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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 197 out of 8,010

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VAERS ID: 1721662 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-07-28
Onset:2021-09-13
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: First dose on 28 Jul 2021, no second dose yet; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (First dose on 28 Jul 2021, no second dose yet) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 088D21A) for COVID-19 vaccination. No Medical History information was reported. On 28-Jul-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 PRODUCT DOSE OMISSION ISSUE (First dose on 28 Jul 2021, no second dose yet). On 13-Sep-2021, PRODUCT DOSE OMISSION ISSUE (First dose on 28 Jul 2021, no second dose yet) had resolved. No concomitant medications were reported. Treatment information was not provided.


VAERS ID: 1721700 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Connecticut  
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 (MODERNA)) / MODERNA 014C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Device connection issue, Underdose
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: USMODERNATX, INC.MOD20213

Write-up: Receiving lower than full dose of the vaccine because of leaking; Content leaked out on her arm and the pharmacist stated that it happened because of the needle; This spontaneous case was reported by a pharmacist and describes the occurrence of UNDERDOSE (Receiving lower than full dose of the vaccine because of leaking) and DEVICE CONNECTION ISSUE (Content leaked out on her arm and the pharmacist stated that it happened because of the needle) in a 36-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 014c21a) for COVID-19 vaccination. No Medical History information was reported. On 13-Sep-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 UNDERDOSE (Receiving lower than full dose of the vaccine because of leaking) and DEVICE CONNECTION ISSUE (Content leaked out on her arm and the pharmacist stated that it happened because of the needle). At the time of the report, UNDERDOSE (Receiving lower than full dose of the vaccine because of leaking) and DEVICE CONNECTION ISSUE (Content leaked out on her arm and the pharmacist stated that it happened because of the needle) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant and treatment information were reported by the reporter


VAERS ID: 1721770 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-09-13
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia
SMQs:, Taste and smell disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: I lost my taste after getting the vaccine; This spontaneous case was reported by a consumer and describes the occurrence of AGEUSIA (I lost my taste after getting the vaccine) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. unknown) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Sep-2021, the patient experienced AGEUSIA (I lost my taste after getting the vaccine). At the time of the report, AGEUSIA (I lost my taste after getting the vaccine) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were reported. No treatment medications were reported.


VAERS ID: 1721823 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Interchange of vaccine products
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Second vaccine administered less than 21 days; Mixed series vaccinations administered; This spontaneous case was reported by a pharmacist and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Second vaccine administered less than 21 days) and INTERCHANGE OF VACCINE PRODUCTS (Mixed series vaccinations administered) in a 3-week-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 058E21A) for COVID-19 vaccination. Previously administered products included for COVID-19 vaccination: Pfizer Covid-19 vaccine on 09-Sep-2021. On 13-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Sep-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Second vaccine administered less than 21 days) and INTERCHANGE OF VACCINE PRODUCTS (Mixed series vaccinations administered). On 13-Sep-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Second vaccine administered less than 21 days) and INTERCHANGE OF VACCINE PRODUCTS (Mixed series vaccinations administered) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment medications were reported. It was reported that the gave the pharmacist gave Moderna COVID-19 vaccine on 13-Sep-2021 to a patient who was at the pharmacy asking for their flu vaccine. Most recent FOLLOW-UP information incorporated above includes: On 17-Sep-2021: Follow-up received and does not contain any new information.


VAERS ID: 1721828 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-01
Onset:2021-09-13
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20X / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Rash macular, Vaccination site pruritus
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: 3 Large blotches on the left arm after 3rd shot/Itchy blotches on left arm after 3rd shot; Itching left arm injection site after 3rd shot; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE PRURITUS (Itching left arm injection site after 3rd shot) and RASH MACULAR (3 Large blotches on the left arm after 3rd shot/Itchy blotches on left arm after 3rd shot) in a 76-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. BU0C21A, 029M19A and 007M20X) for COVID-19 vaccination. No Medical History information was reported. On 01-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 02-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 13-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 13-Sep-2021, the patient experienced VACCINATION SITE PRURITUS (Itching left arm injection site after 3rd shot). On 15-Sep-2021, the patient experienced RASH MACULAR (3 Large blotches on the left arm after 3rd shot/Itchy blotches on left arm after 3rd shot). At the time of the report, VACCINATION SITE PRURITUS (Itching left arm injection site after 3rd shot) and RASH MACULAR (3 Large blotches on the left arm after 3rd shot/Itchy blotches on left arm after 3rd shot) had not resolved. Concomitant product use was unknown by the reporter. Treatment information was not provided. The patient states that she did not contact her doctor and she was not using any medication but placed Ice on it once. This case was linked to MOD-2021-320257 (Patient Link).


