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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 196 out of 8,010

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VAERS ID: 1709077 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 LA / IM

Administered by: School       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: None on file
Current Illness: None on file
Preexisting Conditions: None on file
Allergies: None on file
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Moderna was received from deep freezer on 8/6/21. Was placed in refrigerator on 8/6/21. 30 day expiration date was 9/5/21. Moderna was left in refrigerator and used until 9/13/21. On 9/14/21 we realized we were beyond the 30 days and immediately notified the Pharmacy for direction. The Pharmacists are in communication with Moderna to see if the doses are considered valid or invalid. Risk Management is involved to decide on the best course of action and if we notify the patient before we hear back from Moderna.


VAERS ID: 1709108 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 LA / IM

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

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

Write-up: Moderna was received from deep freezer on 8/6/21. Was placed in refrigerator on 8/6/21. 30 day expiration date was 9/5/21. Moderna was left in refrigerator and used until 9/13/21. On 9/14/21 we realized we were beyond the 30 days and immediately notified the Pharmacy for direction. The Pharmacists are in communication with Moderna to see if the doses are considered valid or invalid. Risk Management is involved to decide on the best course of action and if we notify the patient before we hear back from Moderna.


VAERS ID: 1709110 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-08
Onset:2021-09-13
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: This patient received the Moderna Covid Vaccine on 9/8/2021. The nurse had the Patient fill out the pre-screen on this vaccine prior and the pateint noted she did get the Vaccine Pfizer for COVID 5/20/2021. This information was not relayed to me ( the medical provider). Instead of holding the vaccine as recommended on the prescreen the nurse gave the vaccine and provider was not notifed. It was not aware of this information until the vaccine was input in the IIS on 9/13/2021. I was unable to check prior since I wass unable to gain access the IIS. I had reach out to the help desk during the time and finally had access on 9/13/2021, when I noted the problem. The nurse was counseled on the problem and informed of the purpose of the prescreen and to notify medical provider in the future.


VAERS ID: 1709111 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-30
Onset:2021-09-13
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 LA / IM

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

Write-up: 1. There were NO REPORTED ADVERSE EVENT. 2. Vaccine was administered at 7 days past the UPDATED EXPIRY of 08/23/21 though still within vaccine PACKAGE EXPIRY date of 08/31/21. 3. Only filing as a VACCINE ADMINISTRATION ERROR report


VAERS ID: 1709119 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-31
Onset:2021-09-13
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 1 LA / IM

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

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

Write-up: 1. There were NO REPORTED ADVERSE EVENT. 2. Vaccine was administered at 8 days past the UPDATED EXPIRY of 08/23/21 though still within vaccine PACKAGE EXPIRY date of 08/31/21. 3. Only filing as a VACCINE ADMINISTRATION ERROR report


VAERS ID: 1709190 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-11
Onset:2021-09-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Neck mass, Neck pain, Pruritus, Tenderness
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: My body itches, both arms, at the wrists,both nipples, abdomen. The left side of my neck hurts, and I feel a lump to the lower left side of my neck and it''s painful to touch


VAERS ID: 1709446 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-01
Onset:2021-09-13
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3187 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Joint swelling, Loss of personal independence in daily activities, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol, Aspirin, torsemide10mg
Current Illness: no
Preexisting Conditions: Blood pressure heart birth defect
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Woke upon 9/13 to swollen knee . Aches all over fever 100.2 normally 97.8 on the 14th Knee was worse . unable to do normal activity.


VAERS ID: 1709447 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pneumonia vaccine -local reaction with vomiting 2007
Other Medications: Anastrozole, Aspirin, Budesonide Inhalation, Fenofibrate, Levothroxine,Losartan, Metoprolol, Omega 3 Fatty acid, Vitamin C
Current Illness: None
Preexisting Conditions: Stent placement (2012), diabetic (diet controlled , breast cancer (x2 with lumpectomies), Obesity, asthma, hypertension (controlled)
Allergies: IVP dye, Pneumonia vaccine, statins
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Right arm became hot, red and itchy 6 hours after injection into Other arm. Bumps appeared a few hours later that same evening. I began taking Benedryl, applying lidocaine cream for the itching and cold compresses. The next day the arm appeared about the same and I contacted Dr. who prescribed Valacyclovir HCL 1 Gr. TID. I took 1 around 6pm on 9/14 and the second one on 9/15 about 7am. By noon that day the redness was subsiding and the intense itch was improved. On 9/16 she had me see her PA who could not confirm my suggestion of Shingles. She sent me home with some Triamcinolone Cream. As of today, the bumps remain but are fading and the itching is much less.


VAERS ID: 1709474 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Rectal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none.
Current Illness: chronic stomach discomfort (undiagnosed)
Preexisting Conditions: migraines with aura
Allergies: Augmentin, Papaya, Metrogel, Topiramate
Diagnostic Lab Data: pending.
CDC Split Type:

Write-up: Patient began having blooding diarrhea the morning after vaccination. Has history of hemorrhoids with mild bleeding about 2 years prior. Patient reports that this was occurring with bowel movements only. was occurring about 6-7 times per day and then gradually decreased. Still having rectal bleeding with bowel movements, painless.


VAERS ID: 1709682 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-07
Onset:2021-09-13
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Antiphospholipid syndrome, Computerised tomogram head, Computerised tomogram thorax, Echocardiogram, Endotracheal intubation, Pulmonary embolism, Right ventricular dysfunction, Syncope, Troponin I
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Pulmonary hypertension (narrow), Cardiomyopathy (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: - Metformin 1500mg once daily - norethindrone-ethinyl estradiol (ALAYCEN 1/35) 1-35 MG-MCG tablet once daily
Current Illness: Issues with contraception
Preexisting Conditions: Diabetes Mellitus Fibroids
Allergies: none
Diagnostic Lab Data: CTA Chest TTE Troponin I Antiphospholipid Syndrome CT Head
CDC Split Type:

Write-up: Syncopal episode found to be massive PE requiring intubation with associated right heart strain (estimated BOVA 4).


VAERS ID: 1709854 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear pruritus, Erythema, Face oedema, Papule, Pruritus
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: On the day following the vaccine, she developed itchiness of both ears which spread to her entire face. She also has facial edema, erythema with a few erythematous papules scattered over her cheeks.


VAERS ID: 1710065 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-01
Onset:2021-09-13
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Electrocardiogram abnormal, Pericarditis
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prevacid Solutab
Current Illness: NA
Preexisting Conditions: Epidermoloysis Bullosa Tourettes Syndrome
Allergies: NA
Diagnostic Lab Data: Echo and x-ray scheduled.
CDC Split Type:

Write-up: Chest tightness/pain. Abnormal EKG. Pericarditis.


VAERS ID: 1710070 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-03
Onset:2021-09-13
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023CZ1A / 1 RA / SC

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Injection site erythema, Injection site rash, Peripheral swelling, Pruritus, Skin warm
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: Vitamins, anxiety medication (nightly ambien, blood pressure medicine, and anxiety medication, medical marijuana
Current Illness: Cough
Preexisting Conditions: No
Allergies: Sulfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 10 days after - Developed bumps at injection site. Itchy, red, swollen, warm to touch. The itching went away but arm still swollen, red, warm. Today 9-17-21 noticed it grew much larger and has a red ring around it


VAERS ID: 1710201 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / IM

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

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

Write-up: after injection - injection site instantly started to raise , I notified pt of the site reaction and got immediately got a cold compress to apply to site while holding compress to site I had the patient self administer 50mg or diphenhydramine solution. after cold compress removed swelling and redness would come back. pt complained of heat at site with cold compress. I switched to frozen compress and after 10 minutes swelling did not come back as fast when frozen compress removed. pt decided to leave sent diphenhydramine and frozen pack with patient to use as needed and with instructions to seek medical care if needed. Patient returned on 9/17/21 a bruise at injection site was only remaining issue.


