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

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



Case Details (Reverse Sorted by Onset Date)

This is page 194 out of 8,010

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VAERS ID: 1696455 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Virgin Islands  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 4 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Antibody test negative, Extra dose administered, Interchange of vaccine products
SMQs:, Medication errors (narrow)

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

Write-up: Recipient was fully vaccinated as of 02-16-2021 with 2 doses of Moderna. He came to the vaccination center on 08/23/2021 and received 1st dose Pfizer. He did not inform staff that he was previously vaccinated. When contacted after the 08-23-21 visit, the recipient stated he came for the Pfizer because he had 2 antibody tests several months after receiving the second Moderna and both were negative. So he came for the Pfizer as a booster. Recipient came in again on 09-13-2021 and received second Pfizer.


VAERS ID: 1696458 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injected limb mobility decreased, Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Within a few hours, the pain developed in my left arm at the injection shot. By morning it was extremely painful to move my arm in any direction. Pain feels like it''s traveling through my arm to my hand.


VAERS ID: 1696461 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058EZ1A / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, chills, severe headache, body pain and weakness


VAERS ID: 1696477 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / SYR

Administered by: School       Purchased by: ?
Symptoms: Abdominal pain, Testicular pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Sexual dysfunction (broad)

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

Write-up: Extreme testicle pain and up into the abdomen region.


VAERS ID: 1696488 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Dizziness, Fatigue, Injection site pain, Lymphadenopathy, Pain in extremity, Paraesthesia, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Erythromycin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever of 101 degrees Tingling in left arm from shoulder to fingers Swollen lymph nodes under left arm Severe aching pain from left shoulder across chest and under the left arm Extreme fatigue Dizziness, light headedness Arm tenderness at injection site


VAERS ID: 1696495 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-17
Onset:2021-09-13
   Days after vaccination:88
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Employee forgot that she already received COVID19 (Janssen) back in 6/17/21 and gave this reporter consent to administer her first dose of COVID19 (Pfizer) on 9/13/21.


VAERS ID: 1696513 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 59676-0580-15 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Grip strength decreased, Hypoaesthesia, Muscular weakness, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Sexual dysfunction (broad)

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

Write-up: Shortly after getting vaccine (20min afterward) my left hand and forearm started to tingle and go numb. That sensation spread up my arm to my neck on the left side. Over night the tingling persisted and now my hand is very weak on the pinky and ring finger and the tingling /numbness is localized to the outside area of my left arm, neck on left side and the pinky side (half of my hand). Lifting is not normal and grip is weak. Also getting tingling in my jaw on left side. Currently 10:12 am on the following day after vaccine- symptoms seems to be progressing in location.


VAERS ID: 1696559 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 109B21A / 7+ - / IM

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

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

Write-up: The patient was given an injection that had been out of the vial for more than the time it was supposed to be. no adverse reaction seen.


VAERS ID: 1696564 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 109B21A / 7+ - / SYR

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

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

Write-up: The patient was given an injection that was drawn up longer than that is recommended. No reaction seen.


VAERS ID: 1696590 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-06-05
Onset:2021-09-13
   Days after vaccination:100
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 RA / IM

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

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

Write-up: hospitalization (non-ICU)


VAERS ID: 1696622 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Wyoming  
Vaccinated:2021-09-01
Onset:2021-09-13
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TYLENOL PM 2QPM
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: 13 DAYS AFTER VACCINATION PATIENT EXPERIENCED SWELLING, REDNESS AND HIVES AT INJECTION SITE.


VAERS ID: 1696624 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoaesthesia oral, Paraesthesia oral, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: VITAMIN D, NUVARING, PROPRANOLOL LA, IMITREX
Current Illness: OVARIAN CYSTS, MIGRAINE, NONTOXIC GOITER, VIT D DEFICIENCY, ANXIETY
Preexisting Conditions:
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: WITHIN 20 MINUTES OF PFIZER VACCINE #1 SHE FELT TINGLY LIPS AND LEFT ARM NUMBNESS BELOW SHOT SITE. $g4 HOURS LATER GOT HIVES ON RIGHT THIGH


VAERS ID: 1696638 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-22
Onset:2021-09-13
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 RA / IM

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

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

Write-up: hospitalization (non-ICU)


VAERS ID: 1696639 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 20421A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Heart rate increased, Hypoaesthesia oral, Pharyngeal swelling, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NOT KWOWN
Current Illness: NOT KNOWN
Preexisting Conditions: NOT KNOWN
Allergies: NOT KNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: LIGHT HEADED DIZZY THROAT SWELLING LIP NUMBNESS INC HEART RATE SHORTNESS OF BREATH AND WHEEZE. GAVE 1 25MG BENADRYL AND COLD WATER. WAITED ANOTHER 15 MINUTES. PATIENT GOOD TO LEAVE. CALLED THIS AM STATED HE TOOK ANOTHER BENADRYL AS HE HAD SYMPTOMS,


VAERS ID: 1696667 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-01
Onset:2021-09-13
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Blood test normal, Chest pain, Dyspnoea, Electrocardiogram abnormal, Haemorrhagic disorder, Heart rate increased, Left atrial enlargement, Menstruation irregular, Nausea, Neck pain, Pain in extremity, X-ray
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Fertility disorders (broad), Arthritis (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Women''s multivitamin and Omega''s
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Keflex
Diagnostic Lab Data: EKG, initial blood work, X-ray and additional blood work was collected. At the ER my EKG results showed left atrial enlargement. The doctor asked a series of questions about recent life experiences that could have triggered this response. When he asked if and when I had received the vaccine he immediately ran additional tests (X-ray and additional blood work). My blood work came back negative for blood clots and explained I was experiencing inflammation of the heart or sack surrounding it. He discharged me and told me to take anti-inflammatory meds. If symptoms worsened to come back. He also suggested I follow up with my PCP. No discharge paperwork was provided.
CDC Split Type:

Write-up: On day 2 post vaccine I began my period early with abnormal bleeding. That lasted approximately two days then stopped. On the morning of September 13, 2021 I began noticing I was having difficulty breathing and felt nauseous. Shortly after I started to experience severe pain in the left side of my chest and side, pain down my left arm and up the left side of my neck. My heart rate and BP were both also elevated and remained elevated throughout my time in the emergency department. They connected me to an EKG and took initial blood work. At the ER my EKG results showed left atrial enlargement. The doctor asked a series of questions about recent life experiences that could have triggered this response. When he asked if and when I had received the vaccine he immediately ran additional tests (X-ray and blood work). My blood work came back negative for blood clots and explained I was experiencing inflammation of the heart or sack surrounding it. He discharged me and told me to take anti-inflammatory meds. If symptoms worsened to come back. He also suggested I follow up with my PCP. No discharge paperwork was provided.


