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever of 101 for 3 days Body aches Significant headache for 4 days Vomiting X3 day after shot Loss of appetite Deep fatigue Loss of taste which continues And metallic taste with some foods which continues


VAERS ID: 1779123 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-24
Onset:2021-10-08
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Sofia Antigen COVID-19 test with a positive result.
CDC Split Type:

Write-up: Patient was vaccinated for COVID-19 on 4/3/21 and 4/24/21, so was fully vaccinated when testing positive for COVID-19 on 10/8/21.


VAERS ID: 1779132 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-27
Onset:2021-10-08
   Days after vaccination:254
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acyclovir 400 MG Tablet 1 tablet Orally Twice a day x 5 days prn cold sores Albuterol Sulfate (2.5 MG/3ML) 0.083% Nebulization Solution 3 ml as needed Inhalation every 4 hrs as needed Prochlorperazine Maleate 10 MG Tablet 1 tablet Ora
Current Illness: none
Preexisting Conditions: Hypercholesterolemia. Endometriosis 1989. pos ANA. vocal cord nodules- seen by Dr. in 1999. Asthma. Allergies. type 2 DM. Glaucoma.
Allergies: Codeine: GI upset; Crestor: joint/bone pain/aches; Darvon: rash; Demerol: rash; Vicodin: rash; Darvocet A500: Rash - Allergy Tramadol HCl: terrible dreams - Allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: cough, cold, congestion, diarrhea, headaches x 5 days. starting 10/8/21. LOT #1 is not available


VAERS ID: 1779137 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site reaction, Loss of personal independence in daily activities, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen, Tylenol
Current Illness: Mild tachycardia
Preexisting Conditions: Mild anxiety Mild intermittent asthma (Last eval 2019)
Allergies: SULFA Drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Coarse tremor in right arm primarily in a pronation supination pattern that is intermittent and aggravated with certain movements to include typing, driving, and lifting objects. Symptoms improving with time. Patient has tried heat and ice as well as Tylenol and ibuprofen as needed.


VAERS ID: 1779180 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-19
Onset:2021-10-08
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: lung cancer stage IV, pancytopenia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: admission to hospital for remdesivir treatment and steroids


VAERS ID: 1779202 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-10-04
Onset:2021-10-08
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Migraine, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (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: I take Wellbutrin 450mg once a day in a tablet. Prozac 20mg one tablet once a day. Propranolol 20mg twice a day, and I have migraine Minatrix 50mg as needed. I take Vitamin D, they''re 3000iu and I take it once a day, and Iron 45mg slow rel
Current Illness: None
Preexisting Conditions: Migraines, anxiety and depression.
Allergies: i am allergic to penicillin, Demerol and codeine
Diagnostic Lab Data: None
CDC Split Type: vsafe

Write-up: I had a migraine, and it wouldn''t go away. I''ve had migraines before but they never lasted this long. It was in the left side of my head, the same as the injections. My Imitrex Tylenol wouldn''t help remove. My armpit was swollen. They gave me a shot of Toradol, and a prescription for Fioricet


VAERS ID: 1779204 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

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

Write-up: Utilized NACL 0.9% Bacteriostatic as a diluent NDC # 00409-1966-01


VAERS ID: 1779217 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-05
Onset:2021-10-08
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor 10mg, Zestoretic 20/25mg
Current Illness: None
Preexisting Conditions: Low back pain, HTN, Hyperlipidemia
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed Shingles 3 days later.


VAERS ID: 1779218 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-13
Onset:2021-10-08
   Days after vaccination:237
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Diarrhoea, Dyspnoea, Nausea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Patient has a history of breast cancer and hypertension. Patient''s second dose of Pfizer-BioNTech COVID-19 Vaccine was on 3/6/2021, Lot #EN6205. Both vaccinations were given at Hospital.
Allergies: Sulfa antibiotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient went with her husband 10-12 days ago. Patient developed cough, nausea, diarrhea, and weakness. The patient and her husband were positive for COVID by a home test. Patient saw her PCP who recommended home quarantine. During the past 48 hours prior to hospital admission, the patient was more short of breath.