VAERS ID: 1710211 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Burning sensation, Confusional state, Erythema, Feeling hot, Formication, Hypoaesthesia, Intermenstrual bleeding, Limb mass, Muscle twitching, Pain in extremity, Paraesthesia, Peripheral coldness, Sensory disturbance, Skin indentation
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: As described by pt- Monday got the shot. In the first 5 mins I felt uncomfortable throbbing/pulsing in my vein (artery?) at the base of left clavicle. I said ''it''s not pain,'' but nurse said: "muscle pain is to be expected." Felt hot, w/same skin-crawl sensation on my head. Face was tingling, but that and vein subsided after about 10 mins. Tip of left thumb was "asleep" but back normal on Tuesday w/o peeling this time. Awoke Monday. night w/pain in my rt index knuckle, red lump, sore to the touch, w/a very strange indentation there. Fingertips all cold, but now ok. Leg twitching came back on Tuesday, still twitching. And felt confused all of Tuesday. Had a larger amount of spotting this time, only Tue and Wed. Mild leg pain, rt foot burning Wednesday, but ok now. Still with some muscle twitches.


VAERS ID: 1710790 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Alabama  
Vaccinated:0000-00-00
Onset:2021-09-13
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 antibody test, Therapy non-responder
SMQs:, Lack of efficacy/effect (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Diabetes; Non-smoker
Preexisting Conditions: Comments: The patient had no known allergies. The patient did not have any drug abuse or illicit drug use.
Allergies:
Diagnostic Lab Data: Test Date: 20210913; Test Name: SARS-CoV-2 IgG antibody test; Result Unstructured Data: IgG antibody 0.1 non-reactive; Comments: Interpretative information: CDC Split Type: USJNJFOC20210929231

Write-up: CONFIRMED IMMUNOLOGICAL VACCINE FAILURE; This spontaneous report received from a consumer concerned a 76 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included diabetes, non-alcohol user, and non-smoker. The patient had no known allergies. The patient did not have any drug abuse or illicit drug use. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 042A21A, expiry: 19-SEP-2021) dose was not reported, 1 total administered on 07-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 13-SEP-2021, the patient underwent COV 19 IGG AB test (SARS-COV-2 IGG antibody test) which showed IgG antibody 0.1 non-reactive and COV 19 IGM AB test (SARS-COV-2 IGM antibody test) which showed IgM antibody0.2 non-reactive (confirmed immunological vaccine failure was not reported). On 14-SEP-2021, the patient underwent COVID 19 AB test (COVID-19 antibody test) and result was not reported. The patient described tests as blood tests. The patient reported that, according to the doctor test results showed that he did not have antibodies against COVID-19. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of confirmed immunological vaccine failure was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0-20210929231-Covid-19 vaccine ad26.cov2.s-Confirmed immunological vaccine failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1712071 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / UNK LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101198177

Write-up: Sore arm; This is a spontaneous report from a contactable consumer, the patient. A 31-year-old non-pregnant female patient received BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: 301308A) via an unspecified route of administration in the left arm on 13Sep2021 at 12:30 (at the age of 31-years-old) as a single dose for COVID-19 immunisation. Medical history was not reported. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient did not receive any concomitant medications. On 13Sep2021, the patient experienced sore arm. The event sore arm did not result in doctor or other healthcare professional office or clinic visit and emergency room or department or urgent care. Therapeutic measures were not taken as a result of the sore arm. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the event sore arm was unknown at the time of report.


VAERS ID: 1712090 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-10
Onset:2021-09-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Rash pruritic, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Shellfish allergy (known allergies: shell fish)
Allergies:
Diagnostic Lab Data: Test Date: 20210908; Test Name: Nasal Swab; Test Result: Negative ; Test Date: 20210826; Test Name: Nasal Swab; Test Result: Negative
CDC Split Type: USPFIZER INC202101204796

Write-up: Itchy rash; This is a spontaneous report from a contactable consumer, the patient. A 58-year-old male patient received second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 10Sep2021 at 13:00 (at the age of 58-year-old) as a single dose for COVID-19 immunisation. Medical history included "high blood" and shellfish allergy. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient received unspecified concomitant medications from an unknown date for an unknown indication and unknown if ongoing. The patient previously received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 20Aug2021 at 16:00 (at the age of 58-year-old) as a single dose for COVID-19 immunisation. On 26Aug2021, the patient underwent nasal swab test and the result was negative. On 08Sep2021, the patient underwent nasal swab and the result was negative. On 13Sep2021, the patient experienced itchy rash. The adverse event did not result in doctor or other healthcare professional office or clinic visit and emergency room or department or urgent care. Since the vaccination, the patient had not been tested for COVID-19. Therapeutic measures were not taken as a result of the event. The clinical outcome of the event itchy rash was not recovered at the time of this report. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1712121 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-09-11
Onset:2021-09-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain
SMQs:, Retroperitoneal fibrosis (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: LORAZEPAM; BUPROPION
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101211137

Write-up: Back pain lower muscles then upper back pain pretty bad back pain; This is a spontaneous report from a contactable consumer, the patient. A 47-year-old non-pregnant female patient received BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 11Sep2021 at 15:30 (at the age of 47-years-old) as a single dose for COVID-19 immunisation. The patient had no medical history and no known allergies. Prior to vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccine within four weeks prior to the vaccination. Concomitant medications included lorazepam (MANUFACTURER UNKNOWN) 1mg and bupropion (MANUFACTURER UNKNOWN) 75mg; both for an unknown indication from an unknown date and unknown if ongoing. On 13Sep2021 at 16:00, the patient experienced back pain, lower muscles then upper back pain, reported as pretty bad back pain. The event did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Therapeutic measures were not taken as a result of the event. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the event back pain lower muscles then upper back pain pretty bad back pain was resolving at the time of this report. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1712707 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-01
Onset:2021-09-13
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Women''s One a Day OTC vitamins
Current Illness: Na
Preexisting Conditions: Depression, enlarged heart
Allergies: Sulfa
Diagnostic Lab Data: Na
CDC Split Type:

Write-up: Menstrual change. My period is always on time and lasts 3/4 days. Period has been spotty Monday and Tuesday but wasn''t supposed to start until Saturday which is highly unusual for me.


VAERS ID: 1713196 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-01
Onset:2021-09-13
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK LA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood pressure increased, Blood test normal, Chest X-ray normal, Computerised tomogram normal, Condition aggravated, Dizziness, Electrocardiogram normal, Fatigue, Headache, Magnetic resonance imaging normal, Rash, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), 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: Hydroxine, buspar, lyrica, concentyxx, singulair, melatonon, famotidine, junel, tylenol, metropolol
Current Illness: Gi care for stomach issues - anxiety mood issues around period
Preexisting Conditions: Tachycardia. Asthma,anxiety, fibromylagia, psioratic arthritis, pmdd, urinary incontinence, sinusitis, obesity, gerd, sleep apnea, insomnia
Allergies: Nsaids, iodine, reglan
Diagnostic Lab Data: 9/15 Cat scan Mri Chest xray Blood work Ekg
CDC Split Type:

Write-up: 9/13 rash left arm still present and spreading 9/15 urgent care and then er - headache, fatigue, weakness, dizzy, tachycardia- taken from urgent care to er for elevated blood pressure - medicine given for head ache - imaging done to rule out clots which was ok bloodwork was ok Still dealing with weakness, headache, tachycardia, and elevated blood pressure


VAERS ID: 1713198 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

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

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

Write-up: Site: Pain at Injection Site-Medium, Additional Details: arm pain from shoulder to elbow


VAERS ID: 1713216 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dehydration, Injection site erythema, Injection site induration, Injection site swelling, Injection site warmth, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Dehydration (narrow)

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

Write-up: Started feeling dehydrated. Drank water but didn''t micturate. Arm started swelling. Large hard region developed on deltoid of left arm about 6 inches in diameter during the night. Skin was red and hot. On Thursday (3 days after injection) the entire upper arm was swelling about 25% larger than normal, the large hard region remained. Friday the swelling started to decrease. Saturday (5 days after injection) the swelling stopped.


VAERS ID: 1713296 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-14
Onset:2021-09-13
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: tested PCR positive on 9/13/2021
CDC Split Type:

Write-up: Patient is fully vaccinated as on 03/14/2021 with Janssen vaccine and contracted COVID, tested positive on 9/13/2021


VAERS ID: 1713326 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-04
Onset:2021-09-13
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

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

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

Write-up: delayed rash, swelling, itchy


VAERS ID: 1713394 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Dizziness, Injection site erythema, Injection site induration, Injection site pain, Injection site swelling, Injection site warmth, Tenderness
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Around Thyroid 90 mg
Current Illness:
Preexisting Conditions: Hypothyroid thyroiditis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approx. 5 inch x 4 inch red, firm, swollen area on right upper arm in the area of the injection. This area is warm and painful. I also have some pain and tenderness on the underside of my arm and in my armpit area. These symptoms were worse on the 6th day after the injection. I have also been a bit dizzy all week long since the injection.


