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From the 5/7/2021 release of VAERS data:

Found 188,897 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 19 out of 1,889

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VAERS ID: 1246581 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fatigue, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Effexor XR. Cozaar. Omeprazole DR. Black Cohosh. Calcium+vitamin d. Biotin.
Current Illness: N/a.
Preexisting Conditions: Moderately High blood pressure.
Allergies: N/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: Light headed. Almost lost consciousness 6-7 times. Nausea. Fatigue. Sore arm.


VAERS ID: 1246591 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-20
Onset:2021-04-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN EW0164 / 2 LA / SYR
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN ER8733 / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xarelto, Plavix, Hydroxyurea
Current Illness: N/A
Preexisting Conditions: Essential Thromocythemia; DVT in left leg
Allergies: Tylenol, Shellfish
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Heavy, clotty period


VAERS ID: 1246607 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Headache, Hyperhidrosis, Lymphadenopathy
SMQs:, Neuroleptic malignant syndrome (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: Swollen axillary lymph node, flu vaccine, Sept 2018, age 28
Other Medications: Labetalol, Tylenol, colace
Current Illness: Seasonal allergies, gave birth
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Headache all day, excessive sweating, swollen lymph node near collarbone


VAERS ID: 1246808 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Nervousness, Pain, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: after first dose of Moderna
Other Medications: Armour Thyroid, Rhodiola, Amitryptaline, Citalopram
Current Illness: none
Preexisting Conditions: IBS
Allergies: Amoxicillin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: I got my second dose of Moderna vaccine on Wednesday. The day after the first dose, I was very shaky all day, had diarrhea, and ended up with hives on my arms, neck and face. The hives went away pretty quickly after taking Benedryl. This is now two days after my second dose. I''ve had intense body aches, fatigue, headaches, and today developed hives all over my chest and stomach. I have taken one Benedryl and the hives are still there.


VAERS ID: 1246898 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-06
Onset:2021-04-22
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

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

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

Write-up: Right sided Bell''s palsy. Treated with antiviral and prednisone.


VAERS ID: 1246910 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-08
Onset:2021-04-22
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test
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 positive patient


VAERS ID: 1247841 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-11
Onset:2021-04-22
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 20A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19 treatment, Chest X-ray abnormal, Cough, Dyspnoea, Feeling abnormal, Hypoxia, Lung infiltration, Pyrexia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), COVID-19 (narrow)

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

Write-up: Patient received the Johnson & Johnson COVID vaccine on 4/11/21 and developed dyspnea, fevers, and nonproductive cough about 2 days later. He continued to feel worse over time and presented to urgent care on 4/22/21. He had a chest X-ray done which showed bilateral infiltrates and he was found to be hypoxic, so he was sent to the ED. Patient was then admitted to the hospital for COVID treatment since he required 4 L O2 in the ED.


VAERS ID: 1247950 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-11
Onset:2021-04-22
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN JANSSEN 202A21A / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Musculoskeletal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Janssen COVID-19 Vaccine EUA I have been feeling interscapular pain since around 6:00pm on April 22 and the pain has continued up until now which is 4:00pm April 23. I feel it more when I curve my upper back (like in the cat position in yoga). On a scale of 1 (mild) to 5 (severe), I would say it is a 2.


VAERS ID: 1248213 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-12
Onset:2021-04-22
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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 has developed a rash on which started on her hands but gradually on all over her body 2 weeks after receiving the vaccine


VAERS ID: 1248420 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-09
Onset:2021-04-22
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Headache, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Two weeks after I got the shot I got the following symptoms. Not sure if they are related or not to the vaccine. - left arm tingling - belly tingling - headache (persistent but mild) - diarrhea - felt like I was about to faint when walking


VAERS ID: 1248429 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-12
Onset:2021-04-22
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Computerised tomogram head normal, Computerised tomogram spine, Deep vein thrombosis, Dyspnoea, Fibrin D dimer increased, Head injury, Loss of consciousness, Platelet count normal, Pulmonary embolism, Spinal X-ray, Syncope, Ultrasound Doppler abnormal
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: PEPCID 20MG DAILY, METHADONE 10MG DAILY, GABAPENTIN 100MG TID, METFORMIN 500MG DAILY, NORCO 7.5MG BID AS NEEDED FOR PAIN, VITAMIN D3 50,000 UNITS ONCE A WEEK, ATENOLOL 25MG DAILY AND ONE ADDITIONAL ONE DAILY AS NEEDED.
Current Illness: S/P TOTAL RIGHT HIP REPLACEMENT 3/24/21
Preexisting Conditions: HYPERLIPIDEMIA BENIGN ESSENTIAL HYPERTENSION PREDIABETES MAJOR DEPRESSION & SEVERE ANXIETY OSTEOARTHRITIS (BILAT KNEES) OSTEOPOROSIS GENERALIZED ANXIETY DISORDER DJD LUMBOSACRAL SPINE W/ LUMBOSACRAL RADICULOPATHY W/ SEVERE SPINAL STENOSIS ATHEROSCLEROTIC DISEASE, S/P CVA, MULTIPLE TIA CHRONIC GERD CHRONIC INTERMITTENT HA CHRONIC OBSTRUCTIVE ASTHMA VITAMIN D DEFICIENCY RECURRENT BENIGN PROSITIONAL VERTIGO
Allergies: SULFA, TAPE INTOLERANCES: VERSED, NSAIDS
Diagnostic Lab Data: CT of head and c-spine negative. Lumbar spine x-ray negative. D-dimer elevated. CT angio showed moderate pulmonary embolism in the right lung. Venous doppler reveals bilat lower extremity DVT''s . Platelet count normal at 337. Patient given argatroban drip due to concern for vaccine-induced pulmonary embolism. Hematology consulted. Patient also states she denies taking daily 81mg ASA prophylaxis since discharge.
CDC Split Type:

Write-up: Patient came to ED with complaints of syncopal episode. passed out, hit her head, felt mildly short of breath with ambulation.


VAERS ID: 1248595 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-08
Onset:2021-04-22
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain lower, Activated partial thromboplastin time prolonged, Blood culture positive, Gram stain positive, Heparin-induced thrombocytopenia test, International normalised ratio abnormal, Ovarian vein thrombosis, Sepsis, White blood cell count increased
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), 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? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: iron deficiency anemia, uterine fibroids s/p surgery, menorrhagia, tobacco use disorder (4 cigarettes/day since age 17), obesity (BMI 34.9)
Allergies: none
Diagnostic Lab Data: 4/22: WBC 23.1, blood culture growing GPC in pairs and chains (anaerobic bottle) and GPC in chains (aerobic bottle), INR 1.1, PTT 34 4/23: WBC 15.9 (s/p ABx), INR 1.2, PTT 69 (s/p heparin drip). Switched to fondaparinux SQ. HIT panel pending.
CDC Split Type:

Write-up: Patient had severe lower quadrant abdominal pain and fever to 38.2 C at home. Fever starting on 4/20, abdominal pain starting on 4/21. Presented to ED and was found to have bilateral ovarian vein thromboses. Was found to be septic with WBC 23.1, blood culture growing GPC in pairs and chains (anaerobic bottle) and GPC in chains (aerobic bottle). Further speciation pending.


VAERS ID: 1248724 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-27
Onset:2021-04-22
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / N/A UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: NKA
Diagnostic Lab Data: 4/22/2021 SARS-CoV-2 PCR Positive (A)
CDC Split Type:

Write-up: Military member received J&J vaccine on 27 March and then was positive for COVID on 22 April 2021.


VAERS ID: 1248816 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-07
Onset:2021-04-22
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dry eye, Eye pain, Headache, Injection site pain, Pain in extremity, Sensitive skin
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Glaucoma (broad), Corneal disorders (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Tendinopathies and ligament disorders (broad), Dehydration (broad)

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

Write-up: 1 day after: mild chills, sore arm, headache (night) 2 days after: mild chills, achy eyes, dry sandpapery eyes, skin sensitivity, headache (night) 15, 16 days after: dry sandpapery eyes (all day), injection site shooting pain -come/ go Ibuprofen taken


VAERS ID: 1248833 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-25
Onset:2021-04-22
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / UNK LA / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Lung opacity, Mental status changes, Pyrexia, SARS-CoV-2 test positive
SMQs:, Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: insulin, lasix, ceftazidime, amlodipine, metoprolol, losartan, keppra, nystatin, lactulose, oxybutynin, calcium acetate, calcitriol, atorvastatin, sinemet, aspirin, senna, tylenol
Current Illness: delirium, UTI
Preexisting Conditions: HTN, DM2, parkinsons disease, urinary retention s/p suprapubic catheter, seizure, ESRD on PD, sacral decubitus ulcer, dyslipidemia,
Allergies: none
Diagnostic Lab Data: CXR with opacities, COVID PCR+ (NP swab) on 4/22.
CDC Split Type:

Write-up: Admitted to hospital 4/22 with altered mental status and fever. Found to be COVID+ by PCR.