VAERS ID: 1779220 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

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

Write-up: NACL 0.9% bacteriostatic was given as a diluent NDC #00409-1966-01


VAERS ID: 1779237 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: NACL 0.9% bacteriostatic was given as a diluent NDC #00409-1966-01


VAERS ID: 1779260 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-28
Onset:2021-10-08
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / UNK LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 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? 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 19


VAERS ID: 1779283 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-07
Onset:2021-10-08
   Days after vaccination:93
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: positive for covid


VAERS ID: 1779286 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-05
Onset:2021-10-08
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (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: I take Elequis 2.5mg every 12 hours, Dofetilide 250mg every 12 hours, diltiazem xr 120mg once daily. naltrexone 3mg once daily, Restasis 0.05 percent one drop both eyes every 12 hours. I take viibryd 5mg every 12 hours, and i also ta
Current Illness: None during the time of vaccination
Preexisting Conditions: I have anorexia nervosa, hypertension, atrial fribolation,, and mast cell activation syndrome. rynaud''s syndrome, and erythormelalgia
Allergies: I''m allergic to Sulfa drugs, Iodine, Iodine dye, I''m allergic to lamotrigine, levaquin, lamisil and mirapex
Diagnostic Lab Data: None
CDC Split Type: vsafe

Write-up: I had a nose bleed on 10/8/ and on 10/11. This was through a patient portal. The doctor responded, I take eloquis, no history prior to taking this but I wasn''t sure if Vibrate that I took on September 29th. She''s not sure if they''re related to the mixtures of these two medications. Due to having the 3rd dose on October 5th, I''m not sure if its related to the vaccine.


VAERS ID: 1779289 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: SHORTLY AFTER ADMINISTRATION, PATIENT STARTED TO PERSPIRATE AND PALE. HIS BLOOD PRESSURE AND TEMPERATURE WERE TAKEN AT 4:36 PM BP WAS 178/75, TEMPERATURE WAS 97.8 DEGREES F AND TAKEN AGAIN AT 4:50, BP 123/75, TEMPERATURE WAS 97.0.


VAERS ID: 1779292 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-12
Onset:2021-10-08
   Days after vaccination:238
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/11 SARS/COV-2, , POSITIVE
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1779297 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 1 LA / IM

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

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

Write-up: Client reported nausea, lightheadedness, dizziness 14 minutes onset from receiving first Moderna dose. Client denied shortness of breath, trouble breathing, throat tightening, chest pain. Client able to sit in zero-gravity chair. Vital signs assessed, with initial blood pressure 148/100, then rechecked and 130/110. Client denies history of high blood pressure, arm and blood pressure cuff readjusted. Vitals signs at 12:26 pm: blood pressure 102/76, pulse 78, respirations 18. Client continues to complain of nausea, dizziness, and headache now. Benadryl offered and client declines. Vital signs remain stable during observation, client reports symptoms have lessened but not resolved. At 1:06pm, headache and lightheadedness continue, Benadryl offered again and client declines again, also offered EMS, client declines. Client calls husband to come for her, she states she wants to go home. 1:16pm, husband arrives. Client educated on follow up with primary care for second dose guidance and ER precautions given. Client is able to stand, wheelchair offered and client declines. Client is able to leave observation area, walking with husband and escorted by RN at 1:18pm.


VAERS ID: 1779352 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PE2589 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Injection site pain, Injection site swelling, Mobility decreased, Pruritus
SMQs:, Anaphylactic reaction (broad), Parkinson-like events (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: METFORMIN,BASAGLAR,OZEMPIC,MONTELUKAST,VALSARTAN,B-12, VITAMIN-D
Current Illness:
Preexisting Conditions: DIABETES, ASTHMA
Allergies: ISOPRIL,ASPRIN, CHEMICAL PRODUCTS
Diagnostic Lab Data: I HAVE NOT CONSULTED MY DOCTOR
CDC Split Type:

Write-up: IMMEDIATE ITCHING , THE SITE IS STILL SWOLLEN AND SORE LIMITED LIFT OF THE ARM.