VAERS ID: 1713514 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-28
Onset:2021-09-13
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: unknown
Diagnostic Lab Data: PCR test 9/15/21- COVID positive
CDC Split Type:

Write-up: Patient received vaccination on 8/28. Just 2 weeks after, on 9/13, patient presented with fever and chills. PCR COVID test results on 9/15 came back positive for COVID.


VAERS ID: 1713543 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-04
Onset:2021-09-13
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3180 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Diarrhoea, Fatigue, Food craving, Headache, Hunger, Malaise, Nasal congestion, Nausea, Pain, Respiratory tract congestion
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall 20mg XLR Clonazepam 1mg
Current Illness:
Preexisting Conditions:
Allergies: Dairy, eggs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Initial listed reactions began an hour after receiving injection on 9/4/2021. One side affect I experienced that was not listed was an extreme hunger and strong food cravings which is very out of the ordinary for me. I have a small appetite and eat extremely healthy, avoiding most salt, all fried foods, oil, and sugar that does not come naturally from fruit and vegetables. After a few days of extreme fatigue, nausea, and body aches, I began to feel normal again. On 9/13/2021, 9 days after receiving the vaccine, I began experiencing extreme stomach pain, nausea, severe diarrhea, extreme fatigue, headaches, and nasal and chest congestion. All of these symptoms except for the diarrhea, which lasted for about 12 hours the night of 9/13, have continued for a week. I am due for my second dose on 9/25 and I am still very ill from the first one.


VAERS ID: 1713601 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-09-11
Onset:2021-09-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: no allergies
Diagnostic Lab Data: Patient did not answer when I called to follow up. 9/18/21
CDC Split Type:

Write-up: Patient received Moderna on 9/11/21. Came to Pharmacy on 9/18/21. Presented left arm with a severe bumpy rash where his vaccine was given. He said as week progressed it just kept itching and getting redder and uncomfortable. He said it was "weeping" and he was worried about if if had "staph" in it. Referred to local Urgent care or hospital. He had been taking Benadryl by mouth on topical and it didn''t relieve for very long at all.


VAERS ID: 1713612 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A 21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Vertigo, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Without health insurance I am forced to hope this is what many people on forums have discussed having and not the more severe outcome of sinus path brain blood clots which have also been happening although under reported in my opinion. Fingers crossed.
CDC Split Type:

Write-up: I''ve had a moderate head ache for five straight days that started shortly after getting the shot. I do not suffer from headaches normally. My vision seems to be slightly blurred but most of all I am suffering from dizzyness or vertigo which has been persistent and consistent. I feel like the ground is moving beneath me . This has not subsides for one minute since it started shortly after getting the shot .


VAERS ID: 1713800 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 LA / IM

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

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

Write-up: Systemic: Allergic: Itch Generalized-Mild, Systemic: Allergic: Rash Generalized-Mild


VAERS ID: 1713855 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / UNK RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary pain, Chest pain, Contusion, Erythema, Feeling abnormal, Lymphadenopathy, Mass, Pain, Pain in extremity, Pyrexia
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), 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? Yes
Hospitalized? No
Previous Vaccinations: I got the flu shot twice in my 20s and ran fever and had body aches for about 3-4 days.
Other Medications: Pantoprazole Claritin
Current Illness:
Preexisting Conditions: Asthma Migraines Acid reflux
Allergies: Compazine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within a few hours my entire right arm, underarm, and chest was extremely sore, progressed to my entire body hurting and fever. That lasted for 48 hours but the arm, underarm, and chest pain remained . I noticed then my underarm hurt because there was a massive, swollen lymph node (I assume). The next day a bruise started to appear around the mass. The swelling went down some but the bruise continued to grow. It has now spread to my right breast, is still growing and red. I feel terrible.


VAERS ID: 1713863 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-03
Onset:2021-09-13
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness:
Preexisting Conditions: Type 2 diabetes
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Abnormal vaginal bleeding.


VAERS ID: 1713918 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Chest X-ray abnormal, Chest pain, Dizziness, Dyspnoea, Electrocardiogram, Fatigue, Headache, Myalgia, Nausea, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (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: Dose 1 of the Shingles Vaccine 2019 61 years of age
Other Medications: Tamsulosin, Atorvastatin, Multi vitamin,
Current Illness:
Preexisting Conditions: Arthritis
Allergies: Allergic to All NSaids (i.e. aspirin, ibuprofen, naproxen sodium)
Diagnostic Lab Data: 9/14/2021: Rushed to the emergency room at where I had an EKG, Chest X-Ray, A bag of fluids and Zofran administered via IV. Also received 1000 mgs of Tylenol tablets. EKG was normal, chest X-Ray showed an irregularity in lower left lobe which will have a follow up visit to PC Tuesday 9/21. ER Doc recommended CT Scan of lungs to figure out what''s up with that lung.
CDC Split Type:

Write-up: Burning in scrotom, difficulty breathing, chest pain mimicking heart attack symptoms, headache, nausea, vomiting, muscle aches, shortness of breath, dizziness, fatigue all began by 8 a.m. 9/14 (the morning after the injection) Started feeling better by midday on the 9/16 but still has lingering effects today.


VAERS ID: 1714039 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-09-07
Onset:2021-09-13
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Oral herpes
SMQs:, Oropharyngeal infections (narrow), Opportunistic infections (broad)

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

Write-up: A week after I had my first dose of Pfizer I got a cold sore. This is not uncommon for me as I?ve had them pretty much my entire life. Before the one I got on Monday 9/13 even healed I got a second cold sore. Now like I said I?ve had these my entire life and I have never once had two cold sores at the same time or even within weeks of eachother.


VAERS ID: 1714376 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-02
Onset:2021-09-13
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Dysmenorrhoea, Fatigue, Menometrorrhagia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (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: Zoloft 25mg Probiotic gummy vitamin
Current Illness:
Preexisting Conditions: Ptsd Anxiety Depression
Allergies: Lactose
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heavy menstrual cycle with excessive bleeding, cramps that were more painful than normal, lower back pain that I normally don?t have during this time, and exhaustion, beginning Monday morning and ending Thursday night.


VAERS ID: 1714404 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Chills, pain in the arm could not be lifted
Other Medications: N/A
Current Illness: Diverticulitis
Preexisting Conditions: Diverticulitis
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: The same day at 8:00pm after receiving the first dose, the chills began, on the second day pain in the arm could be lifted, chills and fever


VAERS ID: 1714415 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Other       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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: vaccinated with expired vaccine by 14 days. No adverse reaction noted.


VAERS ID: 1714436 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Other       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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vaccinated with expired vaccine of 14 days. No adverse reaction noted.


VAERS ID: 1714447 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Other       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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vaccinated with expired vaccine of 14 days. No adverse reaction noted


VAERS ID: 1714453 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Other       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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vaccinated with expired vaccine of 13 days. No adverse reaction noted.


VAERS ID: 1714456 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Other       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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Vaccinated with expired vaccine of 13 days. No adverse reaction noted.


VAERS ID: 1714487 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-09
Onset:2021-09-13
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Drainage, Thyroiditis
SMQs:, Anaphylactic reaction (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Thyroiditis 4 days after 2 vaccine. Cough and drainage.


VAERS ID: 1714889 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-30
Onset:2021-09-13
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Headache, Intermenstrual bleeding, Menstruation irregular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec. Albuterol. Probiotic.
Current Illness: No
Preexisting Conditions: Had gallbladder removed in February. Asthma.
Allergies: Intolerance to dairy and gluten
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1st dose: 08/09/21. 2nd dose: 08/30/21. My monthly cycle is always the same. On time, flow, etc does not change. Since receiving the 1st vaccine, my period was a week early and the flow was spotty, then heavier than usual. This started August 20th, expected to start Aug 27th. My cycle after the second dose, started 4 days early and was just spots of blood for 3-4 days. I still have not had a full period this month. Expected start date: Sept 17. Spotting began: Sept 13. I also have been waking up with minor headaches off and on since vaccination (I rarely ever get headaches).