VAERS ID: 1696670 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 2 LA / IM

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

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

Write-up: Patient received the vaccine after 4pm, which was after the expiration time of 3:17pm after dilution.


VAERS ID: 1696682 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-13
Onset:2021-09-13
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / UNK - / -

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

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

Write-up: admitted to the hospital with symptoms on 9/13/21 chest pain and shortness of breath, gradually worsening x 1 week.


VAERS ID: 1696707 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-17
Onset:2021-09-13
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / UNK - / -

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

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

Write-up: Patient admitted for other reasons than COVID, she was test asymptomatically for discharge back to the nursing home that she lives at


VAERS ID: 1696723 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-20
Onset:2021-09-13
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Pernicious anemia, liver cirrhosis, hard of hearing, COPD, arthritis.
Allergies:
Diagnostic Lab Data: PCR positive for COVID on 9/13/21
CDC Split Type:

Write-up: The patient was tested on 9/13/21 and was asymptomatic. He tested positive.


VAERS ID: 1696736 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphagia, Erythema, Hypersensitivity, Pharyngeal swelling, Pruritus, Swelling face
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Estrogen patch Nurtec
Current Illness:
Preexisting Conditions: Secondary adrenal insufficiency Chronic severe migraine
Allergies: Penicillin Latex Reglan Zinc oxide Morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: 10 mins after vaccine my throat started swelling making it difficult to swallow and itching started. My left side of my face felt swollen and red even though it wasn?t. Nerve endings because hypersensitive. Symptoms only got stronger and more severe.


VAERS ID: 1696753 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-13
Onset:2021-09-13
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: COVID positive 9/13/21
CDC Split Type:

Write-up: Hospitalization on 9/14/21


VAERS ID: 1696756 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-09
Onset:2021-09-13
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Normocytic anaemia, Transient global amnesia
SMQs:, Haematopoietic erythropenia (broad), Chronic kidney disease (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: Duloxetine, synthroid, nebivolol, rosuvastatin, irbesartan
Current Illness: No
Preexisting Conditions: Hypertension, Hyperlipidemia, obesity, obstructive sleep apnea
Allergies: penicillin, tramadol
Diagnostic Lab Data: only abnormality this far is a mild anemia normocytic anemia, which is notable chronic hemoglobin relatively approximate to baseline, has diastolic CHF per echo EF 50-55%
CDC Split Type:

Write-up: Transient Global Amnesia, Acute CVA ruled out, currently hospitalized to rule out seizure


VAERS ID: 1696768 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Heart rate increased, Hyperhidrosis, Nervousness, Paraesthesia oral, Throat irritation, Tunnel vision
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Optic nerve disorders (broad), Retinal disorders (narrow), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Breathing issues for over a year, no diagnosis made.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Throat burning, lips tingly, sweaty and shaky, tunnel vision, lightheaded, super fast heart rate. All within 5 minutes of the injection.


VAERS ID: 1696786 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-03-19
Onset:2021-09-13
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood creatinine increased, Blood glucose increased, Blood lactic acid decreased, COVID-19, Central venous catheterisation, Chest X-ray normal, Coma scale, Computerised tomogram abdomen normal, Computerised tomogram head normal, Electrocardiogram abnormal, Feeling hot, Hyperhidrosis, Hypotension, Hypoxia, Loss of consciousness, Mental status changes, Pyrexia, SARS-CoV-2 test positive, Sepsis, Tachycardia, Troponin, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chief Complaint Pt via EMS found by wife in car after being in there for uknown length of time with windows fogged over and patient unconscious. Febrile en route and in triage. BG 215 en route. Diaphoretic . GCS 14. 500 ml fluids en route. History of Present Illness 65-year-old fully COVID-vaccinated (Pfizer in June) male who has presented to the ER this evening via EMS for altered mental status, fever, sepsis and COVID-19 illness. History is somewhat limited. Most of the history is obtained from EMS and the patient''s wife over the phone by the ER provider this evening. Patient has not been home very much over the last 4 to 5 days. Apparently the husband has been trying to avoid her due to her illness whi


VAERS ID: 1696828 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-11
Onset:2021-09-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash, Rash erythematous, Rash pruritic, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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: Citrizine allergy tab 10mg
Current Illness: None
Preexisting Conditions: Asthma and seasonal allergies
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Swelling and rash/hives. Itching at rash sight and minimal redness.


VAERS ID: 1696860 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Peripheral swelling, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Headache, swollen arm, rash on upper body


VAERS ID: 1696863 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Private       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: Sore arm, 27, Oct 2020, flu shot
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore arm 5 hours after shot


VAERS ID: 1696868 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-10
Onset:2021-09-13
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN62.4 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 RA / IM

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

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

Write-up: COVID symptoms started on 9/7/21, tested covid+ on 9/8/21, scheduled to receive regeneron infusion but developed shortness of breath and oxygen saturations fell to 81 and 82% on room air, sent to ER for hospitalization


VAERS ID: 1696905 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Chills, Headache, Pain, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, escitalopram (10 mg), biotin
Current Illness: N/A
Preexisting Conditions:
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Chills, sweating, fever, severe body aches, headache, chest pains


VAERS ID: 1696920 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Chills, Fatigue, Headache, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Chills, fever, headache, nausea, weak and fatigue 8 hours after the 2nd dose


VAERS ID: 1696945 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-02-12
Onset:2021-09-13
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 RA / IM

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

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

Write-up: Covid positive 9/13/21


VAERS ID: 1696951 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH CVS18068 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Headache, Pain of skin
SMQs:, Arthritis (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: Vit D
Current Illness: None
Preexisting Conditions: None
Allergies: Zithromax Levoquin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: All symptoms started at midnight after the injection And lasted 24-48 hrs Joint pain Skin painful to touch Severe headache OTC severe cold and flu medicine


VAERS ID: 1696953 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Erythema, Lip oedema, Paraesthesia oral, Pruritus
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pfizer-BioNTech COVID-19 Vaccine EUA: After being administered the vaccine at 8:43 am, recipient developed lip tingle, slight edema on the lips, itchy and redness on the cheek at 8:58 am. Patient refused to go to the emergency department. Patient was given diphenhydramine and methylprednisolone. After 1 hour of observation - lips and cheeks improved. Patient no longer complained of itchy lips. At 10:50 am, patient stated they were fine and left the clinic.