VAERS ID: 1779374 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Carpal Tunnel Syndrome, degenerative joint disease, fatigue, depression/anxiety, GERD, lateral epicondylitis, plantar fasciitis, seborrheic dermatitis
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient given third (booster) dose of Pfizer, but original series (#1/#2) given with Moderna.


VAERS ID: 1779376 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Contusion, Formication, Hypoaesthesia, Injection site erythema, Neurological examination, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C, Zinc, Lysiene
Current Illness: Not aware of any
Preexisting Conditions: Not aware of any
Allergies: Not aware of any
Diagnostic Lab Data: Neuro physical tests by Provider upon return to clinic. Declined blood work and MRI although asked what I should look out for in the event I needed to go to ER.
CDC Split Type:

Write-up: Received J&J Covid vaccine in left shoulder--no blood after needle or next day upon removing bandaid. After 15 min observation period, felt tingling and numbness in left hand fingers. As I drove home, numbness and tingling moved to the left side of my head, changing nerve feelings randomly from ear, to cheek, to jaw, to gums. These symptoms were told to be expected, and thankfully greatly diminished upon awaking the next morning, although still not 100% gone a few days later. Also, upon going to bed, would feel random crawling feelings on ears, face and scalp. Side effect that was reported to be potentially serious in waiver was unusual bruishing. 24-36 hours after shot, I noticed red horse shoe shaped squiggle on inside of left bicep. No overly tender and could not feel bumps. Turned to bruise. Followed literature side effect precaution so returned to clinic on Monday afternoon and was given neurological tests by provider. At this time, I just hope no further symptoms present and experience dissapates as literature indicates should occur.


VAERS ID: 1779402 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
SMQs:, Medication errors (broad)

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

Write-up: Patient arrived for second dose, told the immunizer that she was there for her second dose of Pfizer, the immunizer got the patient registered and went through the pre vaccination checklist questions. The Pfizer dose was given, and the patient pulled out her card and realized that she had actually gotten moderna as her first dose. The patient stayed for 15 minutes for observation with no obvious reaction.


VAERS ID: 1779422 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-09
Onset:2021-10-08
   Days after vaccination:241
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Laboratory test abnormal, Nasopharyngitis
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine; Acetaminophen; Amlodipine; Calcium; Furosemide; Meloxicam; Methotrexate; Prolia; Vitamin D; Metoprolol, Meloxicam
Current Illness: none
Preexisting Conditions: Hypothyroidism. Hypertension. Partial tear right rotator cuff. Polymyalgia rheumatica; diagnosed in 2010. Polyclonal gammopathy . Post menopausal . Osteopenia. Diverticulosis. Major trauma as pedestrian when struck by car 2/17 with extensive injuries requiring multiple surgeries. Osteoarthritis of left knee, unspecified osteoarthritis type. Status post total left knee replacement. Dermatochalasis of right upper eyelid. Dermatochalasis of left upper eyelid. Sacroiliitis.
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: tested positive 10/11/21 after 2-3 days of cold like symptoms


VAERS ID: 1779471 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Fatigue, Genital hypoaesthesia, Headache, Hypoaesthesia, Muscular weakness, Pain, Paraesthesia, Pyrexia, Tinnitus
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hearing impairment (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (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: Adverse event - Fever, chills, body and head aches, stinging stomach pain. Age - 58 Vacc. date - Dec 2020 Vacc. type/Brand name:
Other Medications:
Current Illness:
Preexisting Conditions: Currently recovering from a spinal cord injury from Jun 2020.
Allergies:
Diagnostic Lab Data: none performed yet
CDC Split Type:

Write-up: First day after receiving vaccine - fever (102 deg), body and head aches, ringing in ears, tiredness Day two, also experienced strong tingling in feet and partly up the left leg (mid calf). When walking, noticed numbness in feet and also weakness in keeping ankle stable. Also noticed numbness in groin area, primary on the penal shaft. Day three - day one symptoms have subsided, whereas day two symptoms persist or have increased somewhat.