VAERS ID: 1249785 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-10
Onset:2021-04-22
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Cerebrovascular accident, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Arthritis (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: Hypertension
Preexisting Conditions: Hypertension
Allergies: No known drug or food allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: 51 female with h/o HTN (improved, off meds) presented to ED from her PMD office for further work up due to right leg weakness since yesterday and was dx with a stroke. Patient has received JJ vaccine 4/10/21. Patient denies f/c, n/v/d, CP, SOB, abdominal pain. Patient reports mild posterior right hip tenderness. She denies numbness.


VAERS ID: 1251068 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-02
Onset:2021-04-22
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Limb discomfort, Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

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

Write-up: PT STATED HE WENT TO THE CLINIC AND THEN THE ER WITH A BUMP ON THE BACK OF HIS LEG. PT WAS TOLD IT WAS A BLOOD CLOT.


VAERS ID: 1251424 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-04-10
Onset:2021-04-22
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Dyskinesia, Speech disorder
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Dyskinesia (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: metoprolol er 100mg, losartan 100mg, cymbalta 60mg
Current Illness: none
Preexisting Conditions: high blood pressure
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bell''s Palsy on right side of face developed 4/22/21. Pt thought he was having a stroke and went to the ER. Doctor gave him B12 to inject 2 doses. Worsening 4/24/21 and having a lot of trouble speaking and eating/drinking.


VAERS ID: 1251454 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-04-12
Onset:2021-04-22
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time prolonged, Blood fibrinogen, Cerebral venous sinus thrombosis, Computerised tomogram head abnormal, Fibrin D dimer normal, Headache, Magnetic resonance imaging head abnormal, Platelet count normal, Prothrombin time normal
SMQs:, Haemorrhage laboratory terms (broad), Embolic and thrombotic events, venous (narrow), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amitriptyline 25mg daily Norethindrone 5mg nightly
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: 4/24/21 Platelets=207 D-dimer=<0.27 Fibrinogen=271 PT=12.4 PTT=27.7 (All of these tests are within our normal range)
CDC Split Type:

Write-up: Headache== Found to have venous sinus thrombosis on CT and MRI


VAERS ID: 1251641 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-03
Onset:2021-04-22
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C CoQ10 Tumeric
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Very sore arm, starting three weeks after the shot was given, continuing more than a day.


VAERS ID: 1255047 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-08
Onset:2021-04-22
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Gait disturbance, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Sudden loss of walking ability. I can not walk. My legs below knee are hurting a lot. This has escalated in last few days


VAERS ID: 1255052 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-12
Onset:2021-04-22
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood creatine phosphokinase normal, Blood lactate dehydrogenase normal, Blood thyroid stimulating hormone normal, C-reactive protein normal, Computerised tomogram head normal, Computerised tomogram spine, Dysstasia, Full blood count normal, Gait inability, Malaise, Metabolic function test normal, Muscular weakness, Myalgia, Red blood cell sedimentation rate normal, Treponema test negative, Urine analysis normal, Vitamin B12 normal
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: sinemet
Current Illness:
Preexisting Conditions: Parkinson''s disease
Allergies:
Diagnostic Lab Data: CMP, CBC, CK, ESR, CRP, TSH, b12, LDH, UA, syphilis screen, CT head, CT T/L spine - all results/imaging were reviewed, findings were unremarkable considering the patient''s age, and would not explain patient''s symptomatology. Unfortunately, the patient has a pacemaker that is incompatible with MRI.
CDC Split Type:

Write-up: severe lower extremity weakness. on 4/13/2021 experienced myalgias and generalized weakness/malaise, which have persisted. on 4/21/2021 the patient was able to walk using her walker however extremely slowly. At baseline she is able to walk around the house with a walker relatively briskly. on 4/22/2021 the patient was unable to transfer from a sitting to standing position, and was no longer able to ambulate with her walker.


VAERS ID: 1255988 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-04-03
Onset:2021-04-22
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / SC

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, C-reactive protein increased, Chest pain, Cytomegalovirus test negative, Diarrhoea, Dyspnoea, Echocardiogram normal, Electrocardiogram T wave inversion, Epstein-Barr virus antibody positive, HIV test negative, International normalised ratio increased, Mononucleosis heterophile test negative, Nausea, Oropharyngeal pain, Pain, Platelet count increased, Pleuritic pain, Procalcitonin increased, Pyrexia, Streptococcus test negative, Troponin increased, Vomiting, White blood cell count increased
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Hypokalaemia (broad), Sepsis (broad), 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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE REPORTED
Current Illness: About 1 week ago, he started having some body aches and some fever, he had some joint pains, soreness, followed by GI symptoms of nausea, vomiting, diarrhea and emesis. He then started having some chest pain and left-sided, what sounds like pleuritic pain, and he also got a little short of breath that brought him to the hospital. A week ago, he had gone to the urgent care center where he had a COVID test and Streptococcus A test that was negative. His sore throat eventually resolved. When he came to the hospital on the 21st, that was yesterday, his temperature initially was 98.3. Vital signs were normal. His temperature a few hours later went up to 101.9 at home. Patient has been taking some Tylenol and Motrin. His white count on admission was 32,000. Troponins were elevated. He had some EKG changes with T inversions. He was seen by Cardiology, which was not thought to be an acute cardiac event. Echocardiogram was done to rule out cardiomyopathy. Otherwise no illnesses
Preexisting Conditions: NONE
Allergies: Doxycycline - ?hives
Diagnostic Lab Data: 4/21: WBC 32.2, plt 463, INR 1.6, troponin 2.32, C-reactive protein 27.09, procalcitonin 1.06 4/22: WBC 30.2, plt 434, CMV DNA negative, EBV early antigen IgG/nuclear Ag IgG Indx/Capsid Ag IgG Ab positive, HIV negative, mono negative
CDC Split Type:

Write-up: Body aches, joint pain, sore throat, fever, vomiting diarrhea, chest pain, starting several days before admission. Possible acute myopericarditis


VAERS ID: 1256152 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-03-17
Onset:2021-04-22
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Muscle spasms, Pain
SMQs:, Dystonia (broad)

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

Write-up: Severe right leg cramps. Extreme pain.


VAERS ID: 1257355 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dyspnoea, Pain
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Spironlactone
Current Illness: None.
Preexisting Conditions: Diabetes - MODY2
Allergies: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body aches, chills, shortness of breath. Took ibuprofen for a day and then the adverse effects were no longer present.


VAERS ID: 1257425 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-20
Onset:2021-04-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Decreased appetite, Dysphagia, Oral herpes, Pain, Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Trileptal, propanalol, Lomotil, motrin, b12 vitamin, unisom, abreva,
Current Illness: Migraines, insomnia, crazy hallucinations(seeing a neurologist)
Preexisting Conditions: Seizure disorder, migraines, insomnia, GI problems
Allergies: PCN
Diagnostic Lab Data: None yet. Its sunday.
CDC Split Type:

Write-up: I started getting what I thought was a cold sore on the 22nd, and applied Abreva to stop it, but it just blew up and started spreading. Now I have multiple on my lip, all over the roof of my mouth, feels like spreading into throat. Extremely painful and can''t eat much at all, even swallowing is hard. No fever. Went to urgent care today and she put me on acyclovir & lidocaine gel, which I hope helps, but I feel like its too far gone and its getting worse. I''m scared! I hope you all have an idea on how long this will progress. HELP


VAERS ID: 1257457 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-04-07
Onset:2021-04-22
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal pain upper, Asthenia, Chills, Dizziness, Feeding disorder, Flatulence, Hypersomnia, Muscle spasms, Pain, Retching, Somnolence, Tinnitus, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Hearing impairment (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: captopril, levochyroxine, meloxicam, zoloft, zorcor, mult vitamin
Current Illness: none
Preexisting Conditions: none
Allergies: novacaine
Diagnostic Lab Data: none yet.
CDC Split Type:

Write-up: After the shot and prior to the event on 4/22/21, was extremely drousy and slept for 3-4 days during waking hours. No energy. Then on 4/22.21, at 11:30 am started experiencing stomach pain and upset that went into chills, aches all over, cramps and finally vomiting to the point of dry heaves. After which the vomiting ceased. did not eat solid food for 3 days, just soup and cereal in milk. Ate a chicken sandwich on Sunday afternoon and back on liquid. Stomach still upset. No diareha but excessive powerful fladulation. Took Alkaselser and discovered it has asprin in it. Not sure if is reacting to the Covid shot 2 weeks prior. Still in abdominal distress , dizziness and ringing in the ears. Not sure if reaction to the second Covid shot or something else. Please advise.