VAERS ID: 1696967 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient stated he passed out 2 years prior with a flu vaccination. 21yo at the time.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Male patient, 23yo, had marked on screening form that he had fainted previously, so I asked him about that incident prior to the vaccination. He said that 2 years ago he passed out after a flu shot, so I asked if he was feeling ok today and if he had eaten anything. He said he had eaten a granola bar and was feeling fine. I proceeded with the vaccination, watching him closely. He immediately slumped in the chair and passed out. I yelled for another pharmacy team member to come assist me with him. By the time the 2nd team member was in the room, the patient had regained consciousness. We propped his feet up on a box to elevate them some while he sat for a few more minutes. I asked if he wanted me to call anyone, he said no that he was fine. I let him sit in the consultation room another few minutes until he felt ok to walk. After 10 minutes, he felt ok to walk and went to the waiting area to have a seat for another 25-30 minutes. I continued to monitor him, and then asked him to walk around the store for a few minutes to make sure he was ok before leaving the store. After 30 or so minutes, he felt ok to leave. Called patient about 2 hours after leaving and he was still doing okay.


VAERS ID: 1696978 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 RA / IM

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

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

Write-up: Pt was supposed to receive Pfizer but instead received Moderna for their second dose.


VAERS ID: 1697001 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-15
Onset:2021-09-13
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone, C-reactive protein, Differential white blood cell count, Hypertension, Metabolic function test, Pregnancy test urine negative, Urine analysis
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: C-REACTIVE PROTEIN (INFLAMMATION) COMPREHENSIVE METABOLIC PANEL HCG SCREEN URINE HCG, QUANTITATIVE LAB ONLY-COMPLETE BLOOD COUNT WITH DIFFERENTIAL TSH URINALYSIS DIPSTICK REFLEX TO MICROSCOPIC URINALYSIS MICROSCOPIC
CDC Split Type:

Write-up: hypertension


VAERS ID: 1697010 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 3 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Arrhythmia, Atrial flutter, Electrocardiogram abnormal, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Dehydration (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: Metoprolol, Lisinopril, Namenda, Seroquel, Vitamin C, Acetaminophen, Citalopram, Vitamin D3, Ferrous Sulfate, Donepezil, Atorvastatin, Asprin.
Current Illness: only chronic conditions
Preexisting Conditions: cerebral infarction, hernia, HTN, CKD, anorexia, prediabetes, dementia, myopia
Allergies: No known allergies
Diagnostic Lab Data: EKG- 9/13/2021
CDC Split Type:

Write-up: Elder''s vital signs prior to administration of COVID-19 vaccine were BP- 102/66, Pulse- 70, Resp- 18, Temp- 97.6, 97% O2 sat, approximately 30 minutes post vaccine administration, Elder''s vital signs were BP- 114/77, Pulse- 140, Resp- 18, Temp- 98.3, 96% O2 sat. Elder was monitored closely with NO adverse signs or symptoms from elevated pulse. Elder''s heart rhythm was normal no arrhythmias noted. Vital signs were subsequently taken and pulse varied between 123 and 142. MD was notified and no orders given at this time other than to monitor Elder closely. At approximately 2pm, Nurse was in re-assessing Elder and Elder''s pulse was noted to be abnormal. Still rapid at 140 BPM but now rhythm is abnormal. 12 lead EKG was performed and results were interpreted as Atrial flutter. MD was notified and EKG strip was sent to MD. MD consulted with ER MD. MD ordered an additional dose of Metoprolol 50mg to be administered now, recheck pulse in 30 mins. Pulse was 144 and irregular at recheck at approximately 1730.


VAERS ID: 1697163 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: No adverse event
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Visual Assessment, monitored for 15 mins with no adverse effect.
CDC Split Type:

Write-up: Client was monitored and there were no sign nor symptoms


VAERS ID: 1697172 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. - / 2 LA / SYR
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 AR / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Back pain, Chills, Diarrhoea, Gait inability, Headache, Hyperhidrosis, Injected limb mobility decreased, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), 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:
Other Medications: Duloxetin 20 mg daily
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 9 pm day of second shot weak and diarrhea Late evening early morning of shot body aches, headaches, unable to walk or move left arm from pain, back pain and hip pain unbearable fever chills sweating through multiple shirts in a hour


VAERS ID: 1697185 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Confusional state, Dyspnoea, Nausea, Palpitations, Pharyngeal swelling, Thirst
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Client became nauseous,felt like throat was swelling,dyspneic,palpitatipns,thirsty,confused as to location. Oxygen started at 4liters, epinephrine 0.3mg given right lateral thigh at 1139. Placed on mat in supine position with legs elevated. BP 166/95,HR 112,R22 at 1138. Client was able to speak without difficulty,reports feeling as if is running,leg tremors noted. Pulse ox range from 95 to99%. 911 called at 1136,arrived at 1150. Client reported feeling A little better at 1145, VS 140/82,p 111,resp18 at this time. 1147 ambulance here,started saline lock at 1150,Benadryl 50 mg given IVP by EMT. Client placed on g,urney and taken to hospital ER.


VAERS ID: 1697218 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-03
Onset:2021-09-13
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bone pain, Oropharyngeal pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Osteonecrosis (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: Synthoid 81 aspirin, zinc, vitamin C, multi vitamin, calicum, magnesium with vit D, Omega oil
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: 0
CDC Split Type:

Write-up: Achy bones, sore throat, fever 2nd day adverse effects started


VAERS ID: 1697221 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Ear pain, Heart rate increased, Lethargy, Pain, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Fever, body aches, ear pain, shakes, lethargic, weak, high heart rate


VAERS ID: 1697395 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Hyperhidrosis, Pain, Pallor, Pyrexia, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 0
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fainted and lost all of my color within 5 mins of receiving shot. Was drenched in sweat and browned out for a solid period of time. EMS had to come and my fianc? had to come pick me up. I now have a 102.1 fever and have been shaking and sweating or having the chills throughout today. My whole body aches. This could not have come at a worse time with work.


VAERS ID: 1697404 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products, Wrong product administered
SMQs:, Medication errors (narrow)

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

Write-up: Patient was at the pharmacy to receive a Flucelvax. Patient was given a Moderna in error. Patient received PFIZER on 9/9/2021


VAERS ID: 1697575 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Hypotension, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none illness
Preexisting Conditions: does not have
Allergies: does not have any allergy to medication or food substance
Diagnostic Lab Data: Blood pressure was taken 94/58 pulse 91 and then 115/69 pulse 97
CDC Split Type:

Write-up: Patient had hypotension resulting in 94/ 58mmGh, pulse 91, nausea and headache. After 8 minutes he obtained a pressure of 115/69 pulse 97 and severe headache


VAERS ID: 1697578 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Fatigue, Feeling abnormal, Headache, Musculoskeletal pain, Musculoskeletal stiffness, Neck pain, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), 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: Vit D, Vit C
Current Illness: none
Preexisting Conditions:
Allergies: Sunflower seeds
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: The afternoon of the shot I got a sharp pain in shoulder blade on left side - also sharp pain on left side of chest - neck pain - headache. No treatment so far except ibuprofen in the afternoon of the 13th and today, the 14th. Sharp shoulder and chest pain lasted for about 30 mins. Still sore in shoulder blade. Neck pain has been the entire time since it started. Headache has been the entire time with occasional sharp pain in the back of my head. Achy and stiff since the afternoon of the 13th. Completely exhausted. Brain fog today, the 14th.