VAERS ID: 1779525 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Mobility decreased, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Cardiomyopathy (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: Acedabuteral, Zenpak, seizure drug
Current Illness: no
Preexisting Conditions: ventricular tachycardia
Allergies: tylenol, morphin, augmentin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Couldn''t get out the bed for 2 days. On the 9th he had a racing heart that lasted for 30 seconds.


VAERS ID: 1779570 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Administration error: Patient received booster dose approximately 1 week before 6 month period from second dose (second dose given 4/16/2021). Patient reported no adverse event.


VAERS ID: 1779577 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-06
Onset:2021-10-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Herpes zoster, Pyrexia, SARS-CoV-2 test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mirtazapine, pristiq, prenatal vitamins, Adderall
Current Illness: Microscopic lymphocytic colitis, vitiligo, PTSD, GAD, MDD, ADHD
Preexisting Conditions: Microscopic lymphocytic colitis, vitiligo, PTSD, GAD, MDD, ADHD
Allergies: Corn, soy, milk, gluten, artificial sweeteners, pork, beef, tree nuts, peanuts, legumes, onions, mango, leafy greens, green beans, asparagus, spinach
Diagnostic Lab Data: Covid test
CDC Split Type:

Write-up: Shingles flare up, high fever, Covid symptoms


VAERS ID: 1779591 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-10-06
Onset:2021-10-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA OO1C21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose increased, Headache, Rash
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 100 mcg, Farxiga-5mg
Current Illness: none
Preexisting Conditions: Diabetes
Allergies: Penicillin
Diagnostic Lab Data: I took allergy medicine
CDC Split Type:

Write-up: My sugar level shot up to 300 on and off all day. I walked around. All day. Day 2 I developed a headache. Day 3 I developed a rash all over my body.


VAERS ID: 1779596 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C2IA / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram head, Computerised tomogram neck, Dysarthria, Fear, Gait disturbance, Hypoaesthesia, Magnetic resonance imaging head, Memory impairment, Pain, Paraesthesia, Pyrexia, Tremor, Ultrasound Doppler
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: VENLAFAXINE
Current Illness: NONE
Preexisting Conditions: DEPRESSION
Allergies: NONE
Diagnostic Lab Data: MRI Brain, CT Angio head and neck and CT head w/o contrast. Carotid Ultrasound
CDC Split Type:

Write-up: day after vaccine 10/8/21 I woke with a fever and severe body aches these lasted about 48 hours on the 3rd day 10/9/21 I felt better and went out shopping at which time I felt the left side of my face go numb and my speech became garbled, the numbness traveled down my left arm into my left leg which made it hard to walk I had to drag my leg behind me. I was scared I was having a stroke. I was taken to the ER while on the way there my face/arm/leg started to tingle and by the time I arrived at the ER I could not remember my name and my left leg started to shake at first slowly then extremely violently. I was admitted to the hospital for testing and observation and was discharged Sunday 10/11/21


VAERS ID: 1779610 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Severely swollen Lymph Nodes under left arm pit for up to 5 days after shot.