VAERS ID: 1721831 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Unknown  
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 (MODERNA)) / MODERNA 079C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Fall, Syncope, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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: USMODERNATX, INC.MOD20213

Write-up: fainting; dizziness; almost falling; progressive altered vision/started to loss his vision reduced to 80%; This spontaneous case was reported by a physician and describes the occurrence of SYNCOPE (fainting) in a 77-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 079c21a) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 13-Sep-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 SYNCOPE (fainting) (seriousness criterion medically significant), DIZZINESS (dizziness), FALL (almost falling) and VISUAL IMPAIRMENT (progressive altered vision/started to loss his vision reduced to 80%). At the time of the report, SYNCOPE (fainting), DIZZINESS (dizziness), FALL (almost falling) and VISUAL IMPAIRMENT (progressive altered vision/started to loss his vision reduced to 80%) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant product information were provided by the reporter. No treatment information was provided. Company comment: This case concerns a 77-year-old, male subject who experienced the serious events of syncope, and non-serious events of dizziness, fall, and visual impairment . The events occurred approximately 1 day after the first dose of Spikevax. There was no rechallenge as at the time of the events, as the patient was yet to receive the second dose of the vaccine. The patient''s medical history was not provided. Causality was not provided by the reporter. The benefit-risk relationship of the vaccine is not affected by this report.; Sender''s Comments: This case concerns a 77-year-old, male subject who experienced the serious events of syncope, and non-serious events of dizziness, fall, and visual impairment . The events occurred approximately 1 day after the first dose of Spikevax. There was no rechallenge as at the time of the events, as the patient was yet to receive the second dose of the vaccine. The patient''s medical history was not provided. Causality was not provided by the reporter. The benefit-risk relationship of the vaccine is not affected by this report.


VAERS ID: 1721929 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
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 - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Cardiac failure, Dyspnoea, Extra dose administered, Fatigue, Feeling abnormal, Feeling hot, Headache, Illness
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), 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: USPFIZER INC202101205889

Write-up: Heart failure; Weak; She wasn''t sure if she was running a fever but feels really hot right now; She also mentioned she had started walking but she felt like she couldn''t breathe. She had difficulty breathing while walking; felt weird; Headache; Extremely tired; received booster or third dose of product; a little ill; This is a spontaneous report from a contactable consumer (patient). A 52-year-old female patient received third dose of BNT162B2 (COMIRNATY, solution for injection, Batch/Lot number/ NDC number/ expiration date was not reported) via an unspecified route of administration on 13Sep2021 15:00 as dose 3, single for covid-19 immunisation. Medical history and concomitant medication were not reported. The patient previously took first and second doses of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Batch/Lot Number and expiration date: not reported), via an unspecified route of administration on as dose 1, single and dose 2, single both for COVID-19 immunisation. On an unspecified date, the patient experienced heart failure. On 13Sep2021 15:00, the patient received booster or third dose of product. On the same day at 17:00, patient felt weird, headache, extremely tired and at 17:30, patient felt weak, she wasn''t sure if she was running a fever but feels really hot right now. On 13Sep2021, she also mentioned she had started walking but she felt like she couldn''t breathe. she had difficulty breathing while walking and little il. Additional information included that the caller is calling regarding the Pfizer COVID-19 vaccine. She received her booster or her third dose yesterday and by the time she got home she felt weird and a little ill around 5:00PM. She also stated that she experienced a headache, weakness, and she felt extremely tired. She also mentioned that she is still not feeling that great right now. She stated that she did good with the 2 previous doses of the Pfizer COVID-19 vaccine and only experienced side effects with the third dose. She also stated that she wasn''t sure if she was running a fever but feels really hot right now. She also mentioned she had started walking but she felt like she couldn''t breathe. She had difficulty breathing while walking. She also brought up her medical condition that she had, she has heart failure and she is taking medication for that. The agent did not get name of that medication. It is not specified if the caller had the heart failure prior to receiving the Pfizer COVID-19 vaccines. Outcome of the events was unknown. The lot number for [BNT162B2] was not provided and will be requested during follow-up.