VAERS ID: 1697583 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Injection site pain, Nausea
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid 88mcg
Current Illness: Head cold 3 weeks prior to vaccine
Preexisting Conditions: Hypothyroid
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain (feels like aches you typically have with the flu but just in the center of my chest). Started the afternoon of the vaccine and still occurring occasionally Nausea lasted a few hour after vaccine Arm soreness at injection site, lasted one day


VAERS ID: 1697585 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: a daily multi-vitamin
Current Illness: none
Preexisting Conditions: none
Allergies: An Cef or Ceflosporin
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Within 5 minutes of the vaccination, I became slightly light-headed. I never experienced significant dizziness nor vertigo. The dizziness disappeared about 3 hours later.


VAERS ID: 1697755 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Diarrhoea, Headache, Injection site pain, Nausea, Pain, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Nausea & diarrhea Fever of 102+ for 18 hours Fever of 100 for remainder Headache Aches & chills Pain around injection site including arm soreness Symptoms have been ongoing since approximately 2-3 hours post vaccine Symptoms are not controllable with Advil, Tylenol, or Motrin


VAERS ID: 1697940 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Arthralgia, Back pain, Cardiac flutter, Discomfort, Fatigue, Mobility decreased, Muscle contracture, Muscle strain, Musculoskeletal stiffness, Neck pain, Nodule, Pain in extremity
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tachyarrhythmia terms, nonspecific (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: Humira, Emgality, levothyroxin, corlanor, lamictil, folic acid, Adderall, xywave, Neurtec as needed, probiotic, minerals, multi vitamin, Zyrtec, antibiotic, Vitamin D 50,000 units 2x week, nascobal vitamin B12 nasal spray
Current Illness: Stye
Preexisting Conditions: Crohn?s Disease, tachycardia, hypothyroidism, vitamin D deficiency, narcolepsy, Chronic Migraines
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Right arm, right side of neck and upper right back are all very stiff and very sore. I couldn?t lift my arm above my head . If I tried the pain was simply unbearable. My neck keeps pulling to the right. My back shoulder on my right side has knots in it. My heart rate is fluttering. My wrist, fingers and elbow have sharp pains. I am extremely tired and feel like all I want to do is sleep. When I woke up this morning my right arm was not functioning. It felt like a heavy weight I had to carry. I couldn?t turn my head left or right because of the muscle contracting in my neck. My hand and are are in severe pain. Last night my Stomach cramped up and I was in extreme pain. I could feel a hard strained muscle in my lower right abdomen. The muscle was so contracted under my skin that you could see the knot protruding from my stomach.. I am concerned about getting a second vaccine I cant?t go through this voluntarily after the extreme pain I have endorsed


VAERS ID: 1697957 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-13
Onset:2021-09-13
   Days after vaccination:123
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Blood creatine phosphokinase normal, Blood test normal, Brain natriuretic peptide normal, Condition aggravated, Disability, Dizziness, Fibromyalgia, Full blood count normal, Immediate post-injection reaction, Metabolic function test normal, Nausea, Pain, Pruritus, Troponin normal
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Cyclobenzaprine 10 TID Pristiq 100 mg Benadryl 25 mg 4-6 pills per day - has caused heart burn Yasmin Elmiron 100 TID Allegra 180 mg daily Gabapentin 900 mg daily Hydroxychloroquine 200-- $g300 mg recently Xopenex - fine Magnesium Melatonin
Current Illness: Lupus, fibromyalgia, PTSD, GERD, ADHD, asthma, migraine, depression, eating disorder
Preexisting Conditions: Lupus, fibromyalgia, PTSD, GERD, ADHD, asthma, migraine, depression, eating disorder
Allergies: Penicillin
Diagnostic Lab Data: CBC, CMP, BNP, CK, troponin unremarkable.
CDC Split Type:

Write-up: Pruritis, dizziness, nausea, worsening chronic pain, worsening anxiety that developed immediately after receiving 2nd dose of COVID19 pfizer vaccination. Was seen in ER with unremarkable blood work. Has since had worsening flare of her fibromyalgia and chronic pain which has resulted in significant disability. Diffuse pruritis has improved.


VAERS ID: 1698517 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cardiovascular evaluation, Chest pain, Dizziness, Hypoaesthesia, Influenza like illness
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertension, hyperlipidemia
Allergies:
Diagnostic Lab Data: CARDIAC WORK UP IN THE EMERGENCY ROOM, NO IDENTIFIED HEART ATTACK OR ARRYTHMIA ON INITIAL ENCOUNTER IN THE EMERGENCY ROOM.
CDC Split Type:

Write-up: FLU LIKE SYMPTOMS FOR A DAY, THEN DEVELOPED CHEST PAIN, DIZZINESS, LEFT ARM AND HEAD NUMBNESS


VAERS ID: 1699565 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-11
Onset:2021-09-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary mass, Axillary pain, Pain, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Overweight
Allergies: Contrast dye
Diagnostic Lab Data: In my way to the hospital today
CDC Split Type:

Write-up: Large, painful lump in left armpit after shot. It''s not going down, just getting larger...pain radiating down my arm also.


VAERS ID: 1699874 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-26
Onset:2021-09-13
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, COVID-19, Chest X-ray abnormal, Condition aggravated, Lung infiltration, Pneumonia, SARS-CoV-2 test positive, Staphylococcal infection, Staphylococcus test positive
SMQs:, Interstitial lung disease (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin EC (ECOTRIN) 325 MG tablet atorvastatin (LIPITOR) 20 MG tablet Empagliflozin (JARDIANCE) 10 MG TABS Heparin & NaCl Lock Flush 100-0.9 UNIT/ML-% KIT HYDROcodone-acetaminophen (NORCO) 10-325 MG tablet insulin glargine (LANTUS) 100 UNI
Current Illness:
Preexisting Conditions: HTN (hypertension) Abnormality of gait Diabetic neuropathy (HCC) Peroneal neuropathy COPD (chronic obstructive pulmonary disease) (HCC) Chronic low back pain Depression, unspecified depression type Tubular adenoma of colon Cataract Tobacco dependence Diabetic retinopathy of both eyes (HCC) Insulin dependent type 2 diabetes mellitus, uncontrolled (HCC) Hypoxemia Chronic pain of right knee
Allergies: Lovastatin
Diagnostic Lab Data: COVID-19 test negative on 9/2/2021 and COVID-19 test positive on 9/13/2021.
CDC Split Type:

Write-up: Patient presented to emergency department on 9/2/2021 with right knee pain. He was tested for COVID-19 at admission and test was negative. During workup he was found to have infiltrates on chest xray suspicious of pneumonia and nasal swab came back positive for MSSA. Patient was found to be COVID-19 positive during screening for potential facility placement at discharge. He was not treated for COVID-19 infection during admission. He was discharged home on 9/13/2021.