VAERS ID: 1257661 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B 21A / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Headache, Migraine, Mobility decreased, Myalgia, Neck pain, Vision blurred, Visual impairment, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: around 2 hours after the shot I developed a headache. I suffer from chronic migraines but this way way more intense than my normal ones. the pain was all over my head, I had vision changes being very blurry and cloudy. the pain shot all the way down my neck. i had to go to urgent care expecting to get a toradol shot and go home. instead was sent via ambulance to the ER in fear i may have had a bleed. i ended up in the ER on saturday 4/24/21. they never gave me a CAT scan i was sent over there for. instead made me sit there for 2 hours in room before being seen. then came in said here''s some meds and made me wait another 2 hours. i was discharged faster than it took them to take my copay for the visit! so for having a blinding headache for 2 days they didnt take it very seriously. on top of the headache i had sever muscle and joint pain to the point i couldnt move. i couldnt keep food down either.


VAERS ID: 1257699 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 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: Metformin, Ozempic, Vitamin D
Current Illness: None noted
Preexisting Conditions: Diabetes
Allergies: None noted
Diagnostic Lab Data: None
CDC Split Type:

Write-up: No, adverse events. However, wrong vaccine given since it was discovered later that patient had Pfizer for their 1st dose. Database sites were checked and it appears that vaccinating facility that gave first dose did not report it to registry.


VAERS ID: 1257721 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-03-15
Onset:2021-04-22
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 LA / IM

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

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

Write-up: Patient was only 17 years old, at the time of vaccination was not confirmed that patient qualified for the vaccine, patient''s mother has signed the consent form, patient and mother has the same name and last name.


VAERS ID: 1257741 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: An rash that got itchy after 2 days and dull pain after 4 days


VAERS ID: 1257747 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046821A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Headache, Lymphadenopathy, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamin, E, D, Evening Primrose
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin, and Sulfur
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Day 1, arm soreness, runny stools, fever, fatigue, headache. Day 2, arm soreness, runny stools, fever, fatigue, headache, Day 3, arm soreness, swollen lymph node (left side) collarbone, fatigue, headache. Day 4, arm soreness, swollen lymph node (left side) collarbone, fatigue, headache,


VAERS ID: 1258089 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-10
Onset:2021-04-22
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Deep vein thrombosis, Pain in extremity, Peripheral swelling, Ultrasound Doppler
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol OTC
Current Illness: None stated
Preexisting Conditions: GERD
Allergies: NKDA
Diagnostic Lab Data: Doppler study 04252021
CDC Split Type:

Write-up: Client complained of pain and swelling in right calf area 2 -3 days before going to ER , at ER. Doppler study confirmed popliteal DVT


VAERS ID: 1258458 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-31
Onset:2021-04-22
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / N/A LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Abdominal tenderness, Angiogram pulmonary abnormal, Anticoagulant therapy, Atelectasis, Back pain, Chest pain, Computerised tomogram thorax abnormal, Cough, Dizziness, Dyspnoea, Dysuria, Hypopnoea, Lung opacity, Painful respiration, Peripheral embolism, Platelet count normal, Pleural effusion, Pneumonia, Pneumonitis, Pulmonary embolism, Pyrexia, SARS-CoV-2 test negative, Scan with contrast, Scan with contrast abnormal
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: mesalamine, azathioprine, dicyclomine, multivitamin
Current Illness: unknown
Preexisting Conditions: Crohn''s disease
Allergies: Remicade
Diagnostic Lab Data: 2021-04-23 CTA chest w/ and w/out contrast: Central and peripheral pulmonary emboli in the right lower lobe. No CT evidence of right heart strain. Groundglass opacities within theright lower lobe which are somewhat bandlike in appearance and concerning for early pulmonary infarcts. Alternatively this may relate to subsegmental atelectasis or less likely an inflammatory/infectious process. Small right pleural effusion. No acute inflammatory process in the abdomen or pelvis. 2021-04-23 platelets 252k/mcL 2021-04-23 COVID test - negative
CDC Split Type:

Write-up: 2021-04-23 Patient presents to the ED with right-sided mid-back pain and shortness of breath starting 2021-04-22 evening. Pain is sharp and worsens with coughing and deep inspiration; she feels that she is taking shallow breaths. On ED presentation, no shortness of breath, chest pain, dizziness, fevers, dysuria, or abdominal pain. She does have reproducible pain on her right mid-back area. There is some mild diffuse tenderness in her abdomen, but reports that she always has a tender abdomen due to Crohn''s disease. No peritoneal signs. No recent travel. Patient was found to have pulmonary embolism. Hematology/Oncology specialist was consulted and recommended initiation of argatroban for treatment of pulmonary embolism. Patient was admitted to inpatient.


VAERS ID: 1258629 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-14
Onset:2021-04-22
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 RA / SYR

Administered by: School       Purchased by: ?
Symptoms: Computerised tomogram thorax abnormal, Pulmonary thrombosis, Thrombosis, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: None
Preexisting Conditions: None
Allergies: Advil, metronidaz, amlodipine, fessalon, hydrocodone-norco, nadolol, lisinopril, spriospirondactone.
Diagnostic Lab Data: Cat scans for the lungs and ultrasound on the legs.
CDC Split Type: 1805018

Write-up: Blood clots in the left leg and in the lungs.


VAERS ID: 1258808 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-08
Onset:2021-04-22
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 6 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ear congestion, Epistaxis, Headache
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan, Rosatatin, Celexa
Current Illness:
Preexisting Conditions: Breast Cancer
Allergies: Penicillin and Zithromax
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nosebleed, headache, ear congestion all tweo weeks post vaccination.


VAERS ID: 1258972 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-07
Onset:2021-04-22
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Antiplatelet therapy, Basal ganglia infarction, Blood pressure increased, Chest injury, Diplopia, Dysarthria, Echocardiogram, Eye patch application, Fall, Gait disturbance, Headache, Hemiparesis, Lacunar stroke, Lethargy, Magnetic resonance imaging head abnormal, Musculoskeletal chest pain, Mydriasis, Ultrasound Doppler
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypertension (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Ocular motility 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? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atorvastatin Ca 40 mg po every hs Clopidogrel Bisulfate 75 mg po daily Lisinopril 10 mg by mouth daily.
Current Illness: HISTORY OF PRESENT ILLNESS: This is a 47-year-old male with history of diabetes mellitus type 2, hypertension, hyperlipidemia, stroke, who presented to the emergency department, complaining of right-sided weakness, gait imbalance, double vision and slurred speech beginning at 2:00 p.m. yesterday. He also complains of a headache. The patient''s double vision has since resolved; however, he remains with slurred speech, headache and right-sided weakness as well as imbalance gait. The patient states he had a stroke approximately 2 years ago, resulting in difficulty ambulating; however, that improved. He does not take aspirin. The patient denies any palpitations. He does have right-sided lower rib chest pain as a result of a fall that occurred following the onset of his symptoms. He landed on his right side. No head injury, no loss of consciousness.
Preexisting Conditions: PAST MEDICAL HISTORY: 1. Hypertension. 2. Hyperlipidemia. 3. Diabetes mellitus type 2. 4. Anxiety. 5. Stroke.
Allergies: PCN
Diagnostic Lab Data: See previous box
CDC Split Type:

Write-up: Hospitalist Discharge Summary Admission date/time Apr 23, 2021 at 00:19 Discharge date: Apr 26, 2021 Hospital course 47M pmh DMII, HTN, HLD, L basal ganglia stroke, pw right-sided weakness, gait imbalance, double vision and slurred speech beginning at 2:00 p.m. 4/22. on admission, double vision resolved; slurred speech, headache and right-sided weakness imbalance gait remain. 4/23am pt developed L pupil dilation and lethargy, MRI brain demonstrating acute stroke, allow permissive htn treat for sbp$g220mmhg or DBP $g120mmhg, cont asa/statin; US carotid nonacute/benign; TTE pending; ST/PT/OT. Tele benign. 4/24 BPs remain elevated, allow permissive htn to standards <220/120; cont st/pt/ot, a little improved participation today po intake etc. 4/25 cont to improve slowly, will be good candidate. cont allow permissive htn, no events on tele, cont asa/statin for significant stroke, add plavix. 4/26 pt cont improve clinically, BP stabilizing still permissive htn, recommend start home BP meds within 2-3 days once out of acute phase, pt accepted today, TTE benign doppler benign, but doesn''t seem like bubble study done, recommend repeat as outpatient to ensure no positive bubble defer to pt''s pcp f/u. double vision persists, pt currently w eye patch relief, recommend outpatient ophtho follow up closely after or during time. cont asa/plavix/statin, then transition to asa/statin as rx per guidelines. no afib on tele, consider zio patch on d/c to ensure no afib in young patient w x2 stroke. recommend hypercoag workup outpatient. Acute stroke, L lacunar -asa/plavix/statin -permissive htn -tele -PT/OT/ST -TTE benign, nml ef, no bobble done? -repeat tte outpatient w bubble to ensure no R$gL shunt -US carotid nonacute -MRI Brain 4/23 1. Focal patchy restricted diffusion and FLAIR signal hyperintensity in the left medial thalamus/rostral midbrain compatible with acute lacunar type ischemic infarct. 2. No significant intracranial mass effect, midline shift or extra-axial collection. 3. Chronic left basal ganglia infarct approximating the anterior limb of the left internal capsule involving the head of the left caudate nucleus.


VAERS ID: 1259350 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-04-01
Onset:2021-04-22
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Headache, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine, Vicodin, Lorazepam, Zolpidem, Finasteride,
Current Illness: None
Preexisting Conditions: Endometriosis, fibromyalgia, hidradenitis, hyperhydrosis,
Allergies: Sulfa: angioedema Azithromycin: palpitations
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient presents with concern for Covid vaccine reaction. Patient states she had the Johnson & Johnson vaccine about 2 weeks ago. Patient reports she had a headache about 1 week ago that woke her up from sleep about 1 AM but resolved by 4:30 AM. Patient denies having a headache since then. Patient noticed some small red dots on her nose today and was concerned when her friend told her this could be from the vaccine. Patient called her PCP who advised her to come to the ED for evaluation for thrombotic thrombocytopenia.


VAERS ID: 1259449 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-08
Onset:2021-04-22
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Herpes zoster, Nausea, Pruritus
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: I had shingles when I was 19. I also have venereal herpes, no outbreaks in a couple years. No other health conditions
Allergies: Sulpha drugs, penicillin, formaldehyde, lanoline
Diagnostic Lab Data: None
CDC Split Type:

Write-up: While I had nausea and fatigue Saturday morning after the vaccine, this report is about my nasty shingles outbreak. Rash started on left hand and calf and spread up my leg. Started with itching, not so much pain as in my prior outbreak which when I was 19 was local on my left arm. This is a bigger rash are, blistered red swollen, oozing, burning...the usual.


VAERS ID: 1259941 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-01
Onset:2021-04-22
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benicar and lopressor multivitamin
Current Illness:
Preexisting Conditions: High blood pressure chronic fatigue fibromyalgia and high cholesterol
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Large brusing on left arm. Bruising through out body. All brusing appeared 2 weeks after vaccination


VAERS ID: 1260986 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-04-19
Onset:2021-04-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 1 - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Genital blister, Pruritus genital, Rash vesicular
SMQs:, 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: Cortisone cream
Current Illness: None
Preexisting Conditions: Klinefelters Syndrome
Allergies: Doxycycline
Diagnostic Lab Data: None yet, still waiting for an appointment.
CDC Split Type:

Write-up: Three days after the first injection I noticed an itching sensation in my genital region. Upon closer inspection I noticed blister like bumps just under the head of my penis and down my scrotum. Initially I tried lotion, then Neosporin and finally Cortisone to stop the intense itching. When I shower with hot water it intensifies the itching. I went to the doctors on 4-26 and Dr. prescribed Prednisone. He''s trying to get me into the dermatologist but the earliest is May 7th.


VAERS ID: 1261017 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Balance disorder, Decreased appetite, Dizziness, Fall, Fatigue, Feeling abnormal, Gait disturbance, Headache, Mania, Memory impairment, Nausea, Pain, Sleep disorder, Vertigo
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lithium, Lamictal, Valium, Risperidone, Zofran, Lo Loestrin. Vitamins: D, multi, C, B12, Methylfolate, Liposomal Glutathione.
Current Illness: None.
Preexisting Conditions: Repaired brain aneurysms, bipolar 2 disorder, panic disorder, ocd.
Allergies: Prednisone, Buspar.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vertigo, dizziness, nausea. It comes stronger in waves, but I have no appetite and baseline dizziness. I am having trouble walking straight and I bump into things or trip over them. I have fallen because I was not steady. If I get up too fast everything gets dark and it feels like I''m going to pass out. I''m also experiencing brain fog: it''s hard to think and I''m really forgetful. It also seemed to trigger a manic episode, like the first vaccine did. I can''t sleep my normal amount. My initial effects, for the first 48 hours, were the typical pain, headache, and intense fatigue. Those are mostly better, aside from fatigue and mild headache.


VAERS ID: 1261043 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Back pain, Bowel movement irregularity, Chills, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE.
Current Illness: No illnesses.
Preexisting Conditions: Lower Back Pain ( Disk Problem) - likely relevant Retinal disorder (blood vessels) Past Retina detachment.
Allergies: Possibly to fluorescein.
Diagnostic Lab Data: none - did not see a physician.
CDC Split Type:

Write-up: Fever 38C, Chills, local pain - lasted less than two days. Intense lower back pain - lasted about two days. Irregular Bowel movement, abdominal pain - come and goes, not fully recovered at time of writing. There was no constipation (in sense of difficulty to pass stool) but no bowel movement either, only pain. Treatment: after 24 hours start taking pain killers (Tylenol night, Aleve). Hot bath helped with back pain and abdominal pain. Laxative (Bisacodyle) helped with Bowel movement, and relieved pain - but took long time and unknown if back to normal. Now on liquid diet (water,clear soup, tea with sugar) to allow to rest a bit, seems more comfortable at the moment.


VAERS ID: 1261428 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Unknown  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2021-04-22
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Burning sensation, Muscle spasms
SMQs:, Peripheral neuropathy (broad), Dystonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210448115

Write-up: CRAMP IN UNDERARM OF RIGHT ARM; BURNING IN UNDERARM OF RIGHT ARM; This spontaneous report received from a patient concerned a 19 year old of unspecified sex. The patient''s weight, height, and medical history were not reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805031, expiry: UNKNOWN) dose was not reported, administered on 02-APR-2021 14:00 for prophylactic vaccination. No concomitant medications were reported. On 22-APR-2021, the subject experienced cramp in underarm of right arm. On 22-APR-2021, the subject experienced burning in underarm of right arm. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from cramp in underarm of right arm, and burning in underarm of right arm. This report was non-serious.


VAERS ID: 1261464 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-04-22
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210448662

Write-up: RASH ON TORSO AND ABDOMEN AREA; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: UNKNOWN) dose was not reported, administered on 10-APR-2021 for prophylactic vaccination. The batch number was not reported and it has been requested. No concomitant medications were reported. On 22-APR-2021, the subject experienced rash on torso and abdomen area. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from rash on torso and abdomen area. This report was non-serious.