VAERS ID: 1779617 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Extra dose administered, Lymph node pain, Lymphadenopathy, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: painful and severe swelling of the under arm and lymph nodes on the arm given the injection (booster) lasting 4 days as well as a fever of 101.8 which lasted about 48 hours in addition to body aches and chills


VAERS ID: 1779700 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-10-01
Onset:2021-10-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Angiocardiogram, Anticoagulant therapy, Back pain, Bed rest, Blood test abnormal, Chest pain, Disturbance in attention, Fibrin D dimer increased, Hyperhidrosis, Myocardial infarction, Troponin increased
SMQs:, Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, arterial (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cymbalta; Nortriptyline; Lovastatin; Ambien; Alprazolam; Dronabinol
Current Illness: no
Preexisting Conditions: Fibromyalgia; major depressive disorder; high cholesterol - hyperlipidemia
Allergies: Lyrica; Anything in ''cillin family of antibiotics
Diagnostic Lab Data: Blood tests - full blood panel; key information: Elevated Troponin and elevated d-Dimeler. I was admitted to hospital and was no longer an ER patient. And they continued to measure my Troponin levels. They continued to rise over the next 24 hours. I was given an angio-gram and the cardiologist interpreting that saw that my left side of my heart was significantly underperforming. And she had me transported to another hospital where she thought I could get some Emergency operation if necessary. Hospital. I will get operated on - open heart surgery bypass - any day now. We''re in one of the situations where staffing and bed are limited and I''m waiting for my number to be called. Definitely, going to have the surgery though. From the 8th - today - have been at hospitals for 5 days
CDC Split Type: vsafe

Write-up: At 07:30 am, Friday, October 8th, I was heading to work. I walk to school. As I was exiting my door, I noticed my chest and back were hurting. And I am 61 and it had been a long week and I was sort of attributing it to normal work fatigue. As the morning progressed, I continued to have some low level chest and back pain. At about 10:30, with students, I was getting a bit sweaty. The attention in my brain - as to whether this was serious or trivial event was beginning to dominate over being able to talk to students. I went to school nurse. 9-1-1 was called. I was transported by ambulance to Hospital. Elevated Troponin - indicative of heart damage. At this point, with the additional information I now I have, I know that that event was a heart attack. I will have open heart surgery soon - will move a couple of arteries around. So there is permanent issues surrounding it. Treatment at this time: Nitroglycerin patches and sublingual. Heparin drip IV also. There is another medicine - a blood pressure med that I wasn''t on before. I think it''s one of the beta blockers. I am on oxygen right now. Bedrest and time at the hospital while waiting for surgery.


VAERS ID: 1779884 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Lymph node pain, Lymphadenopathy, Myalgia, Pyrexia, Scintillating scotoma, Visual impairment
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: I first had diffuse myalgias, chills and a fever of 102. That lasted for 12 hours. Then, I had an enlarged, tender axillary lymph node in my left axilla. That lasted for 2 days. Then, I had a scintillating scotoma that obscured all of my vision. It lasted for 30 minutes and finally resolved without sequellae. I took 2 tablets of Aleve prophylactically in the event that the scotoma was an aura for a migraine.


VAERS ID: 1779897 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-21
Onset:2021-10-08
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Heavy menstrual bleeding, Menstruation irregular
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Fertility 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: Metoprolol 50 mg Setraline 100 mg Estrogen 1.5 Progesterone
Current Illness: Fibromyalgia,ebv
Preexisting Conditions: Fibromyalgia ,ebv
Allergies: Cypro
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Very heavy bleeding with clots after not having period for month and being on hormone replacement therapy! Comes in waves following abdomen pain and cramping!


VAERS ID: 1780110 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 5 OT / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Extra dose administered, Inappropriate schedule of product administration, Pruritus, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: 63 yr , Moderna 12/30/20
Other Medications: Lisiniprol 2.5 mg Crestor 10 mg Aspirin 81 mg Probiotic
Current Illness: None
Preexisting Conditions: None
Allergies: Bactrim, augmentin, cipro, elidel cream
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Tachycardia , increased blood pressure, dizziness 15 minutes after 3 injection in my right arm. Same symptoms 5 minutes after my 4 th injection in my left arm. When I got home I was itching but no hives.