VAERS ID: 1699879 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-13
Onset:2021-09-13
   Days after vaccination:243
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amantadine, anafranil, aspirin, levetiracetam, norco,olanzapine, pepcid, propranolol,tamsulosin
Current Illness:
Preexisting Conditions: HTN, BPH, Parkinsons, seizures, dementia, GERD
Allergies: n/a
Diagnostic Lab Data: COVID test= Detected
CDC Split Type:

Write-up: cough, congestion, slightly SOB, resides in nursing home


VAERS ID: 1700052 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Paraesthesia, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: no known. medical cannabis noted by pt.
Current Illness: none noted
Preexisting Conditions: anxiety
Allergies: none noted
Diagnostic Lab Data: none noted by pharmacy
CDC Split Type:

Write-up: Pt received second Pfizer vaccine in a timely manner. Pt was anxious and verbalized anxiety prior to vaccine. 5 minutes after vaccine administration, pt reported lightheadedness and tingling. Patient was monitored as she passed out and subsequently had convulsions for 10-15 seconds. Patient came to and slowly regained constitution. 911 was called and paramedics evaluated the patient. Patient refused to go to hospital but was evaluated by EMTs.


VAERS ID: 1700094 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-11
Onset:2021-09-13
   Days after vaccination:186
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram normal, COVID-19, Chest pain, Computerised tomogram head normal, Confusional state, Coordination abnormal, Dyspnoea, Headache, Hemiparesis, Infusion, SARS-CoV-2 test positive, Thrombolysis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient is a 73 year old female past medical history of hyperlipidemia, GERD, anxiety and tested positive for COVID 19 on 08/10/2021. She was brought to the emergency department earlier today by her husband for evaluation of chest pain, shortness of breath, headache and left-sided weakness that started approximately 1 hour prior to arrival. Initial CT head negative for any acute intracranial abnormality or evidence of large vessel occlusion. CTA was obtained to rule out aortic dissection in setting of chest pain and shortness of breath, result negative. Stroke alert was activated she was evaluated by tele neurologist who recommended IV alteplase. Tested positive on 9/13/2021. Patient is a 73 year old female past medical history of hyperlipidemia, GERD, anxiety and tested positive for COVID 19 on 08/10/2021. She was brought to the emergency department earlier today by her husband for evaluation of chest pain, shortness of breath, headache and left-sided weakness that started approximately 1 hour prior to arrival. Initial CT head negative for any acute intracranial abnormality or evidence of large vessel occlusion. CTA was obtained to rule out aortic dissection in setting of chest pain and shortness of breath, result negative. Stroke alert was activated she was evaluated by tele neurologist who recommended IV alteplase. IV tPA bolus given at 12:45 and infusion complete at 13:55. After IV tPA infusion patient developed worsening headache symptoms. CTA head/neck and perfusion studies were subsequently obtained, negative for any acute occlusion or hemorrhage. CCM was consulted to evaluate patient for ICU admission for close neurological checks post thrombolytic therapy. I personally evaluated patient in ED room. She is awake, alert, oriented to person and place, in no apparent respiratory distress. Hemodynamically stable. IV tPA infusion complete. She is complaining of headache 6/10, confusion and states she feels uncoordinated. Reports that her weakness has improved. Denies any visual disturbances or paraesthesias.


VAERS ID: 1700112 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Abdominal pain upper, Dizziness, Fatigue, Headache, Hypoaesthesia, Insomnia, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

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

Write-up: Pain in left arm, swollen underneath arm, unable to sleep due to pain, head aches, tiredness, left arm feels limp, dizziness and stomach pains


VAERS ID: 1700171 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-18
Onset:2021-09-13
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Outpatient Medications acetaminophen (TYLENOL 8 HOUR ARTHRITIS PAIN) 650 MG tablet acetaminophen (TYLENOL) 650 MG suppository aluminum, magnesium & simethicone (MAALOX EX) 400-400-40 MG/5ML bisacodyl (DULCOLAX) 10 MG suppository bismuth sub
Current Illness: NA
Preexisting Conditions: Undiagnosed cardiac murmurs Palpitations Retinal artery branch occlusion of right eye Bilateral carotid artery disease Atrial tachycardia COVID-19
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized; COVID-19 positive (9.13.21); fully vaccinated Admission Date: 9/13/2021 Discharge Date: 9/14/21 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: COVID-19 HOSPITAL COURSE: 84 year old female who was sent to ED for COVID testing after known exposure at facility. Patient was asymptomatic but tested positive for COVID 19. Due to COVID status facility unable to accommodate patients return so patient was admitted to observation while safe discharge plan was arranged. Patient had a caregiver from the facility who volunteered to take patient to her home and provide care until patient able to return to her AL facility. She confirmed awareness of patients care needs and was able to obtain patients prescriptions from AL facility. Plan was confirmed with patients guardian who was in agreement. CONSULTS / RECOMMENDATION: none INPATIENT PROCEDURES: none Discharge disposition: home or self care


VAERS ID: 1700190 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Ammonia normal, Aspartate aminotransferase increased, Blood potassium decreased, COVID-19 pneumonia, Chest X-ray abnormal, Confusional state, Extra dose administered, Pyrexia, SARS-CoV-2 test negative, Sluggishness, Transient global amnesia
SMQs:, Liver related investigations, signs and symptoms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: This 72-year-old female with acute onset of confusion onset yesterday morning. Upon exam this morning patient was awake alert oriented x4 however was sluggish in her responses. Patient did arrive with a fever 100.5 Fahrenheit. Patient had a Covid test upon arrival which was negative. Patient had third Covid shot on Monday, 9/13/2021. However chest x-ray revealed suspicious for Covid pneumonia. We will recheck Covid status this morning. MRI of the head with and without contrast has been ordered. Metabolically patient has a potassium of 3.3, and slight elevation of AST, ALT with known hepatitis C. Patient''s ammonia level is unremarkable. Therefore neurology impression at this time is transient global amnesia versus other side effect to the third Moderna vaccine or active COVID-19. Patient''s exam did not support TIA.