VAERS ID: 1261939 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure measurement, Body temperature increased, Fatigue, Hypertension, Myalgia, Somnolence
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: AMLODIPINE; LISINOPRIL
Current Illness: Hypertension
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210423; Test Name: Blood Pressure; Result Unstructured Data: went for a routine health check up and found his blood pressure to be very high (188/100)
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Blood pressure to be very high (188/100); Elevated temperature; Sleeping a lot; Fatigue; Body aches; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of HYPERTENSION (Blood pressure to be very high (188/100)) in a 60-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 045A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Hypertension. Concomitant products included AMLODIPINE and LISINOPRIL for Hypertension. On 22-Apr-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 22-Apr-2021, the patient experienced BODY TEMPERATURE INCREASED (Elevated temperature), SOMNOLENCE (Sleeping a lot), FATIGUE (Fatigue) and MYALGIA (Body aches). On 23-Apr-2021, the patient experienced HYPERTENSION (Blood pressure to be very high (188/100)) (seriousness criterion medically significant). On 24-Apr-2021, HYPERTENSION (Blood pressure to be very high (188/100)), BODY TEMPERATURE INCREASED (Elevated temperature), SOMNOLENCE (Sleeping a lot), FATIGUE (Fatigue) and MYALGIA (Body aches) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 23-Apr-2021, Blood pressure measurement: 188/100 (High) went for a routine health check up and found his blood pressure to be very high (188/100). Patient reported normally his Blood Pressure is between 120-130.Treatment for the event included ibuprofen. The patient received both scheduled doses of mRNA-1273 prior to the event; therefore, action taken with the drug in response to the event is not applicable. This case concerns a 60-year-old male with a serious unexpected event of hypertension, and nonserious unexpected body temperature increased, somnolence and expected fatigue, myalgia. Event onset 2 days after first dose mRNA-1273. Event outcomes unknown. Based on current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.; Sender''s Comments: This case concerns a 60-year-old male with a serious unexpected event of hypertension, and nonserious unexpected body temperature increased, somnolence and expected fatigue, myalgia. Event onset 2 days after first dose mRNA-1273. Event outcomes unknown. Based on current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.


VAERS ID: 1261971 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, No adverse event
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Confusion-Mild, Additional Details: Pt reported that she is not sure she received the vaccine, as she felt a splatter on her face/arm when the vaccine was administered. Pt does not report any adverse side effects.


VAERS ID: 1262122 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-04-16
Onset:2021-04-22
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Deafness, Fatigue, Hypoaesthesia, Pain in extremity, Tinnitus
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hearing impairment (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Folic acid,pot chloride,certirizine,ferrous sulfate(prescription)!! Vitamin D3 over the counter "Sundown"!
Current Illness: None!
Preexisting Conditions: Not at this time!!
Allergies: None!!
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: For almost a week now I''ve experienced a slight hearing loss, seems to be in my right ear!! There is a constant slight numb like feeling in the right ear! At times out of no where there is a ringing sound in my ear!! This concerns me!! Other effects like soreness in the arm ,fatigue, and joint pain went away within a few days! I took tylenol for that!! I was told that you all could give me no answers!! I waited to see if this would pass!! I''m trying to see my MEDICAL PROFFESSIONAL about this issue!! I have questions! How long will this last and is this normal!! I''ve called your hotlines, what''s the use if they can''t answer questions!! I''m a Substitute Teacher, this makes me uncomfortable!! What should I do!!


VAERS ID: 1262124 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Mouth swelling, Paraesthesia oral, Pruritus
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), 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)

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: none
Current Illness: none
Preexisting Conditions: none
Allergies: seasonal
Diagnostic Lab Data: none
CDC Split Type:

Write-up: oral tingling, oral swelling, pruritus


VAERS ID: 1262135 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-04-18
Onset:2021-04-22
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO171 / 1 LA / SYR

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: Bupropion Buspirone Prenatal vitamins
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I was given a diagnosis of shingles 4 days after receiving my first dose


VAERS ID: 1262341 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-31
Onset:2021-04-22
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Electrocardiogram S1-S2-S3 pattern, 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: None
Current Illness: None
Preexisting Conditions: OA
Allergies: Bees- Anaphylaxis
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Sacral shingles along S2


VAERS ID: 1262742 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-05
Onset:2021-04-22
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Contraception, Injection site erythema, Injection site swelling, Thrombophlebitis superficial, Ultrasound scan
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: Tobacco use, diabetes, Crohn''s disease
Allergies: Beta-lactam antibiotics, mercaptopurine analogues
Diagnostic Lab Data: Ultrasound of right arm on 4/22 shows a superficial clot in the right cephalic vein. No deep vein involvement.
CDC Split Type:

Write-up: Patient received vaccine on 4/5/21. She presented to her PCP on 4/22 with swelling and redness in the inside upper area of her right arm. Determined to be a superficial thrombosis. Patient has not history of VTE, but does smoke. Uses a Mirena IUD for contraception as well. Platelet count remained normal during this time, and was never affected.


VAERS ID: 1262795 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-06
Onset:2021-04-22
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, COVID-19, Computerised tomogram thorax, Cough, Dyspnoea, Pulmonary embolism, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: insulin-dependent type 2 diabetic, hypertensive, high cholesterol
Allergies: NSAIDs
Diagnostic Lab Data: COVID-19 BioFire CTA Chest
CDC Split Type:

Write-up: Patient developed cough, fever, shortness of breath on 4/22/21. Tested positive for COVID-19 and was found to have a pulmonary emoblus in the ER on 4/27/21. She is currently admitted at Hospital, under my care. I''m also her primary care physician.


VAERS ID: 1263264 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-06
Onset:2021-04-22
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy, Hemiplegia, Hypoaesthesia, Neck pain, Paraesthesia oral
SMQs:, Peripheral neuropathy (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hearing impairment (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: April 22nd, woke with neck pain. Persisted for 2 days and developed tingling of one side (left) of the tongue. Continued pain and numbness until unspecified time when left sided paralysis began. Went to ER and was diagnosed with Bell?s Palsy. Taking a steroid and Valtrex as prescribed by hcp.


VAERS ID: 1263769 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Incorrect dose administered, Incorrect product formulation administered, No adverse event
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: Not known
Current Illness: Not known
Preexisting Conditions: Patient received vaccine through EMS / Health Department homebound program, where her mother schedules her appointments due to a mental/cognitive disorder.
Allergies: Not known
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient from homebound vaccination program received a Janssen vaccine for the first dose on 04/07/21. Due to a scheduling oversight on our system and 2 different spellings of the same name, this patient also received a first dose of Moderna through the same program on 04/22/21. The patient has had no adverse reaction to receiving these 2 vaccines.


VAERS ID: 1263940 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-08
Onset:2021-04-22
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Anticoagulant therapy, Blood electrolytes normal, Blood fibrinogen normal, Deep vein thrombosis, Electrocardiogram normal, Fibrin D dimer increased, Full blood count, Haematocrit normal, Haemoglobin normal, Headache, Heparin-induced thrombocytopenia test positive, Immunoglobulin therapy, Immunology test, Peripheral swelling, Platelet count decreased, Pulmonary embolism, Vaccination complication, White blood cell count increased
SMQs:, Cardiac failure (broad), Angioedema (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: None reported
Diagnostic Lab Data: On admission to current facility: HIT antibody: negative Fibrinogen: 200 mg/dL D-dimer: 28,980 FEU CBC: WBC 12.3 10*9/L, hemoglobin: 14.7 g/dL, hematocrit 41.1%, platelets 54 10*9/L Electrolytes within normal ranges Vaccine-induced (VITT) HIT ELISA (detects presence of IgG antibodies to heparin-platelet factor 4 (PF4) complexes: 3.016 OD ECG: normal sinus rhythm
CDC Split Type:

Write-up: Janssen COVID-19 Vaccine EUA: two weeks after vaccination patient reported to an urgent care with right leg swelling and headache. Two days later patient presented an emergency department, diagnosed with left lower extremity deep vein thrombosis (DVT) and bilateral pulmonary emboli (PE). Transferred to current hosptial for management including anticoagulation with a direct thrombin inhibitor, intravenous immune globulin (IVIG), and additional laboratory testing.


VAERS ID: 1263950 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-06
Onset:2021-04-22
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Intermenstrual bleeding, Menstrual disorder
SMQs:, Haemorrhage terms (excl laboratory terms) (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: Omeprazole 20mg 1xday Claritin Fish oil Women''s under 50 multivitamin Elderberry extract supplement
Current Illness: None
Preexisting Conditions: Elevated bloop pressure Obesity
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I had two menstrual cycles in quick succession with spotting in between. The first started on 4/9 and was not out of the ordinary except that spotting continued, then a second started on 4/22. I would normally have cycles no sooner than 21 days apart.