VAERS ID: 1722196 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Product administered to patient of inappropriate age, Vaccination complication
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: Premature ventricular contractions; Tachycardia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Typical post vaccination side effects; Son accidentally vaccinated at age 17; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION COMPLICATION (Typical post vaccination side effects) and PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Son accidentally vaccinated at age 17) in a 17-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Tachycardia and Premature ventricular contractions. On 13-Sep-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 VACCINATION COMPLICATION (Typical post vaccination side effects) and PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Son accidentally vaccinated at age 17). At the time of the report, VACCINATION COMPLICATION (Typical post vaccination side effects) and PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Son accidentally vaccinated at age 17) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication information was provided. No treatment medication were provided.


VAERS ID: 1722200 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Mississippi  
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 (MODERNA)) / MODERNA UNK / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Dose administered after improper storage and handling/a predrawn syringe that was left out for 24-36 hours; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Dose administered after improper storage and handling/a predrawn syringe that was left out for 24-36 hours) in a 46-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. UNK) for COVID-19 vaccination. No Medical History information was reported. On 13-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Dose administered after improper storage and handling/a predrawn syringe that was left out for 24-36 hours). On 13-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Dose administered after improper storage and handling/a predrawn syringe that was left out for 24-36 hours) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication was reported No treatment medication was reported


VAERS ID: 1722202 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Georgia  
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 (MODERNA)) / MODERNA 051A21A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Amnesia, Dyspnoea, Headache, Heart rate, Heart rate increased, Oesophageal pain, Pain in extremity, Palpitations
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CLONIDINE; LOSARTAN; AMLODIPINE; ALPRAZOLAM; XANAX; FLUOXETINE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Ischemia
Allergies:
Diagnostic Lab Data: Test Name: Heart rate; Result Unstructured Data: high
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: memory loss; shortness of breath; feels in her esophagus (in the middle of her chest) down to her stomach a burning sensation; arm hurts; headache; heart keeps racing; heart rate is really high; This spontaneous case was reported by a consumer and describes the occurrence of AMNESIA (memory loss), DYSPNOEA (shortness of breath), HEART RATE INCREASED (heart rate is really high), OESOPHAGEAL PAIN (feels in her esophagus (in the middle of her chest) down to her stomach a burning sensation) and PAIN IN EXTREMITY (arm hurts) in a 40-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 051A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Ischemia. Concomitant products included CLONIDINE, LOSARTAN, AMLODIPINE, ALPRAZOLAM, ALPRAZOLAM (XANAX) and FLUOXETINE for an unknown indication. On 13-Sep-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 HEART RATE INCREASED (heart rate is really high) and PALPITATIONS (heart keeps racing). On an unknown date, the patient experienced AMNESIA (memory loss), DYSPNOEA (shortness of breath), OESOPHAGEAL PAIN (feels in her esophagus (in the middle of her chest) down to her stomach a burning sensation), PAIN IN EXTREMITY (arm hurts) and HEADACHE (headache). At the time of the report, AMNESIA (memory loss), PAIN IN EXTREMITY (arm hurts) and HEADACHE (headache) outcome was unknown and DYSPNOEA (shortness of breath), HEART RATE INCREASED (heart rate is really high), OESOPHAGEAL PAIN (feels in her esophagus (in the middle of her chest) down to her stomach a burning sensation) and PALPITATIONS (heart keeps racing) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Heart rate: high (High) high. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Patient takes Hydrochlorizone , stomach pill as concomitant medication for unknown indication. Patient also take sucralaste for esophagus. Patient took Goodies Powder as treatment.