VAERS ID: 1700215 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-07
Onset:2021-09-13
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FP7533 / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, COVID-19, Condition aggravated, Decreased appetite, Hypoxia, Lethargy, Mental status changes, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Parkinson''s desease, atrial fibrillation, COPD, GERD, hiatal hernia CAD with aortic valve replacement, DM, OSA
Allergies: NKA
Diagnostic Lab Data: SARS CoV 2 PCR COVID19 detected on 9/13/21
CDC Split Type:

Write-up: He completed COVID vaccines in April 2021. He has a history of COVID positive in Feb, 2021. He came to the emergency department at Hospital due to several days of altered mental status, poor appetite, and weakness, and he was admitted for worsening lethargy and hypoxia on 9/13/21.


VAERS ID: 1700222 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-07
Onset:2021-09-13
   Days after vaccination:129
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 LA / IM

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

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

Write-up: Patient vaccinated for and then tested positive for COVID-19.


VAERS ID: 1700223 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-25
Onset:2021-09-13
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Pt tested positive after full covid vaccination


VAERS ID: 1700275 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear swelling, Pyrexia, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan/Potassium HCT tab 100-25 x1 Metoprolol tab tar 100mg x 2 Glipizide ER 2.5 mg TB24 x 1 Metformin HCL 500mg x 2 Rosuvastatin 5mg x 1 Vitamin D 2000IU x1 every day
Current Illness:
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: AT night on 9/13/21 I experienced fever and some hives on my right temple. I took 400 mg of ibuprofen. The next night 9/14/21 I experienced fever again, took 400mg ibuprofen and this time my whole right side of my face and two ears were swollen.


VAERS ID: 1700289 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-10
Onset:2021-09-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysmenorrhoea, Heavy menstrual bleeding, Impaired work ability, Polymenorrhoea
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: Vitamin C, Vitamin D, Zinc, Glutathione, Quercetin, Multi-Vitamin
Current Illness: None known
Preexisting Conditions: None known
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Period: Heavy bleeding, debilitating cramps, 10 days early, had to stay home from work. Normally: regular intervals in between cycles, light to moderate to light bleeding with little to no cramping. I''ve never stayed home from work for a period.


VAERS ID: 1700320 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-08
Onset:2021-09-13
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / UNK LA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Drainage, Pruritus, Rash, Wound
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Accidents and injuries (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: labetalol HZT prozac
Current Illness: NONE
Preexisting Conditions: high blood pressure, controlled through medication
Allergies: NONE
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Two blisters that itched and drained. One on each forearm, rash on abdomen, open sore in right nostril, open sore on L & R bottom lip, open sore on vulva. Mucous membranes seem to be affected. Patient has not had of these conditions previously, prior to receiving the COVID 19 vaccine.


VAERS ID: 1700330 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Axillary pain, Chills, Dyspnoea, Fatigue, Hyperhidrosis, Injected limb mobility decreased, Oedema peripheral, Pain, Pain in extremity, Sleep disorder
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin that morning. I take it daily for managing my allergies.
Current Illness: none
Preexisting Conditions: none
Allergies: morphine, seasonal
Diagnostic Lab Data: none
CDC Split Type:

Write-up: At 7:00 pm on 9/13 I began to have body aches. I took ibuprofen and went to bed. I woke up at midnight with severe chills and body aches. I took my temperature it was 100.2. I took 1,500 mg of Tylenol. The chill and aches kept waking me up. I got severely drenched in sweat about 4:00 am. I woke up and had extreme soreness on my left arm. I could hardly raise it. My armpit was also tender. I looked in the mirror and noticed a bulge in my arm pit. My armpit is still tender today (9/15). 9/14 I took Tylenol 1,500mg every 4-6 hrs. I had chills and body aches intermittently through out the day. In the morning I had sweats and shortness of breath just doing daily tasks around the house. The night of 9/14 I felt extremely fatigued and went to bed at 8:30 pm. Today 9/15 I feel back to my usual self.


VAERS ID: 1700358 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK AR / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: The adverse event was that an expired Janssen COVID-19 Vaccine has been administered to the patient. There were no adverse event, symptoms or any health related issues regarding the patient after the vaccine dose was given. Only that the vaccine has been given after the expiration date, nothing else.


VAERS ID: 1700370 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: The adverse event was that an expired Janssen COVID-19 Vaccine has been administered to the patient. There were no adverse event, symptoms or any health related issues regarding the patient after the vaccine dose was given. Only that the vaccine has been given after the expiration date, nothing else.


VAERS ID: 1700404 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-10
Onset:2021-09-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Impaired driving ability, Impaired work ability, Lymphadenitis, Lymphadenopathy, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma Hypertension
Allergies: IB Profin
Diagnostic Lab Data: 09/13/2021
CDC Split Type:

Write-up: Lymphadenitis - swollen lymph nodes under arm area of right arm, shoulder & lower arm off work 3 days prescribed hydrocodone unable to drive for 24 - 48 hrs


VAERS ID: 1700450 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Diarrhoea, Ear pain, Feeling abnormal, Feeling cold, Headache, Hyperhidrosis, Injection site pain, Lymphadenopathy, Oropharyngeal pain
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), 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:
Other Medications: None
Current Illness: Factor 5 liden
Preexisting Conditions: none
Allergies: Pnecillians any thing related
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Headache, sore throat, ear ache, diarrhea, lymphnodes swollon under arm, arm hurts at shot site, cold, brain fog, chest pain, and sweating.


VAERS ID: 1700481 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 3 LA / IM

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

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

Write-up: Pt got a Moderna shot instead of flu shot in error. Pt has already received 2 doses of Moderna on 3/19/21 & 4/14/2021.


VAERS ID: 1700512 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-09
Onset:2021-09-13
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / N/A - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data: Positive PCR COVID test on 9/14/21
CDC Split Type:

Write-up: COVID breakthrough case. The patient presented to the hospital on 9/14/21 claiming she had tested positive for COVID on 9/13/21. She is experiencing cough, migraine, SOB, and hypoxia. Patient placed on 3L of oxygen.


VAERS ID: 1700562 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-10
Onset:2021-09-13
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 003C21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Multiple myeloma, chronic back pain
Allergies: NKA
Diagnostic Lab Data: SARS CoV 2 PCR COVID19 detected on 9/13/21
CDC Split Type:

Write-up: He was admitted to the hospital due to one week of cough, SOB and diarrhea on 9/13/21. He stated he was recently exposed to his sister who is now hospitalized with COVID. On hospital day 3, his O2 sat is 98% on room air, and he is not febrile.