VAERS ID: 1264036 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-08
Onset:2021-04-22
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Chills, Fibrin D dimer increased, Headache, Pulmonary embolism, Ventilation/perfusion scan
SMQs:, Haemorrhage laboratory terms (broad), Embolic and thrombotic events, venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: asthma exacerbation 2-3 weeks prior
Preexisting Conditions: asthma, COPD, Osteoporosis
Allergies: Morphine, Sulfa, Penicillin, Iodine, Erythromycin
Diagnostic Lab Data: VQ scan - patient is allergic to contrast; elevated d-dimer
CDC Split Type:

Write-up: immediately following vaccine patient developed chills and headache. Headache has continue to this date. 4/22/21 developed chest pain went to the emergency room and was diagnosed with a bilateral pulmonary embolism.


VAERS ID: 1264304 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-08
Onset:2021-04-22
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blister, Herpes zoster, Pain, Pruritus, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

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

Write-up: Shingles - rash and itchiness around right breast that spread to back over 2 days. Blisters formed in 5 days. Started taking antiviral Valcyclovir on 4th day from rash onset. Pain intensified on day 4.


VAERS ID: 1265622 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Headache, Nausea, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Tinninitus and after 7 days large red circle around the injection area, very sore arm. With second dose on the second day, very nauseated, bad headaches, body aches , super tired. , very sore arm.


VAERS ID: 1265626 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Disorientation, Dizziness, Fatigue, Feeling abnormal, Headache, SARS-CoV-2 test negative
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Negative COVID-19 test
CDC Split Type:

Write-up: Dizziness, disorientation, brain fog, headache, fatigue, weakness


VAERS ID: 1265659 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood glucose, Electrocardiogram, Hypoaesthesia, Lip swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Medication - Meloxicam
Diagnostic Lab Data:
CDC Split Type:

Write-up: Following morning (Thur) after receiving the vaccine, started feeling numbness on my face and swelling. Called my primary care Dr. to report symptoms. She advised I go to urgent care. I went to urgent care and they checked my blood glucose levels, EKG to check my heart was beating correctly. Urgent care advised I go to ER to get further evaluation done. I went to ER where they evaluated me. Advised this is an allergic reaction to the vaccine and to monitor. The following day (Fri) still felt slight swelling/numbness. Symptoms became worse in the evening called nurse line to explain swelling on my lip and face. Advised to take benadryl then go to ER. I went to ER in another location. ER Dr. advised this is an allergic reaction to the vaccine.


VAERS ID: 1266090 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-12
Onset:2021-04-22
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Muscle spasms, Night sweats
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dystonia (broad)

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

Write-up: Night sweats, cramping and menstration longer and heavy


VAERS ID: 1266093 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW964 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Fatigue, Injection site pain, Muscle spasms, Muscle twitching, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline, Bupropion, Portia, Metformin
Current Illness: Infection from a cat bite.
Preexisting Conditions: Asthma
Allergies: I had a reaction to a blood pressure medication
Diagnostic Lab Data: I have not had any laboratory tests done, the medication has helped. I am still experiencing an occasional spasm on the back of my arm and weakness.
CDC Split Type:

Write-up: I started to get muscle twitching in my left arm, it moved to my breast bone and around to the upper portion of my rib cage. I also experienced quite a bit of deep muscle pain around the injection site and extreme tiredness. I spoke to my doctor and he prescribed cyclobenzaprine for the twitching


VAERS ID: 1266128 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-04-01
Onset:2021-04-22
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Oligomenorrhoea, Pain
SMQs:, 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: None
Current Illness: None
Preexisting Conditions: Thrombocytosis
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme fatigue, moderate body aches , delayed menstrual cycle - no treatment


VAERS ID: 1266133 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Feeling hot
SMQs:

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

Write-up: Patient complained of body heat. 1:10pm Patient refused to take B/P. Stated she is feeling better. EMS informed patient if symptoms return to call 911 or primary care doctor. (Patient is alertx3). Verbalized understanding.


VAERS ID: 1266422 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-05
Onset:2021-04-22
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (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 stated that her doctor says she has blood clots and believe it could be due to the vaccine.


VAERS ID: 1266486 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-04-09
Onset:2021-04-22
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Central nervous system lesion, Guillain-Barre syndrome, Inflammation, Lumbar puncture, Magnetic resonance imaging head abnormal, Magnetic resonance imaging spinal abnormal, Spinal cord neoplasm
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Non-haematological tumours of unspecified malignancy (narrow), Immune-mediated/autoimmune disorders (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: MRI, lumbar puncture, extensive infectious/inflammatory/malignancy workup underway
CDC Split Type:

Write-up: Developed ascending paralysis, currently hospitalized and being worked up, but felt to be inflammatory with extensive spinal lesions and brain lesion.


VAERS ID: 1266822 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-19
Onset:2021-04-22
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: B6, magnesium
Current Illness: No
Preexisting Conditions: No
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started my period 9 days early (this has never happened to me before)


VAERS ID: 1267013 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-05
Onset:2021-04-22
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Herpes zoster, Hyperaesthesia, Myalgia, Pain in extremity, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: penicillin shot, tetanus shot and sulfa drug when 5 yrs old
Other Medications: 1 shot 1 time a year for osteoporosis. The rest would just be daily vitamins: 1 multiple vitamin, 1 resveritrol, 1 zeaxantham/leutin, 1 Vit D3, 1 CoQ10, 1 Flaxseed oil capsule, Vitamin B complex,
Current Illness: Not an illness, just that I have osteoporosis.
Preexisting Conditions: Alopecia totalis.
Allergies: Allergies to Tetanus, Penicillin, and Sulfa.
Diagnostic Lab Data: Just physical visit to the doctor and she examined my groin and buttock where the rash appeared.
CDC Split Type:

Write-up: My skin became very sensitive to touch 4-5 days ago, then I noticed some pain in my left leg like muscle overuse, then I woke up yesterday and found a rash. Dr. said its Shingles and said it is likely due to the vaccine.


VAERS ID: 1267199 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-04-05
Onset:2021-04-22
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Myocardial infarction, Thrombosis
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levothyroxine, venlafaxine, montelukast, amlodipine, lisinopril, meloxicam, albuterol prn
Current Illness: none known
Preexisting Conditions: hypothyroid, hypertension, arthritis, depression
Allergies: none known
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: patient developed severe chest pain, ambulance was called and patient was taken to ER. Patient was transferred to higher level facility and was told he had a heart attack and that it was caused by a "blood clot"


VAERS ID: 1268639 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-09
Onset:2021-04-22
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Deep vein thrombosis, Full blood count normal, Metabolic function test, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: focalin 10mg tab twice daily, generic mens mvm - - generic walgreens brand
Current Illness: none
Preexisting Conditions: ADHD
Allergies: none
Diagnostic Lab Data: cbc / cmp - completed US - completed
CDC Split Type:

Write-up: pt developed symptoms of left leg swelling on 4/22/21 with increased pain and fullness in lower leg. found at ER on unspecified date to have a acute DVT, started on Xarelto, and fu in clinic on later unspecified date - with cbc normal, cmp normal goal of 3months of AC and hematology consultation


VAERS ID: 1269280 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-20
Onset:2021-04-22
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Crepitations, Dyspnoea paroxysmal nocturnal
SMQs:, Cardiac failure (broad), Pulmonary hypertension (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Shortness of breath wakes him up from his sleep; Crackling in my throat; This spontaneous case was reported by a consumer and describes the occurrence of DYSPNOEA PAROXYSMAL NOCTURNAL (Shortness of breath wakes him up from his sleep) in a 53-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 047B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 20-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 22-Apr-2021, the patient experienced DYSPNOEA PAROXYSMAL NOCTURNAL (Shortness of breath wakes him up from his sleep) (seriousness criterion medically significant) and CREPITATIONS (Crackling in my throat). On 23-Apr-2021, DYSPNOEA PAROXYSMAL NOCTURNAL (Shortness of breath wakes him up from his sleep) had resolved. At the time of the report, CREPITATIONS (Crackling in my throat) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant product use was not provided. Treatment information was unknown.