VAERS ID: 1780117 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Oedema peripheral, Skin discolouration, Skin warm
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (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: vitamin D 1000mg Vitamin C 500mg
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none, called the doctor and he said the vaccine provides many different reaction take benedryl.
CDC Split Type:

Write-up: I received the vaccine on Thursday and on Friday underneath my left arm (my armpit) began to swell up and throbbing consistently all the way through end of day Sunday. The location was very hot and was dark where it was swollen


VAERS ID: 1780320 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ741AB / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Musculoskeletal stiffness
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Vestibular disorders (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Starting 10/8 patient complained of headaches, lightheadedness, sleeping stiff and dizziness. He said the headaches, lightheadedness and dizziness improved by end of day 10/9 but he is still very stiff when sleeping as of 10/12.


VAERS ID: 1780464 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-01
Onset:2021-10-08
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Shingles


VAERS ID: 1780480 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-12
Onset:2021-10-08
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Intensive care, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol neb, citalopram, divalproex ER, fenofibrate, lorazepam PRN seizures, MVI, norethindrone
Current Illness:
Preexisting Conditions: severe developmental delay, autism spectrum disorder, and epilepsy
Allergies: cefpodoxime, chlorpheniramine-phenylpropan
Diagnostic Lab Data: COVID status positive 10/8/21.
CDC Split Type:

Write-up: Patient received Pfizer COVID vaccine on 3/22/21 and 4/12/21. On 10/8/21, patient was admitted to our facility with acute respiratory failure with hypoxia due to COVID-19 pneumonia. Patient received remdesivir and dexamethasone. On 10/11/21, patient was transferred due to needing maximum setting high flow and currently still there as of today (10/12/21).


VAERS ID: 1780818 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Fatigue, Lethargy, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Nausea-Severe, Systemic: Weakness-Severe, Additional Details: Patient reported on 10/11/21 extreme dizziness, nausea and lack of energy following 3rd dose of pfizer administered and was asking is this was normal. Patient had some of these symptoms following second dose, but not nearly this bad nor long lasting. Stated that she will never get another dose of this vaccine if it is recommended later


VAERS ID: 1780820 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Extra dose administered, Fatigue, Lethargy, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Medication errors (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Body Aches Generalized-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Nausea-Severe, Systemic: Weakness-Severe, Additional Details: patients wife called reporting severe dizziness, nausea and lack of energy in husband with booster dose administered 10/8/21. He had experienced the same but to lesser degree following dose 2, and this time it was worse and well into 4 th day. Suggested they call their doctor, she stated that they will not be getting any further doses if recommended in the future


VAERS ID: 1782208 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061621A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Decreased appetite, Hallucination, Hyperhidrosis, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: THE FIRST DOSE OF MADERNA
Other Medications: norvasc (blood pressure)
Current Illness: None
Preexisting Conditions: N/A
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hallucinating, Fever, Chills, Sweating, loss of appetite, muscle aches and pain, all joints hurts


VAERS ID: 1782232 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling cold, Headache, Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: my arm was very sore for 4-5 days at the injection site
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: A headache began at 2:00 am. the next day. The headache lasted all day. By 3:30 pm (the next day) I had body aches that got progressively worse all day and I was extremely tired. By 6:00 pm I also had chills and I felt cold. This lasted all night. In the morning I felt tired, but the body aches, chills and headache were gone.


VAERS ID: 1782286 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Electrocardiogram normal, Headache, Nausea, Palpitations
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad)