VAERS ID: 1714960 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-12
Onset:2021-09-13
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / UNK - / -

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

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

Write-up: Covid positive contact through work


VAERS ID: 1714966 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-04
Onset:2021-09-13
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Diarrhoea, Fatigue, Headache, Myalgia, Nausea, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Taste and smell disorders (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: diagnosed with bronchitis and sinus infection the week before
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 09/15/2021 had a positive Covid 19 antigen test
CDC Split Type:

Write-up: Started feeling worse on 9/13/2021 with cough and muscle aches, lost taste and smell, headache, fatigue, nausea and diarrhea.


VAERS ID: 1714970 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-11
Onset:2021-09-13
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / UNK - / -

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

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

Write-up: Covid positive contact with friend


VAERS ID: 1715026 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-16
Onset:2021-09-13
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / 2 LA / IM

Administered by: Public       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: unknown
Current Illness: unknown
Preexisting Conditions: asthma, chronic biliary cirrhosis
Allergies: unknown
Diagnostic Lab Data: SARs COVID 19 PCR positive
CDC Split Type:

Write-up: Fully vaccinated for COVID. Last dose 4/16/2021. Tested positive for COVID 9/14/2021.


VAERS ID: 1715063 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-06-18
Onset:2021-09-13
   Days after vaccination:87
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 - / -

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: Vitamin D3
Current Illness:
Preexisting Conditions:
Allergies: N/A
Diagnostic Lab Data: Positive COVID-19 test.
CDC Split Type:

Write-up: Pt. diagnosed with COVID-19.


VAERS ID: 1715211 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-08
Onset:2021-09-13
   Days after vaccination:128
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Dyspnoea, Laboratory test, Peripheral swelling, Pyrexia, Respiratory tract congestion
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (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? 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: history of coronary artery disease, diabetes, renal failure status post kidney transplant to the emergency department with shortness of breath. He also has a history of heart failure. States he''s had a cough and been congested. Admits bilateral lower extremity swelling; patient started with fever and was tested


VAERS ID: 1715234 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-09
Onset:2021-09-13
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Dyspnoea, Palpitations, Pneumonia
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: sent in from urgent care for pneumonia and covid 19. Patient states had symptoms for the past few days very short of breath and heart racing; xray shows pneumonia


VAERS ID: 1715276 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-11
Onset:2021-09-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Feeling abnormal, Herpes zoster, Pain
SMQs:, Peripheral neuropathy (broad), Dementia (broad), Opportunistic infections (broad)

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

Write-up: Pt received vaccine on Sat 9/11 . She reports monday not feeling good at all. Tuesday she had burning, Wednesday she had eruption of shingles on side of lower back. Her Dr started valtrex 500mg 1bid for 14 days on Friday 9/17. Pt reports it hurts to have her shirt on. She asked that we report this as an adverse event from moderna vaccine.


VAERS ID: 1715287 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 RA / IM

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

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

Write-up: Patient reports tender, red, warm spot around 3 inches below injection site that started 3 days post 2nd COVID vaccine.


VAERS ID: 1715297 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-17
Onset:2021-09-13
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 LA / IM

Administered by: Public       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: unknown
Current Illness: unknown
Preexisting Conditions: Hypertension
Allergies: unknown
Diagnostic Lab Data: Positive COVID-19 test.
CDC Split Type:

Write-up: Pt. diagnosed with COVID-19.


VAERS ID: 1715301 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 1 UN / IM

Administered by: Military       Purchased by: ?
Symptoms: Chest pain, Echocardiogram, Electrocardiogram, Laboratory test, Myocarditis
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Musionex, Zoloft, Tramadol
Current Illness: Viral URI
Preexisting Conditions: Previous COVID-19 infection with bilat pneumonia
Allergies: Zyrtec
Diagnostic Lab Data: labs, EKG TTE
CDC Split Type:

Write-up: Admitted to hospital with CP, diagnosis Myocarditis


VAERS ID: 1715438 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-24
Onset:2021-09-13
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / UNK - / -

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

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

Write-up: Covid positive community


VAERS ID: 1715450 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-01
Onset:2021-09-13
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anticoagulant therapy, Differential white blood cell count, Full blood count, International normalised ratio, Metabolic function test, Pain in extremity, Peripheral swelling, Prothrombin time, Thrombosis, Ultrasound Doppler abnormal
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Tendinopathies and ligament 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? No
Previous Vaccinations:
Other Medications: Synthroid tablet 75mcg - 1x a day
Current Illness: None
Preexisting Conditions: hashimoto''s disease, polycystic ovarian syndrome
Allergies: erythromycin, penicillin
Diagnostic Lab Data: US EXTREMITY LOWER VENOUS DUPLEX LEFT LIMITED COMPREHENSIVE METABOLIC PANEL CBC WITH DIFFERENTIAL PROTIME-INR
CDC Split Type:

Write-up: 13 days after receiving the first Covid-19 vaccine I started experiencing pain in my left leg calf area. I have not had any recent injuries or have been involved in any events to cause the leg to be in pain. On Thursday, September 16, 2021, I called my primary care doctor because the pain had increased, and my calf was swollen. I was seen on Friday, September 17, 2021, by the nurse practitioner and she ordered an ultra-sound. Friday afternoon the nurse practitioner called with the results to advise I have a blood clot in my left calf. The nurse practitioner started me on Eliquis 5mg tablets.


VAERS ID: 1715576 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-20
Onset:2021-09-13
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Exposure to SARS-CoV-2, Fatigue, Oropharyngeal pain, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: Finasteride; HCTZ; Lisinopril, Metoprolol; Pradaxa; Tamsulosin; Amlodpine
Current Illness: none
Preexisting Conditions: a-fib, hypertension; inguinal hernia, BPH; nephrolithiasis
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: exposure to COVID. Cough, sore throat, runny nose, fatigue starting 9/13/21. Wife tested positive on 9/17/21


VAERS ID: 1715591 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-04
Onset:2021-09-13
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Nasopharyngitis, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test positive, Streptococcus test negative, Upper respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 9/19/21-Tested positive for COVID, negative for strep
CDC Split Type:

Write-up: Noticed symptoms of what I thought was cold or strep throat on approximately 9/14/21 (sore throat, head congestion, coughing, feverish)


VAERS ID: 1715678 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

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

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

Write-up: Approximately 7:30 pm started noticing a large red, swollen, warm bump at injection site. Painful to touch and move arm. Persisted over the next 3 days. Still painful to touch and large bruise noted at injection site a week later.


VAERS ID: 1715770 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-09-10
Onset:2021-09-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Chest X-ray normal, Chest pain, Dyspnoea exertional, Electrocardiogram abnormal, Fibrin D dimer normal, Oxygen saturation decreased, Pericarditis
SMQs:, Systemic lupus erythematosus (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), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Dupixent Mirena
Current Illness: None
Preexisting Conditions: Eczema
Allergies: Sulfa
Diagnostic Lab Data: 09/15/2021 Abnormal EKG Chest X-ray clear Cardiac blood work within normal limits 09/16/2021 D-dimer within normal limits Pulse ox applied and pt made to ambulate with noticeable drop in O2 saturation level EKG done
CDC Split Type:

Write-up: Chest pain with dyspnea upon exertion that began 3 days after the 2nd dose. EKG, chest X-ray, blood work done. Follow up with PCP. High dose ibuprofen prescribed as well as colchicine for suspected pericarditis..


VAERS ID: 1715773 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Fibrin D dimer, Myocarditis, Nausea, Troponin increased, Vomiting
SMQs:, Acute pancreatitis (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: baclofen, cyclobenzaprine, ibuprofen, propranolol, rizatriptan, topiramate, trazodone
Current Illness:
Preexisting Conditions: anxiety, depression, migraines
Allergies: oseltamivir
Diagnostic Lab Data: D-Dimer 3.54 Tropine 0.242 @1847, 0.783 @ 2111, 1.346 @ 0435 (9/16), 1.029 @0755, 0.467 @1409
CDC Split Type:

Write-up: nausea, vomiting, then chest pain - diagnosis - myocarditis


VAERS ID: 1715812 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-09-10
Onset:2021-09-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21B / UNK RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 0
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: 1ST DOSE CHARTED IN EMR AS PFIZER 2ND DOSE CHARTED IN EMR AS MODERNA VACCINE CARD IS WRITTEN MODERNA 1ST AND 2ND DOSES CHARTING ERROR VERSES A MEDICATION ERROR-UNABLE TO CONFIRM.