VAERS ID: 1269614 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Ear pain, Fatigue, Headache, Pain, Pain in extremity, Respiratory rate increased, Tinnitus
SMQs:, Anticholinergic syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: About an hour a half after getting the Moderna shot on Thursday, I felt dizzy, I had a headache where the inside of my head was hurting, My legs were throbbing. The next day, I was tired but between Friday and Saturday, I had this piercing pain in my ears. I have ringing in my right ear, and my entire legs are throbbing - feels like they''re vibrating. I also feel like I''m breathing faster. Is there anything that I should take?


VAERS ID: 1269621 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Headache, Injection site swelling, Pregnancy, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Normal pregnancy conditions and outcomes (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 100mg, Prenatal vitamin, colace
Current Illness:
Preexisting Conditions: Depression
Allergies: Abilify
Diagnostic Lab Data:
CDC Split Type:

Write-up: 26 weeks pregnant, due 8/7/2021 Headache and rash on hands at time of vaccine, 2inx4in hard raised swelling at injection site onset after 2 days lasting over 1 week


VAERS ID: 1269628 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-17
Onset:2021-04-22
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Injection site rash, Pain, Rash, Somnolence
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: I had my shot which I felt through my neck first of all I was super sore the day of and after but very sleepy the following day. On Tuesday, April 20, 2021 I had itchiness where the shot was administered. I woke up next day with a little red bumps which I thought it was from itchy the night before. Until on Thursday, April 22, 2021 when I woke up I notice a big red round spot only circling around the area where the shot was inserted and where the needle went in. Then Tuesday, April 27, 2021 I had red bumps all over my back in between my should blades. Everything is still noticeable!


VAERS ID: 1270041 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Myalgia, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Soreness and muscle aches in left arm and shoulder that began around 8 hours after the shot. Headache and fever of 99F around 16-18 hours after, took Advil and both went away after a few hours. Fatigue and sore arm for most of the next day. Fever of 100F started around 30 hours after the shot, took Tylenol. Symptoms gone after roughly 48 hours.


VAERS ID: 1270176 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscle spasms
SMQs:, Dystonia (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:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: generalized muscular spasms which have since resolved


VAERS ID: 1270213 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-06
Onset:2021-04-22
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

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

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

Write-up: Adverse event: Tinnitus in R ear 16 days after shot (same side as vaccine was administered in R deltoid) Treatment: None Outcomes: Condition is ongoing no resolution to this point


VAERS ID: 1270243 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-04-13
Onset:2021-04-22
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Deep vein thrombosis, Peripheral swelling, Ultrasound Doppler abnormal
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Doppler study demonstrates an extensive left lower extremity deep vein thrombosis.
CDC Split Type:

Write-up: Pt presents to ER with a 5 day history of left lower extremity swelling without significant pain.


VAERS ID: 1270257 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C 21A / 1 LA / SYR

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

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

Write-up: Red rash at injection site, roughly 2 inches in diameter. Started the same night as getting injected, and is still there unchanged a week later


VAERS ID: 1271601 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-01
Onset:2021-04-22
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Guillain-Barre Syndrome


VAERS ID: 1271930 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-04-01
Onset:2021-04-22
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Anticoagulant therapy, Back pain, Chest pain, Computerised tomogram thorax abnormal, Dizziness, Dyspnoea, Haemoptysis, Nephrolithiasis, Pain, Pulmonary thrombosis, Thrombosis, Ultrasound Doppler abnormal
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Infective pneumonia (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: lisinopril 10 mlg
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: starting have shortness of breath/difficulty breathing and back and chest pain. light headed, pain unbearable. Saturday April 23rd Went to er was treated for kidney stones but they could only find one small one, Was sent home with pain medication. Shortness of breath persisted as did bloody cough and pain in chest and all over. Went back to the er on 4/28 as pain was unbearable (chest pain) once given a cat scan and diagnosed with blood clots in my lungs and then an ultra sound and found a blood clot in my leg (just above knee). It is thought that I was mis-diagnosed on the original trip to the er with kidney stones. I have been put on blood thinners and pain medication and will be following up with my doctor.


VAERS ID: 1272622 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 1 LA / IM

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

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

Write-up: moderna given to 17yo


VAERS ID: 1272656 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / UN

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Burning sensation, Inflammation, Joint swelling, Laboratory test, Peripheral swelling, Ultrasound scan
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydroxychloroquine
Current Illness: LUPUS
Preexisting Conditions: LUPUS
Allergies: NO
Diagnostic Lab Data: Liver inflamed, Ultrasound was done. Labwork. Given Peridsone, Anti-Inflammatory, Painkillers (Norco and Naproxen). Still currently being treated for ongoing symptoms.
CDC Split Type:

Write-up: Severe swelling and pain in all joints. Feet, hands, ankles, knees, burning in back and shoulders, swelling in wrist and fingers. Started after about a week after 1st dose. 2nd does I had to go to the Emergency Room at hosptial.


VAERS ID: 1274392 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-08
Onset:2021-04-22
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 6 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ear discomfort, Epistaxis, Headache
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan, Rosatatin, Celexa
Current Illness:
Preexisting Conditions: Breast Cancer
Allergies: Penicillin and Zithromax
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nosebleed, headache, ear congestion all tweo weeks post vaccination.


VAERS ID: 1274972 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-12
Onset:2021-04-22
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

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

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

Write-up: Pt developed a rash about a week after the vaccine was administered. The rash begins as a small red dot similar to a bug bite and over time becomes a large inflamed rash. The rash has so far only appeared in the patients legs and the patient complains of intense itching. The patient went to urgent care a few days later and was prescribed triamcinolone 0.1 % cream. A few days after that the patient went to see her primary physician and was prescribed Bactrim DS and Ketconazole 2% cream. She visited the pharmacy were she got the vaccine 4/30/21 to inquire if the rash could be related to the vaccine and ask for recommendation for the itching.


VAERS ID: 1276763 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fasting, Feeling abnormal, Hallucination, 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), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 virus test positive (Patient with a prior, confirmed COVID 19 Infection requiring a ventilator in October and November.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: hallucinating; full day spent in bed feeling bad; chills; Body Aches; A little bit of a fever; didn''t eat for 2 full days; This spontaneous case was reported by a consumer and describes the occurrence of HALLUCINATION (hallucinating) in a 62-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 040B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included COVID-19 virus test positive (Patient with a prior, confirmed COVID 19 Infection requiring a ventilator in October and November.) in October 2020. On 22-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 22-Apr-2021, the patient experienced FASTING (didn''t eat for 2 full days), CHILLS (chills), MYALGIA (Body Aches) and PYREXIA (A little bit of a fever). On 23-Apr-2021, the patient experienced FEELING ABNORMAL (full day spent in bed feeling bad). On an unknown date, the patient experienced HALLUCINATION (hallucinating) (seriousness criterion medically significant). On 24-Apr-2021, HALLUCINATION (hallucinating), FASTING (didn''t eat for 2 full days), FEELING ABNORMAL (full day spent in bed feeling bad), CHILLS (chills), MYALGIA (Body Aches) and PYREXIA (A little bit of a fever) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. The patient took Blood pressure medicine(Name Not specified) and aspirin as a concomitant medication. No treatment information was provided. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded


VAERS ID: 1276764 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-25
Onset:2021-04-22
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Chills, Dizziness, Myalgia, Oropharyngeal blistering, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SYNTHROID
Current Illness: Thyroid disorder
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Two blisters in the back of the throat; Dizziness; Arm hurts; Getting weak; Terrible chills; Terrible body aches; horrible fever; This spontaneous case was reported by a consumer and describes the occurrence of OROPHARYNGEAL BLISTERING (Two blisters in the back of the throat) in a 58-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 03B21A and 022M20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Thyroid disorder. Concomitant products included LEVOTHYROXINE SODIUM (SYNTHROID) for Thyroid disorder. On 25-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 22-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 22-Apr-2021, the patient experienced OROPHARYNGEAL BLISTERING (Two blisters in the back of the throat) (seriousness criterion medically significant), DIZZINESS (Dizziness), PAIN IN EXTREMITY (Arm hurts), ASTHENIA (Getting weak), CHILLS (Terrible chills), MYALGIA (Terrible body aches) and PYREXIA (horrible fever). At the time of the report, OROPHARYNGEAL BLISTERING (Two blisters in the back of the throat), DIZZINESS (Dizziness), PAIN IN EXTREMITY (Arm hurts), ASTHENIA (Getting weak), CHILLS (Terrible chills), MYALGIA (Terrible body aches) and PYREXIA (horrible fever) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments Acetaminophen was taken for symptoms. The patient received both scheduled doses of mRNA-1273 prior to the event, therefore action taken with the drug in response to the event is not applicable. Company comments:Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. This case was linked to MOD-2021-090318 (Patient Link).; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1279312 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-21
Onset:2021-04-22
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood urine present
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021449051

Write-up: I have blood in my urine; This is an initial spontaneous report from a contactable consumer (patient). A 57-year-old male patient received the second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection) via an unspecified route of administration on 21Apr2021 16:00 as a single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. He got the second covid shot yesterday at 4PM and he have blood in urine today. He have no other symptoms. Follow-up activities has been raised. Information on the lot/batch number has been requested.