VAERS ID: 1700589 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-10
Onset:2021-09-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

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

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

Write-up: Red rash extending down from the injection site. First appeared 3 days after the injection. Still present at 5 days. Looks similar to images of covid arm.


VAERS ID: 1700593 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Chills, Hyperhidrosis, Oropharyngeal pain, Pain, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: Tylenok
Current Illness: Fybroids
Preexisting Conditions: Fybroids
Allergies: Seasonal allergies only
Diagnostic Lab Data: I only took tylenol and slept most of 9/14
CDC Split Type:

Write-up: Fever started 9/13 around 6pm, temp 100, sweats, my uniform was soaked in sweat from 7pm to the time I arrived home at 8:30pm, chills, body ache, had to bundle up to be able to sleep, temp went up to 102.2 on 9/14 around 10:30 am, fever broke by 4pm completely. Only took tylenol as advised by nurse administering vaccine, sore throat. 9/15 I woke up with hives on both my legs, body ache, chills and sore throat.


VAERS ID: 1700621 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 939908 / 2 RA / IM

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

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

Write-up: Patient received Pfizer vaccine for their 2nd COVID-19 vaccine dose. The initial vaccine was Moderna.


VAERS ID: 1700681 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Erythema, Fatigue, Headache, Impaired work ability, Lymphadenopathy, Pain, Pain in extremity, Peripheral swelling, Pyrexia, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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 50mg, Amlodipine besylate 10mg, Atorvastatin 20mg, Bupropion 200mg, Claritan 10mg
Current Illness: none
Preexisting Conditions: high blood pressure, cholesterol, depression, anxiety
Allergies: Lisinopril
Diagnostic Lab Data:
CDC Split Type:

Write-up: 12hrs after shot: Headache (10 of 10), Fever (HIGHEST 102.8) body ache, chills, weakness, tiredness, swollen lymph node in left axillary area took Tylenol 500mg x2 every 6 hrs up to today. Unable to go to work for next 2 days, only went to work on 3d day (with fever99.9, headache, weak) could not afford to pay out of pocket for dr visit. Left arm still very red, warm to touch, SWOLLEN, PAINFUL on day #3. Was positive for Covid with pneumonia 4 Mar 2021 with very bad symptoms lasting 10 days.


VAERS ID: 1700686 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-01
Onset:2021-09-13
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Brain natriuretic peptide increased, Catheterisation cardiac normal, Chest pain, Computerised tomogram thorax, Electrocardiogram ST segment elevation, Extra dose administered, Hypotension, Myocarditis, Pericarditis, Pleuritic pain, Troponin increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Simvastatin 40mg Vit B12 Also got flu shot at the same time.
Current Illness: none but got the
Preexisting Conditions: hx of Cataracts Hyperlipemia
Allergies: none
Diagnostic Lab Data: CT for PE Angiogram Planned for Echo and likely cardiac MRI but he left AMA. Will try to get pt evaluate for outpt follow up.
CDC Split Type:

Write-up: This was the patients third dose given at the time of his flu shot. Pt woke up on 9/13 with CP rated at 7/10. Pain was pleuritic but also found to have inf ST elevation on EKG. Ruled out for PE and given EKG and elevated troponin he was taken to the cath lab. No CAD. Trop contiued to rise overnight and he became hypotensive down t to the 70sys range. This responded to fluids and the next day he was feeling better. BNP was elevated to $g 7,000 and trop HS peaked at 809 ng/L(443 to 809 to 601) The pt was treated for pericarditis and the next day he improved. Before waiting for a formal echo or MRI he left the hospital AMA. Suspected pericarditis/ Myocarditis picture


VAERS ID: 1700699 (history)  
Form: Version 2.0  
Age: 99.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-09
Onset:2021-09-13
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood glucose, Brain natriuretic peptide, C-reactive protein abnormal, Chest pain, Culture urine, Dehydration, Differential white blood cell count, Dizziness, Full blood count, Lipase, Metabolic function test, Nausea, Troponin I, Urine analysis
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Lab Tests Completed BRAIN NATRIURETIC PEPTIDE C-REACTIVE PROTEIN (INFLAMMATION) COMPREHENSIVE METABOLIC PANEL GLUCOSE BY METER, POCT LAB ONLY-COMPLETE BLOOD COUNT WITH DIFFERENTIAL LIPASE TROPONIN I performed 2 times URINE DIP, REFLEX TO MICROSCOPIC, REFLEX TO CULTURE Icon Imaging Orders Placed Today Imaging Tests EKG XRAY CHEST PORTABLE -
CDC Split Type:

Write-up: Chest Pain Dizziness Nausea Weakness dehydration


VAERS ID: 1700708 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-11
Onset:2021-09-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Exercise tolerance decreased, Headache, Impaired work ability, Influenza like illness
SMQs:, Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benicar 40 mg. / day HCTZ 15 MG / DAY
Current Illness: NONE
Preexisting Conditions: High blood pressure.
Allergies: NONE
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Flu like symptoms. General weakness. Headache. Low exercise tolerance. Not able to work. Symptoms lessening after 4th day.


VAERS ID: 1700721 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Injection site pain, Pain, Pyrexia, Rash
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: rash-all over, shortness of breath, fever 103, body aches, severe injection site soreness


VAERS ID: 1700733 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-07
Onset:2021-09-13
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood magnesium, Chest X-ray, Chest pain, Electrocardiogram, Electrocardiogram ambulatory, Fibrin D dimer, Full blood count, Metabolic function test, Troponin
SMQs:, 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: cefzil
Diagnostic Lab Data: EKG, chest xray, CBC, Metabolic panel, Magnesium level, Troponin, D-Dimer qt all done 9/14/21
CDC Split Type:

Write-up: chest pain during physical activity. cardiac workup. Currently wearing Holter Monitor until 9/16.


VAERS ID: 1700771 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none
Preexisting Conditions: none reported
Allergies: none reported
Diagnostic Lab Data: none, patient observed for hour after second vaccine
CDC Split Type:

Write-up: patient received vaccine #2 only 10 days after receiving first dose


VAERS ID: 1700778 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Public       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: unknown
Current Illness: none
Preexisting Conditions: none reported
Allergies: none mentioned
Diagnostic Lab Data: none
CDC Split Type:

Write-up: given 2nd dose of Pfizer only 10 days after receiving second dose. No signs and symptoms of any adverse reaction, patient was observed for 1 hour after vaccine given.


VAERS ID: 1700811 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 20BA21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: None
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Loud ringing in ears starting about 3 hours after the injection and so far it has not subsided.