VAERS ID: 1715829 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Naprosyn 500mg PO PRN
Current Illness: patient denies
Preexisting Conditions: wrist pain
Allergies: No Known Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: within 15 minutes after receiving first dose of Pfizer-BioNTech vaccine patient began to complain of chest pain and shortness of breath. Pt was taken to Primary Care Clinic. 1345- Initial VS 1348- Epipen right upper thigh; EMS activated 1350- Benadryl right deltoid, pt states sx''s much improved. "My throat feels open now" 1352-IV initiated. Repeat VS: P: 130, SpO2 100%, 143/86 1355- EMS arrived/report given by Dr./pt transported to ED


VAERS ID: 1715847 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / UNK LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin, Vitamin D3 4000iu Daily, Magnesium 250mcg, Turmeric 500mg
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None.
CDC Split Type: vsafe

Write-up: At the injection site there was a no particularly reaction. About a day later it got a little red, swollen and itchy. I thought it would go away but by the third day the redness was getting larger. It was oblong, red, swollen and itchy. By day two there were two oblong spots. I asked the doctor to take a look at it and she said it look like an allergic reaction to it. She prescribed to me methylprednisolone 4mg. I am not taking as much as she recommended me to take.


VAERS ID: 1715889 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Cough, Diplopia, Dysgeusia, Dyspnoea, Headache, Throat irritation, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Ocular motility disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol nebulizer as needed, Flexeril 10 mg QHS prn, Venolin HFA prn, Omeprazole 20mg Qday, Allegra 60 mg QAM, Metoprolol Tart 50 mg BID, Clotrimazole 1% cream BID bilateral feet.
Current Illness:
Preexisting Conditions: Seasonal allergies, Endometriosis, Fibromyalgia, Asthma GERD, Obesity, Chronic constipation, Fatty Liver, Prediabetes, Hypertension, Chronic tachycardia, Tobacco use
Allergies: Penicillin, Aspirin, Prednisone, Morphine, Latex
Diagnostic Lab Data: Chest xray 9/20/21 due to continued mild expiratory wheezing. No result yet.
CDC Split Type:

Write-up: Patient developed a copper taste in her mouth, scratchy throat, cough, and shortness of breath 15 minutes after vaccine administration. She developed a headache on the way home which became severe by the next day with double vision.


VAERS ID: 1715896 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-04
Onset:2021-09-13
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-09-20
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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: On 9/17, tested positive for COVID -NAAT at store
CDC Split Type:

Write-up: Patient is fully vaccinated as on 03/04/2021 with Pfizer and contracted COVID, tested positive on 9/17/2021


VAERS ID: 1716366 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal
SMQs:, Dementia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Patient self reported similar event occurred after the first dose at the time of the second dose
Other Medications: None known
Current Illness: None known
Preexisting Conditions: None known
Allergies: None known
Diagnostic Lab Data: Temporal Temperature (98.6F) Pulse Ox (97%)
CDC Split Type:

Write-up: 15 minutes after vaccination the patient noted they "felt like crap." The patient''s wife is an EMT and called her boss who came as an emergency service and they denied all interventions I offered at the time. They did allow me to check temperature and pulse oxygen level. EMS arrived and took the patient away.


VAERS ID: 1716560 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-11
Onset:2021-09-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO191 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Pyrexia, Rash morbilliform
SMQs:, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Mild hormonal imbalance
Allergies: Amoxicillin
Diagnostic Lab Data: Unable to see my doctor before the rash resolved though I did call them with the issue and received an appointment
CDC Split Type:

Write-up: Morbilliform/measles-like rash for about 36 hours. Self resolved. Resembled the rash I get from Amoxicillin allergy. Preceded by fever (101.8)/chills for 36 hours. Resolved, took tylenol to control


VAERS ID: 1716564 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blister, Fatigue, Headache, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test negative, Somnolence, Streptococcus test negative, Uvulitis
SMQs:, Severe cutaneous adverse reactions (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

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

Write-up: Initial Fever 102-103 x30hours Continuing Fever 99.5 -100.6 for 4 additional days Severe sore throat with Blister on uvula- Diagnosed with uvulitis Headache for 5 days Extreme fatigue - sleeping 12-14 hours 3 nights After vaccine Missed 3 schedule shifts - Medical provider insisted and wrote note out of work greater than one week


VAERS ID: 1717364 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-11
Onset:2021-09-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Diarrhoea, Dizziness, Fatigue, Headache, Injection site pain, Nausea, Pyrexia, Rash, Tongue eruption
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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), Vestibular disorders (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (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: Hydrocodone-Acetaminophen Gabapentin Synthroid Vit B12 Vit D2 Zyrtec Benadryl Vyvanse Meloxicam Hydrochlorothiazide Buspirone Allergy Injections
Current Illness: N/A
Preexisting Conditions: Back Pain
Allergies: Latex Vinyl Hay Seasonal Allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Bumps On Back Of Tongue & Throat Chest Pain Dizziness Nauseous Diarrhea Fever Headache Exhaustion Pain At Injection Site


VAERS ID: 1718172 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-09-13
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoaesthesia, Limb discomfort, Pain in extremity
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: My right arm has been numb; My right arm has been causing pain and discomfort; My right arm has been causing pain and discomfort; This spontaneous case was reported by a consumer and describes the occurrence of HYPOAESTHESIA (My right arm has been numb), PAIN IN EXTREMITY (My right arm has been causing pain and discomfort) and LIMB DISCOMFORT (My right arm has been causing pain and discomfort) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Sep-2021, the patient experienced HYPOAESTHESIA (My right arm has been numb), PAIN IN EXTREMITY (My right arm has been causing pain and discomfort) and LIMB DISCOMFORT (My right arm has been causing pain and discomfort). At the time of the report, HYPOAESTHESIA (My right arm has been numb), PAIN IN EXTREMITY (My right arm has been causing pain and discomfort) and LIMB DISCOMFORT (My right arm has been causing pain and discomfort) outcome was unknown. No concomitant medication details was provided. No treatment medication details was provided. Reporter did not allow further contact


VAERS ID: 1718331 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / -

Administered by: Work       Purchased by: ?
Symptoms: Chills, Nail discolouration, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101198182

Write-up: Experiencing bad chills, tingling in left arm from finger tips to the area of the shot and half of the finger tips are a purplish color; Experiencing bad chills, tingling in left arm from finger tips to the area of the shot and half of the finger tips are a purplish color; Fingertips turning purple; This is a spontaneous report received from a contactable consumer. A 47-years-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for Injection, Batch/Lot number: FC3184) via an unspecified route of administration, administered in Arm Left on 13Sep2021 at 13:30 as DOSE 1, SINGLE (at the age of 47-year-old) for covid-19 immunisation. There were no concomitant medications. Medical history reported as none.The NDC number of Covid Vaccine was unknown. Patient received the first dose of Pfizer covid vaccine on 13Sep2021 at 13:30 and at 15:30 and all of a sudden started experiencing bad chills, tingling in left arm from finger tips to the area of the shot and half of the finger tips were a purplish colour. Patient got up and walked outside and she still has tingling from her left hand to where the shot was. Reporter asked if these were side effects after vaccination and if she needed to worry about them. The patient did not received treatment for the events. The outcome of the events was not resolved. No further information can be obtained.


VAERS ID: 1718743 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-18
Onset:2021-09-13
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER613 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthma, Condition aggravated, Dyspnoea, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Lower leg calf pain for all of September. Patient admitted to hospital 09/21/21 due to shortness of breath since 9/13/21.
Preexisting Conditions: Asthma - patient thought week of SOB was asthma condition related, but inhaler and rest at home was not improving her breathing capacity.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient has asthma and tried to resolve continuous Shortness of breath started 9/13/21 using inhaler, without success. Patient visited ER 9/20/21 and admitted 9/21/21.