VAERS ID: 1281876 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-06
Onset:2021-04-22
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802070 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cerebrovascular accident, Computerised tomogram head abnormal, Dizziness, Hemiparesis, Magnetic resonance imaging head abnormal
SMQs:, Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Docusate 100mg BID Lisinopril 10mg - currently noncompliant with this medication Metformin 1000mg BID Armour Thyroid 45mg Glimepiride 2mg
Current Illness: No known acute illnesses at time of vaccination or one month prior.
Preexisting Conditions: Hypertension Hyperlipidemia Type II diabetes Vitamin D deficiency
Allergies: no known drug or food allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient got her single shot Johnson and Johnson vaccine on 3/6/2021. Then, on or about 4/22/2021, she began to complaint of dizziness and left-sided weakness. She presented to emergency room on 4/29/2021 and was found to have a stroke via CT and MRI.


VAERS ID: 1282349 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-07
Onset:2021-04-22
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Amnesia, Computerised tomogram, Feeling abnormal, Hypersomnia, Hypoaesthesia, Laboratory test, Movement disorder
SMQs:, Peripheral neuropathy (broad), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (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: Ct scan head Labs
CDC Split Type:

Write-up: I woke up on April 22 and could not feel or move my entire body. This lasted from the time I woke up (5:15am) until I was discharged from the hospital later that night. I was weak and in a brain fog the entire weekend (Thursday, Friday, and Saturday). I slept all weekend and have no memory of the entire weekend.


VAERS ID: 1283215 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-05
Onset:2021-04-22
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abortion spontaneous, Exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: I (unknowingly at the time) was pregnant at the time of my vaccine administration. I didn?t find out until a week or 2 later. My estimate due date was 12/26/2021. I did end up miscarrying this pregnancy on 4/22/2021.


VAERS ID: 1284281 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-04-07
Onset:2021-04-22
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Antinuclear antibody positive, Arthralgia, Pain, Viral titre
SMQs:, Systemic lupus erythematosus (narrow), Arthritis (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluticasone, allegra
Current Illness: none
Preexisting Conditions: COPD
Allergies: none
Diagnostic Lab Data: positive ANA, 1:160 Titer, Homogenous pattern
CDC Split Type:

Write-up: Janssen COVID-19 Vaccine EUA Pain started in right shoulder joint, by next morning was in right hip joint. Went to ER, given oxy and toradol, next day, pain was diminished in right but migrated to left shoulder joint, and wrist joints and finger joints of both hands. Minimal swelling in hands. Went to PCP on day 5, prescribed prednisone that helped greatly, pain still present but markedly less. Joint pain now in knee joints also.


VAERS ID: 1284941 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-03-22
Onset:2021-04-22
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Deafness unilateral, Ear pain
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Ear infection (had a major ear infection back in 2003)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: loss of hearing on the right ear; ear ache; This spontaneous case was reported by a consumer and describes the occurrence of DEAFNESS UNILATERAL (loss of hearing on the right ear) in a 64-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 037B21A and 038A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Ear infection (had a major ear infection back in 2003) in 2003. On 22-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 19-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 22-Apr-2021, the patient experienced DEAFNESS UNILATERAL (loss of hearing on the right ear) (seriousness criterion medically significant) and EAR PAIN (ear ache). At the time of the report, DEAFNESS UNILATERAL (loss of hearing on the right ear) and EAR PAIN (ear ache) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Treatment information included Ear washing. 1 percent Neomycin and 3.5 mg Polymyxin Suspension , 3 drops 4 times a day. Action taken with response to the events are not applicable. Company comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1285597 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-10
Onset:2021-04-22
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Ear discomfort, Hypoacusis, Tinnitus
SMQs:, Hearing impairment (narrow)

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

Write-up: Ear canals felt plugged suddenly and hearing was diminished. Several days later tinnitus (ringing in ear) started. I have not be treated.


VAERS ID: 1287628 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-04-09
Onset:2021-04-22
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / N/A RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Ear discomfort, Hypoacusis
SMQs:, Hearing impairment (narrow)

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

Write-up: Muffled hearing, feeling of fullness in ears which persists to this day (5/04/2021)


VAERS ID: 1288774 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-01-21
Onset:2021-04-22
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Fatigue, Feeling of body temperature change, Headache, Lumbar vertebral fracture, Photopsia, Vaccination site pruritus, Vaccination site warmth
SMQs:, Anaphylactic reaction (broad), Accidents and injuries (narrow), Retinal disorders (narrow), Osteoporosis/osteopenia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Blood pressure high; Migraine; Osteoporosis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Headache with flashing light; Hot and cold; Moderna arm / Red below deltoid muscle; Hot at the injection site; Itchy at the injection site; Extreme fatigue / Could not get up for 2 days / Lay down for 2 days; Headache with flashing light; Broke her L2 vertebra; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of LUMBAR VERTEBRAL FRACTURE (Broke her L2 vertebra) in a 77-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 013M20A and 032L20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Osteoporosis, Blood pressure high and Migraine. On 21-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 18-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 22-Apr-2021, the patient experienced LUMBAR VERTEBRAL FRACTURE (Broke her L2 vertebra) (seriousness criterion medically significant). On an unknown date, the patient experienced PHOTOPSIA (Headache with flashing light), FEELING OF BODY TEMPERATURE CHANGE (Hot and cold), ERYTHEMA (Moderna arm / Red below deltoid muscle), VACCINATION SITE WARMTH (Hot at the injection site), VACCINATION SITE PRURITUS (Itchy at the injection site), FATIGUE (Extreme fatigue / Could not get up for 2 days / Lay down for 2 days) and HEADACHE (Headache with flashing light). At the time of the report, LUMBAR VERTEBRAL FRACTURE (Broke her L2 vertebra), PHOTOPSIA (Headache with flashing light), FEELING OF BODY TEMPERATURE CHANGE (Hot and cold), ERYTHEMA (Moderna arm / Red below deltoid muscle), VACCINATION SITE WARMTH (Hot at the injection site), VACCINATION SITE PRURITUS (Itchy at the injection site), FATIGUE (Extreme fatigue / Could not get up for 2 days / Lay down for 2 days) and HEADACHE (Headache with flashing light) outcome was unknown. Not Provided No concomitant medications were reported. No treatment information was provided. Company Comment: Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded for all events except Lumbar vertebral fracture which is unlikely. This case was linked to MOD-2021-092132 (Patient Link).; Sender''s Comments: Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded for all events except Lumbar vertebral fracture which is unlikely.


VAERS ID: 1291841 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-04-12
Onset:2021-04-22
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Feeling hot, Limb discomfort, Rash erythematous, Vasculitis
SMQs:, Anaphylactic reaction (broad), Vasculitis (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lyrica Irbesartin Motrin Tylenol
Current Illness:
Preexisting Conditions: High Blood Pressure Spinal Stenosis
Allergies: Penicillin/Amoxicillin
Diagnostic Lab Data: Blood Work - 4/24/2021
CDC Split Type:

Write-up: Vasculitis Both Lower Legs - Red Rash and Red Spots Warm to Touch


VAERS ID: 1292900 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-22
Onset:2021-04-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
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: Lamotrigine, Venlafaxine
Current Illness: None we are aware of
Preexisting Conditions: Mood disorder
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received a J&J Vaccine on 04/07/21 then scheduled herself for a pfizer shot at our location. Pharmacist at location verbally verified if the patient had had any vaccines in the last 4 weeks and patient verified verbally and on consent form that she had not. Pfizer was then administered. Upon billing, we found she had previously received J&J. No actual adverse event reported


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