VAERS ID: 1700849 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-07
Onset:2021-09-13
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / -

Administered by: Private       Purchased by: ?
Symptoms: Injection site reaction
SMQs:

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

Write-up: localized site reaction


VAERS ID: 1700866 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Impaired work ability, Nausea, Oropharyngeal discomfort, Pharyngeal swelling, Swelling face
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: multi-vitamis
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: around 3:30 -4pm I started to feel dizzy and weak , swelling my face and throat it felt like needles inside my throat also felt nauseated but did not vomit . I took Motrin 20 0mg and went to sleep for couple of hours . 2nd day took another Motrim did not got to work and rested the whole day drinking enough liquids . 3rd day I steel feel dizzy but it is on and off not constant as before the swelling of my face and throat are gone .


VAERS ID: 1700906 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flu vaccine results on hospitalization 2006
Other Medications: Buspar
Current Illness: Asthma and anxiety
Preexisting Conditions: Asthma
Allergies: Oxycodone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unconscious, nausea, vomiting


VAERS ID: 1700910 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omega 3 fish oil
Current Illness: hyperlipidemia
Preexisting Conditions: overweight
Allergies: NKMA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Child was placed on vaccine schedule and team was rushed, vaccine was administered per LPN. Child has been checked on daily and has not experienced adverse symptoms, and parent (mom) has been made aware of incident.


VAERS ID: 1701514 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: according to var filled out by patient, NO allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: 17 y/o patient was administered vaccine (without parental consent) vaccinator verified name, dob , and id but did not realize patient was under 18 because they looked significantly older. pt mom stated to rph that pt began getting hives while pt was sleeping on monday night, pt took benadryl but hives continue to worsen on tues, at which point the patient went to the hospital (ed) and patient was places on steroids. weds pt mom called the pharmacy to let us know pt was vaccinated without parental consent.


VAERS ID: 1701714 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-03
Onset:2021-09-13
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Heart rate increased, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), 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: Lisinopril 40mg; Atenolol 50mg; Sertraline 50mg
Current Illness: High blood pressure; tachycardia; depression
Preexisting Conditions: High blood pressure; tachycardia; depression
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Very high blood pressure. Very high heart rate. Treated with aforementioned medications, and increased BP and HR.


VAERS ID: 1701734 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Malaise, Myalgia, Pain in extremity, Pruritus, Pyrexia, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (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: Dpt, approximate age 45
Other Medications: CoQ10 200mg, calcium 167mg, magnesium 321mg, allergic (cetirizine HCl 10 mg
Current Illness: None
Preexisting Conditions: Lumbar back arthritis, spinal stenosis
Allergies: Latex
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Initial sore arm with increasing pain, itiching and swelling. Fever 100 with ibuprofen for 3days, chills, muscle pain, general feeling of malaise


VAERS ID: 1701887 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-12
Onset:2021-09-13
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC1830 / 1 RA / IM

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

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: none
CDC Split Type:

Write-up: Patient describes her heart is pounding, chest pain, and shortness of breath. Advised patient to get it check out with her Doctor. Patient said that she will go to clinic.


VAERS ID: 1701897 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-03
Onset:2021-09-13
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: B12 injections prescription folate Vitamine D
Current Illness:
Preexisting Conditions: Folate deficiency
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 10 days after my first dose of Moderna a large red patch developed. No itch but slightly sensitive.


VAERS ID: 1703681 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Headache, Injection site induration, Injection site pain, Nausea, Subdural haematoma
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Accidents and injuries (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: TDap shot-33 yo-(2019)Fever, chills, bodyache, headache
Other Medications: None
Current Illness: None
Preexisting Conditions: Rheumatism, Chronic nasal allergies, migraines, allergy-inducted asthma
Allergies: Allergic reaction to imaging iodine contrast, year round nasal allergies.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Dizziness & nausea (lasting 1day), pounding headaches(going on day 4), hardening of the injection site, soreness of the injection site, subdermal bruising (dark red/blue) about the size of a dime


VAERS ID: 1703879 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-13
Onset:2021-09-13
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Blepharospasm, Headache, Muscle spasms, Peripheral swelling, Pruritus, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), 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: Vitamin d3, C, Zinc, multi vitamin
Current Illness:
Preexisting Conditions:
Allergies: Cashews
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, swollen arm for 3 days size of a golf ball, itching, eye twitch on going at this time, anxiety Muscle cramps, 99 temp on and off., and small bumps on arm. Took two Tylenol. Anxiety still ongoing. Never had this with vaccine before. Will not get second shot. Have not visited doctor yet. If eye continues to twitch will go to optometrist or neurologist.


VAERS ID: 1703886 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

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

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

Write-up: The patient consented to Jansen COVID-19 vaccination. Patient did not experience any adverse reactions from the Pfizer vaccine. Patient was informed of the benefits and risks of both the pfizer and Jansen vaccination. Patient was informed of the efficacy of pfizer and Jansen and the drug authority warning associated with Jansen from ages 18-49. Patient was informed that a 2nd dose of pfizer is needed to complete the entire vaccination series. Patient agreed with receiving the 2nd dose of the Covid-19 vaccine.


VAERS ID: 1703902 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Injection site bruising, Injection site induration, Injection site pain, Musculoskeletal stiffness, Palpitations, Ventricular extrasystoles
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Arthritis (broad), Hypokalaemia (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: ELINEST
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: MILD SENSITIVITY TO OXYCODONE
Diagnostic Lab Data: NO FORMAL MEDICAL TESTS BUT KNOWLEDGE OF MEDICAL CONDITIONS AND SYMPTOMS FROM EXPERIENCE AS A PARAMEDIC.
CDC Split Type:

Write-up: HEART PALPITATIONS, FREQUENT PVCs - USUALLY COMES IN WAVES OF 4-8 PER MINUTE THAT LASTS FOR AN HOUR OR MORE THEN DECREASES TO 0-2 PER MINUTE AND REPEATS - NO NOTICABLE PATTERN OTHERWISE, MILD BACK ACHE LESSENING EACH PASSING DAY, PAIN, CONTUSION, AND MUSCLE HARDNESS AT INJECTION SITE - NO IMPROVING MUCH OVER FIRST THREE DAYS, STIFF MUSCLES - PARTICULARLY IN LEGS AND FEET


VAERS ID: 1703907 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

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

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

Write-up: The patient consented to Jansen COVID-19 vaccination. Patient was given Pfizer 1st dose in error by the nurse. Patient did not experience any adverse reactions from the Pfizer vaccine. Patient was informed of the benefits and risks of both the pfizer and Jansen vaccination. Patient was informed of the efficacy of pfizer and Jansen and the warning associated with Jansen from ages 18-49. Patient was informed that a 2nd dose of pfizer is needed to complete the entire vaccination series. Patient agreed with receiving the 2nd dose of the Covid-19 vaccine. Patient was informed that she received the 1st dose of pfizer instead of Jansen.


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