VAERS ID: 1718822 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-13
Onset:2021-09-13
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Blood uric acid normal, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chronic obstructive pulmonary disease, Condition aggravated, Diarrhoea, Dyspnoea, Feeling abnormal, Fibrin D dimer increased, Hypoxia, Lung infiltration, Lung opacity, Oxygen saturation decreased, Pneumonia, Productive cough, Pulmonary arterial hypertension, Pulmonary artery dilatation, Pyrexia, SARS-CoV-2 test positive, Sputum discoloured, Venous thrombosis
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Outpatient Medications albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler allopurinol (ZYLOPRIM) 100 MG tablet Budeson-Glycopyrrol-Formoterol (BREZTRI AEROSPHERE) 160-9-4.8 MCG/ACT AERO fluticasone-salmete
Current Illness: 9.8.21: Office Visit - COPD exacerbation IMPRESSION AND PLAN 1. Chronic obstructive pulmonary disease exacerbation. We will treat with Zithromax. The patient''s oxygen level is 92%. He does not appear acutely distressed, so at this point, we will not use any oral steroids. He will let us know if symptoms do not gradually improve with the above treatment. Call if he has further difficulties. The patient does see Pulmonary and has been changing his inhalers also. He will contact them with any concerns regarding his inhalers. Continue albuterol on a p.r.n. basis for acute symptoms. 2. Chronic diarrhea. Lab orders placed. He has been referred back to Gastroenterology and awaiting line up for colonoscopy. 3. History of gout. Uric acid level is satisfactory. He has not had any recent flare-ups of gout. We will continue current dose of allopurinol. He has had labs in July for monitoring of this medication. Continue current dose. 9.10.21 - called office feeling worse 9.13.21: ED, admitted to hospital, COVID-19 positive
Preexisting Conditions: Non-Hospital Scrotal mass Rosacea Blepharitis of both eyes with rosacea Senile nuclear cataract, bilateral Class 2 obesity Bleeding from the nose COPD exacerbation (HCC) Abscess of back Wound check, abscess Early dry stage nonexudative age-related macular degeneration of both eyes Squamous blepharitis of upper and lower eyelids of both eyes Morbid (severe) obesity due to excess calories (HCC) Essential hypertension Acute gout involving toe of left foot, unspecified cause Nocturnal hypoxemia due to obstructive chronic bronchitis (HCC)
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (9.13.21 - present); Symptoms started week prior; COVID-19 positive (9.13.21); Fully Vaccinated Pt is a 69 y.o. male who presents to hospital with difficulty breathing. The patient is known to have history of multiple comorbidities including chronic obstructive pulmonary disease, obstructive sleep apnea on CPAP, hypertension, pneumonia in the past, tobacco use, hypertension, and diabetes mellitus type 2. On September 9, 2021, the patient was presented to his primary care physician office because of increasing productive cough with poly phlegm, and increase of difficulty breathing. At that time he did not have any fever. Also the patient had some diarrhea at that time. He was given a course of Zithromax. However since then, the patient did not improve. Instead he has been feeling feverish with productive cough, and more difficulty breathing. He came back to the emergency department for evaluation. The patient COVID-19 PCR rapid test came back positive. The chest x-ray showed mild bibasilar hazy and streaky opacities right greater than left compatible with pneumonia. The patient was hypoxic in the emergency department with oxygen saturation 84% on room air. He has been requiring high-flow nasal cannula initially with FiO2 90% and later it went down to 35%. The patient is being admitted to the hospital for further evaluation treatment. Assessment and Plan Medical Decision Making This is a 69 years old gentleman who was presented to the emergency department because of 5 days complaining of productive cough with yellow phlegm, difficulty breathing, and diarrhea. On presentation he was hypoxic with oxygen saturation 85% on room air. The patient is requiring oxygen supplement via high-flow nasal cannula. The chest x-rays showed bibasilar infiltrations compatible with pneumonia. The PCR rapid test for COVID came back positive. 1. Acute hypoxic respiratory failure. Present on admission. Associated with COVID-19 pneumonia and chronic obstructive pulmonary disease exacerbation. The patient is requiring right now high-flow nasal cannula with FiO2 35%. We will keep monitoring. The patient is full code. 2. COVID-19 pneumonia. Present on admission. The patient is on dexamethasone and remdesivir. Will re-evaluate in the morning. We will do daily COVID-19 lab care set. 3. Chronic obstructive pulmonary disease exacerbation. Present on admission. The patient has already failed outpatient Zithromax orally. We will continue breathing treatment. Notes from 9.20.21: ASSESSMENT / PLAN: Acute on chronic hypoxic respiratory failure Severe COVID-19 pneumonia s/p vaccination COPD exacerbation - Continue HFNC and titrate to maintain saturations of 90-94% - Continue Decadron; s/p Remdesivir - Maintain euvolemia and diurese prn -Antitussives prn, encourage IS use and prone - Continue duonebs q 6h prn - Mucinex - Dulera and spiriva and Singulair **DDimer was increasing; no PE noted, small acute thrombus in the cephalic vein that does not require full dose anticoagulation. CTA does show PA dilation; likely c/w PAH.


VAERS ID: 1718834 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 RA / IM

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

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

Write-up: Rash noted to bilateral arms, legs and torso. Solumedrol administered 1 week post onset of rash. Outcome not available at time of submission.


VAERS ID: 1718908 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-02
Onset:2021-09-13
   Days after vaccination:103
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, COVID-19, Cough, Myalgia, Nausea, Productive cough, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol (PROVENTIL) (2.5 MG/3ML) 0.083% nebulizer solution budesonide-formoterol (SYMBICORT) 160-4.5 MCG/ACT inhaler bumetanide (BUMEX) 2 MG tablet cyclobenzaprine (FLEXERIL) 10 MG tablet dexamethasone (DECADRON) 6 MG tablet fluticasone (
Current Illness: Sarcoidosis of lung with sarcoidosis of lymph nodes (CMS/HCC)
Preexisting Conditions: Cardiovascular and Mediastinum Essential hypertension Heart failure with preserved ejection fraction (CMS/HCC) Essential hypertension Acute on chronic diastolic CHF (congestive heart failure) (CMS/HCC) Respiratory Rhinitis Pulmonary emphysema (CMS/HCC) Acute exacerbation of chronic obstructive pulmonary disease (COPD) (CMS/HCC) Pneumonitis OSA (obstructive sleep apnea) COPD (chronic obstructive pulmonary disease) (CMS/HCC) Multifocal pneumonia, persistent Acute respiratory failure (CMS/HCC) Asthma Hospital-acquired pneumonia Hypoxia Pneumonia due to infectious organism Pneumonia COPD with acute exacerbation (CMS/HCC) Digestive Crohn''s disease 2017 Malabsorption due to intolerance, not elsewhere classified Clostridium difficile diarrhea Colitis Endocrine Type 2 diabetes mellitus (CMS/HCC) Immune and Lymphatic Retroperitoneal lymphadenopathy, likely sarcoidosis, stable presence from previous Other Bipolar disorder (CMS/HCC) Abdominal pain Iron deficiency anemia due to chronic blood loss Obesity (BMI 30-39.9) Intractable abdominal pain Hyperlipidemia Lactic acidosis Hypokalemia Left lower lobe pulmonary nodule H/O abdominal hysterectomy Fever postop Tobacco abuse Rhinovirus infection Leukocytosis Diarrhea Fever, recurrent Sepsis (CMS/HCC) Hypomagnesemia Fever of unknown origin Sarcoidosis Excessive use of nonsteroidal anti-inflammatory drug (NSAID) History of peptic ulcer disease Epigastric pain Noncompliance Constipation Suspected COVID-19 virus infection COVID-19 ruled out Hyperglycemia Shortness of breath Obesity Leg swelling Elevated lactic acid level Hyponatremia
Allergies: Lisinopril: Swelling
Diagnostic Lab Data: Positive for COVID-19
CDC Split Type:

Write-up: Chief Complaint:Myalgias Context: Pt is a 47 yr/o female with a hx of Crohn''s disease, COPD, CHF, and sarcoidosis who presents with myalgias that began a few days ago. She has also felt feverish and has had a cough. Her cough is productive of yellow sputum. She has chronic nausea due to her hx of crohn''s disease, but has not had relief recently with her Zofran. She is on Mesalamine for her crohn''s disease. She is fully vaccinated for Covid19. She also mentions she has had back pain recently since going to PT and notes she has not had relief. Has not seen her PCP regarding this issue yet. Requesting something for pain at this time given her continual pain.