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

Write-up: 32-year-old female with no significant past medical history presents to ED today (10/08/2021) for evaluation of palpitations. Patient states that she got her second Covid vaccine earlier this morning, states that at the 12-minute mark during the observation period she started noticing that she was having palpitations. Had vital signs taken, her systolic blood pressure was in the 170s and her heart rate was at 127. States that she was sent here to the ED as protocol. States that it resolved on its own after about 10 minutes. States that she feels back to baseline at this time but does have some nausea. States that after her first Covid vaccine, she did have some swelling around her C-section site. Did not have palpitations after her first vaccination. Endorses mild headache at this time but also worked overnight and then order Covid vaccine. Denies dizziness, lightheadedness, chest pain, shortness of breath, vomiting or diarrhea. A/P Clinically well-appearing patient with stable vital signs presenting for evaluation of palpitations after receiving her second Covid vaccine. No associated chest pain, shortness of breath. States around 12 minutes during the observation period after she got the vaccinations, started having palpitations, elevated blood pressure and heart rate in the 120s. Normalized on its own by the time patient arrived to ED. Vital signs stable at this time. Palpitations at past, no active symptoms other than mild headache. Benign physical examination, EKG unremarkable. Likely COVID-19 vaccination side effect. Strict return precautions discussed. Patient agreeable discharge plan.


VAERS ID: 1782338 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-03
Onset:2021-10-08
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Consciousness fluctuating, Cough, Diarrhoea, Dyspnoea exertional, Loss of consciousness, Malaise, Presyncope, Respiratory symptom, SARS-CoV-2 test positive, Skin abrasion, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (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: Hospital Hyperlipidemia Aneurysm Abdominal Aortic Without Rupture Coronary Artery Disease Without Angina Pectoris History Of Falling Retention Urinary Central Sleep Apnea Syndrome Personal History Of Malignant Neoplasm Of Prostate Anemia Macrocytic Coronary Arterial Bypass Graft Status Post Personal History Insomnia Debility Dysfunction Diastolic Weakness General Non-ST Elevation Myocardial Infarction COVID-19 Infection Non-Hospital Hypertensive Heart With Heart Failure And Chronic Kidney Disease (CKD) Stage 3a Glomerular Filtration Rate (GFR) 45 To 59 (HCC) Fracture Rib Multiple Subsequent With Routine Healing Right Chronic Kidney Disease Stage 4 Glomerular Filtration Rate 15-29 Pneumonitis Due To Inhalation Of Food And Vomit Loss Weight Primary Osteoarthritis Hand Left Gout Percutaneous Transarterial Coronary Angioplasty Status Post Radiculopathy Lumbosacral Rotator Cuff Disorder Left Hypernatremia Edema Lower Extremity Tinea Pedis Repeated Falls Bradycardia
Allergies: NKA
Diagnostic Lab Data: SARS Coronavirus 2, PCR Rapid, V Symptomatic DETECTED 10/8/2021
CDC Split Type:

Write-up: CHIEF COMPLAINT/REASON FOR VISIT Weakness - Generalized HISTORY OF PRESENT ILLNESS An 86-year-old gentleman history of coronary artery disease status post CABG, abdominal aortic aneurysm, hyperlipidemia, chronic kidney disease, hypertension, history of prostate cancer, central sleep apnea. He lives alone and independently. He is brought to the emergency department by EMS with concerns of generalized weakness with a syncopal event today. Patient reports that for the past week he has been feeling generalized malaise, weakness, and upper respiratory symptoms including a cough. He has had 3 episodes of diarrhea in the past week which have been nonbloody. He has been tolerating food and fluids, though admits he has not been hydrating well because he did not feel good. Earlier today the neighbors him taken him to the clinic for outpatient COVID testing given his persistent symptoms. These results are pending. When he was returning back to his home in walking up the stairs he had a near syncopal episode where he collapsed. He denies preceding lightheadedness or palpitations at the time His neighbor assisted him to the ground in the only injury he sustained was an abrasion to the left elbow. However the neighbor states that he was in and out of consciousness for about a minute while he was on the ground. The neighbor also reports that he has noticed that the patient breathe severe with any amount of exertion though the patient himself denies shortness of breath. The patient denies any chest pain, fever. He reports that his cough has been nonproductive. No abdominal pain or headache. Denies preceding nausea and vomiting but did state that he vomited once in the ambulance EN route and was given 4 mg Zofran and started on 1 L of IV fluids.


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