VAERS ID: 1718941 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-12
Onset:2021-09-13
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety disorder, COVID-19, Chronic obstructive pulmonary disease, Chronic respiratory failure, Computerised tomogram thorax abnormal, Condition aggravated, Dyspnoea, Emphysema, Hypercapnia, Hypoxia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (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, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen , Albuterol Sulfate 108 (90 Base) MCG/ACT 2 puffs Inhalation ,Ferrous Sulfate 325 mg Oral 2 times daily Finasteride 5 mg Oral Every morning, Fluticasone-Umeclidin-Vilant 100-62.5-25 MCG/INH 1 puff Inhalation Daily HYDROcodone-
Current Illness: ED Visit on 8/17/21 for dyspnea, Covid 19 virus not detected and anxiety disorder, discharged from ED. Hospital admission on 8/20/21 for COPD exacerbation, chronic respiratory failure with hypoxia and hypercapnia and COVID 19 virus not detected.
Preexisting Conditions: Achilles tendon tear (3/14/15), BPH (benign prostatic hypertrophy) with urinary obstruction, Chronic pain syndrome, Chronic prescription opiate use, CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min, DDD (degenerative disc disease), lumbar, DDD (degenerative disc disease), lumbar, Depression, major, recurrent, moderate (HCC), Diverticulosis of colon, Emphysema/COPD (HCC) (PFT 07/31/01), GAD (generalized anxiety disorder), GERD (gastroesophageal reflux disease), Hemorrhoids, Hyperlipidemia, unspecified, Hypothyroid, Lumbar spinal stenosis, Neuropathy, Osteoarthritis of hand, Osteoarthritis of left shoulder, Osteoarthritis of lumbar spine, Oxygen dependent, PUD (peptic ulcer disease), RLS (restless legs syndrome), Secondary pulmonary arterial hypertension (HCC), and Spontaneous pneumothorax
Allergies: risperidone
Diagnostic Lab Data: Covid + 9/13/21, Ct angio thorax: Emphysema but no evidence of any acute pulmonary or pleural disease. No evidence of pulmonary embolism.
CDC Split Type:

Write-up: Hospitalized 9/13/21; Covid + 9/13/21 fully vaccinated. The patient has decided on symptomatic and comfort management versus continued aggressive treatment as of 9/19/21 and is currently still in hospital


VAERS ID: 1718982 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Lip swelling, Swelling face, Swelling of eyelid
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Dose #1 of COVID vaccine- Moderna
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Zofran
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling of the face, lips, eyelids within 3 hours of vaccine administration. Took benadryl orally and aspirin and within 48 hours, the swelling went down.


VAERS ID: 1719007 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Dyspnoea, Headache, Heart rate increased, Pain
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: Difficulty breathing, rapid heartbeat, dizziness, weakness, short of breath, severe headaches and body aches.


VAERS ID: 1719051 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-25
Onset:2021-09-13
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Ascites, Asymptomatic COVID-19, Cellulitis, Chest X-ray abnormal, Condition aggravated, Hypotension, Lung opacity, Lymphoedema, Portal hypertension, SARS-CoV-2 test positive, Subcutaneous abscess, Ultrasound Doppler, Ultrasound liver
SMQs:, Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, Unasyn, Tessalon, TUMS, lovenox,Pepcid, Lasix, Motrin, Synthroid, Midodrine, Norepinephrine infusion, Zofran, Oxycodone, senna, Aldactone, constulose
Current Illness: 9/7/21 went to ED for leg swelling. Dx with cellulitis of left lower extremity and d/c home on Keflex. 9/13/21 returned to ED for skin problem of left leg again. CT left lower extremity US: A fluid collection, right lower leg is consistent with a subcutaneous abscess. No muscle involvement. No osteomyelitis. COVID + with no symptoms per patient admitted to hospital.
Preexisting Conditions: arthritis, cirrhosis of liver, depression with anxiety, recurrent pneumonia, hypertension, hypothyroidism, migraines, murmur, obesity, Thrombocytopenia, thyroid disease and Vitamin D deficiency.
Allergies: none
Diagnostic Lab Data: 9/7/21: ED visit for Cellulitis of left lower extremity. discharged home on antibiotic 9/13/21: returned to ED with worsening abscess of her left lower extremity. admitted for abscess, lymphedema and COVID 19+ 9/14/21 USV: There is no deep venous thrombosis in the visualized deep veins of the right or left lower extremity. 9/15/21 CXR: There is scattered bilateral mixed interstitial and airspace opacity most prominent in the left mid to lower lung. This is nonspecific and could relate to the patient''s known COVID 19 although can also be seen with pulmonary edema given the associated pulmonary vascular congestion. 9/15/21 Right upper quadrant US: Right upper quadrant ultrasound with complete duplex Doppler liver 1. Cirrhotic liver without definite mass or cyst. 2. Sonographic findings suggesting portal hypertension. 3. The splenic vein and superior mesenteric veins were not seen on this exam. 4. Exam indeterminate for acute cholecystitis is the gallbladder is mostly contracted. 5. Small amount of ascites scattered throughout the abdomen. 9/18/21 CXR: There are persistent subtle bilateral interstitial opacities. However, the appearance has significantly improved from prior. 9/20/21: Patient was hypotensive overnight. Was started on stress dose steroids. Will discontinue stress dose steroids and administer IV fluids. Patient''s blood pressure responded well to fluids. Will continue to monitor vitals overnight. If blood pressure remains stable anticipate discharge tomorrow. If patient continues to be hypotensive will plan to start midodrine.
CDC Split Type:

Write-up: Hospitalized 9/13/21; COVID-19 positive on 9/13/21; fully vaccinated. Admitted for Abscess , Lymphedema and COVID-19


VAERS ID: 1719067 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-09-08
Onset:2021-09-13
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

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

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

Write-up: Patient is impaired and while institutionalized earlier in the year was administered the J&J vaccine. He later came to our facility and we administer both pfizer doses to this patient. He requested the covid vaccine at initial injections and did not acknowledge that he had received another vaccine. 1st administered 8/13/2021 2nd dose administered 9/8/2021


VAERS ID: 1719110 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-15
Onset:2021-09-13
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Emphysema, Lung opacity, Lymphadenopathy, Pleural effusion, Pneumonia, Pulmonary mass, SARS-CoV-2 test positive, Spinal cord compression
SMQs:, Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler aspirin 81 MG enteric coated tablet atorvastatin (LIPITOR) 40 MG tablet [START ON 9/18/2021] azithromycin (ZITHROMAX) 250 MG tablet Calcium Carbonate (CAL
Current Illness:
Preexisting Conditions: Arthritis, hyperlipidemia, wrist fracture, posterior vitreous detachment, low glaucoma risk both eyes, After cataract with vision obscured, dry eyes, presbyopia, epiretinal membrane, nuclear senile cataract, OSA on Cpap, hypertension and dementia
Allergies: None
Diagnostic Lab Data: Admitted with COVID-19 pneumonia CXR 9/13/21: Mild opacity in the left lower lung zone may represent atelectasis or infection. CT angio thorax 9/13/21: 1. No pulmonary embolism. 2. Suspected bronchopneumonia involving the bilateral upper and lower lobes. Recommend follow-up CT in 3 months to ensure resolution. 3. Indeterminate 4 mm right upper lobe nodule. 4. Moderate emphysema. 5. Minimal left pleural effusion. 6. Mildly enlarged bilateral hilar lymph nodes, likely reactive. 7. Age-indeterminate thoracic compression deformities. Discharged on 9/17/21
CDC Split Type:

Write-up: Hospitalized 9/13/21; COVID 19 + on 9/13/21; fully vaccinated.


VAERS ID: 1719114 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-18
Onset:2021-09-13
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol, eliquis, lipitor, robitussin, lisinopril, lopressor, prilosec, deltasone, flomax, spiriva
Current Illness:
Preexisting Conditions: AKI, obesity, anemia, hypokalemia, myopathy,
Allergies:
Diagnostic Lab Data: 9.13.21 pos covid on admission
CDC Split Type:

Write-up: SOB


VAERS ID: 1719178 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Burning sensation, Chest discomfort, Cough, Dyspnoea, Nasopharyngitis, Productive cough, Pruritus, Pyrexia, Rhinorrhoea, SARS-CoV-2 test, Secretion discharge
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Live Polio vaccination 1979
Other Medications: Dicyclimine as needed Methocarbamol 500mg 1 tablet 2x day as needed Inhaler albuteral as needed Nebulizer Coq10 Fish oil capsules Probiotics
Current Illness: No known
Preexisting Conditions: Raynauds, Crohn?s, asthma, PPS from live polio vaccination (1979)
Allergies: Amoxicillin Sulfa drugs
Diagnostic Lab Data: I had a covid test on Sunday 9/19 /2021 I had a covid test in the urgent care today 9/21/2021
CDC Split Type:

Write-up: About 7 hours after vaccination I received a bad burning itchy cough. Lasted for minutes each time. Could not stop coughing. Then it turned into cold like symptoms with running nose and low grade fevers. The cough continued to bother me and I started experiencing a mucus that was thin at first?. One week later I am experiencing chest pressure and breathing issues on the right side, difficulty to breathe and yellow congestion with the cough. I was absolutely in great shape before. Don?t understand so I went to urgent care after my doctor didn?t want to see me in the office.


VAERS ID: 1719215 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-11
Onset:2021-09-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Mild, Additional Details: patient started experiencing blurry vision in his left eye only, starting 2 days after 2nd shot. pt says no problems after 1st one.


VAERS ID: 1719241 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Back pain, Chest X-ray, Chest pain, Electrocardiogram, Headache, Myalgia, Nausea, Neck pain, Pyrexia, Sensitive skin
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Jolessa, Zyrtec, protonix
Current Illness: None
Preexisting Conditions: Long lasting symptoms from Covid contracted July 2020
Allergies: None
Diagnostic Lab Data: EKG 09/14/21 Chest X-ray 09/14/21
CDC Split Type:

Write-up: Severe muscle pain, skin sensitivity, nausea, severe headache, neck and lower back pain, chest pain, fever


VAERS ID: 1719337 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-31
Onset:2021-09-13
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Anosmia, COVID-19, SARS-CoV-2 test positive
SMQs:, Taste and smell disorders (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Employee tested positive during outbreak testing and now has loss of smell.


VAERS ID: 1719466 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816027 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aphasia, Chest pain, Eye swelling, Headache, Hyperhidrosis, Hypoaesthesia, Muscle spasms, Pain, Pain in jaw, Pruritus, Rash, Skin burning sensation, Tremor, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Osteonecrosis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Influenza vaccination, a couple years ago.
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Sjogrens disease, Hashimoto''s Thyroiditis
Allergies: latex, PCN, Erythromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: 20 minutes post vaccination - sweating Later in day began itching, with rash, followed by wheezing, self treated at home. By following morning reports hands curled under, eyes swollen, severe headache, skin was "on fire", full body spasms and cramping. Seen in ED, treated with muscle relaxant, and Percocet. Went on to have reported aphasia, left side numbness of hand and foot, left hand tremors and random muscle spasms. Also began stabbing chest pain radiating to jaw. Chest pain continues to come and go.


VAERS ID: 1719507 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-10
Onset:2021-09-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA CX024414 / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Electrocardiogram normal, Musculoskeletal chest pain, Pleuritic pain
SMQs:, Infective pneumonia (broad)

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

Write-up: Onset of L sided pleuritic chest pain 2 days after receive Moderna dose 1. Continued to worsen prompting evaluation. No systemic symptoms but significant pain, exam showed normal ECG, normal auscultation, but exquisite TTP at 4th and 5th costochondral junctions. Treated with topical and oral diclofenac.


VAERS ID: 1719545 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein, Chest pain, Dyspnoea, Echocardiogram, Electrocardiogram, Troponin
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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies: Amoxicillin
Diagnostic Lab Data: 9/21/21: CRP, troponin, EKG, echo
CDC Split Type:

Write-up: Chest pain, dyspnea - ongoing. Undergoing evaluation for myocarditis but work up incomplete at this time.


VAERS ID: 1719551 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flovent, Flonase, Zyrtec, singulair, Prilosec, levothyroxin
Current Illness: None
Preexisting Conditions: Asthma, allergies, hypothyroidism
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: My skin is itchy all over my body. From my head to my feet. Hives on my elbows and thighs. Began taking Benadryl on 9/20. Doctor prescribed me prednisone on 9/21.


VAERS ID: 1719570 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-08-31
Onset:2021-09-13
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 AR / IM

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: DIAZEPAM 5mg, one before bed; Emergen-C 1000mg Vitamin C twice daily: Ibuprofen 200 mg, two tablets on occasion.
Current Illness: None
Preexisting Conditions: Anxiety
Allergies: Lactose Intolerant
Diagnostic Lab Data: In progress
CDC Split Type:

Write-up: Seizures


VAERS ID: 1719579 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / -

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

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

Write-up: same night developed red arm, then painful rash benadryl and tylenol helped


VAERS ID: 1719781 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-04
Onset:2021-09-13
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Bell's palsy, Full blood count, Hypoaesthesia, Magnetic resonance imaging, Metabolic function test
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hearing impairment (broad), Sexual dysfunction (broad)

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

Write-up: Bells palsy, left arm and left leg numbness


VAERS ID: 1719784 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-02
Onset:2021-09-13
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / SYR

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

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

Write-up: Itchiness all over but primarily palms and bottom of feet


VAERS ID: 1720705 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-01
Onset:2021-09-13
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Acute respiratory failure, COVID-19, COVID-19 pneumonia, Intensive care, Positive airway pressure therapy, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine, aspirin, insulin, gabapentin, metformin...
Current Illness: n/a
Preexisting Conditions: diabetes, hypertension, depression, remote history breast cancer
Allergies: alendronate (nausea), lisinopril (cough), prednisone (nausea)
Diagnostic Lab Data: COVID positive 9/13/21
CDC Split Type:

Write-up: COVID positive on 9/13/21 despite being fully vaccinated. Now with acute respiratory failure due to covid pneumonia requiring ICU admission and BIPAP. Still in process of being treated. Receiving decadron (requiring increased ARDS dosing due to progressively worsening respriatory status) and remdesivir. Received dose of tocilizumab 800 mg IV today.


VAERS ID: 1721194 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Severe muscle soreness spread from left arm injection site throughout the entire body, Subsided 3 days later and was normal 5 days post injection.


VAERS ID: 1721525 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Missouri  
Vaccinated:0000-00-00
Onset:2021-09-13
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 test, 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: Test Date: 20210913; Test Name: COVID-19 rapid POC test; Result Unstructured Data: Positive; Comments: (unknown if antigen, antibody, or PCR)
CDC Split Type: USJNJFOC20210938733

Write-up: COVID-19 TEST POSITIVE; This spontaneous report received from a patient concerned a 43 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808609, expiry: UNKNOWN) dose was not reported, administered on 07-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 13-SEP-2021, the patient experienced covid-19 test positive. Laboratory data included: COVID-19 rapid POC test (NR: not provided) Positive. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of covid-19 test positive was not reported. This report was non-serious. This case, from the same reporter is linked to 20210807937.


VAERS ID: 1721649 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-10
Onset:2021-09-13
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Illness, Oropharyngeal pain, Productive cough
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (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: USMODERNATX, INC.MOD20213

Write-up: My throat''s sore; Mucousy; If I''m getting sick I don''t need to go get the shot; This spontaneous case was reported by a consumer and describes the occurrence of OROPHARYNGEAL PAIN (My throat''s sore), PRODUCTIVE COUGH (Mucousy) and ILLNESS (If I''m getting sick I don''t need to go get the shot) in a 68-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 045B21A) for COVID-19 vaccination. No Medical History information was reported. On 10-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Sep-2021, the patient experienced OROPHARYNGEAL PAIN (My throat''s sore), PRODUCTIVE COUGH (Mucousy) and ILLNESS (If I''m getting sick I don''t need to go get the shot). At the time of the report, OROPHARYNGEAL PAIN (My throat''s sore), PRODUCTIVE COUGH (Mucousy) and ILLNESS (If I''m getting sick I don''t need to go get the shot) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No Concomitant informations were reported. No treatment informations were reported.


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