VAERS ID: 1722226 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Missouri  
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 (MODERNA)) / MODERNA 021C21A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Vaccination site pain
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Arm pain/arm is hurting; headache; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE PAIN (Arm pain/arm is hurting) and HEADACHE (headache) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 021C21A) for COVID-19 vaccination. No Medical History information was reported. On 13-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 13-Sep-2021, the patient experienced VACCINATION SITE PAIN (Arm pain/arm is hurting) and HEADACHE (headache). The patient was treated with ASPIRIN [ACETYLSALICYLIC ACID] for Headache, at an unspecified dose and frequency. At the time of the report, VACCINATION SITE PAIN (Arm pain/arm is hurting) had not resolved and HEADACHE (headache) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications was provided by the reporter.


VAERS ID: 1722512 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-11
Onset:2021-09-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Lip swelling, Migraine, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Lisinopril
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lips, migraine and nausea


VAERS ID: 1722680 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-09-13
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: hospitalized


VAERS ID: 1722726 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-30
Onset:2021-09-13
   Days after vaccination:136
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM

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

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

Write-up: Patient received the Pfizer vaccine on 4/9/21 and 4/30/21, so was fully vaccinated when they tested positive for COVID-19 on 9/13/21.


VAERS ID: 1722835 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-03
Onset:2021-09-13
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

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

Write-up: Heart beating rapidly would last for a few minutes happened a couple of times


VAERS ID: 1722884 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-03
Onset:2021-09-13
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

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

Write-up: About 1 week after vaccination started having heart palpitations lasting a few minutes never had before lasted for about 1 1/2 weeks off and on


VAERS ID: 1722972 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-01-18
Onset:2021-09-13
   Days after vaccination:238
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Haemorrhage, Maternal exposure before pregnancy, Ultrasound scan
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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: Estarylla Tablets 28s
Current Illness: None.
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data: Ultrasound confirming no heartbeat
CDC Split Type:

Write-up: I got a positive pregnancy test on 07/22/21. I had my first ultrasound on 8/18/21 everything was good, baby had a heartbeat. At my second visit on 9/13/21 my baby no longer had a heartbeat. I started bleeding on 9/12/21 the process ended on 9/14/21.


VAERS ID: 1722990 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-09-13
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Atrial fibrillation, COVID-19, Confusional state, Cough, Nausea, Pancytopenia, Pyrexia, SARS-CoV-2 test positive, Sepsis, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Myelodysplastic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: Patient presented to the ED with cough, nausea, vomitting, weakness, confusion, with fever. She tested positive for COVID a few days before. Started on decadron, oxygen, and inhalers. Developed pancytopenia. Started on vancomycin for suspected blood infection Developed atrial fibrillation with rapid ventricular response. Was given lopressor, amiodarone, magnesium, lasix, and atrovent. Patient started to vomit and was given zofran. Remdesivir was given as renal function improved. Patient is still hospitalized as of this moment. Barticinib is being considered.


VAERS ID: 1723028 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-16
Onset:2021-09-13
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, Cough, Cystitis, Decreased appetite, Diarrhoea, Dyspnoea, Fatigue, Nausea, Pyrexia, SARS-CoV-2 test positive, Sepsis, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient came to the ER with shortness of breath with any exertion, slight fever, cough, loss of appetite, diarrhea, fatigue, nausea, vomitting. Tested positive for COVID 11 days ago. Was given vancomycin for suspected sepsis. Also had acute kidney injury and treated with hydration. Cystitis was also present and treated with rocephin. Was given supportive care for COVID. Discharged in stable medical condition.


VAERS ID: 1723090 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-09
Onset:2021-09-13
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 pneumonia
SMQs:, Infective pneumonia (narrow), 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: APAP prn, melatonin prn
Current Illness: None
Preexisting Conditions: CAD, HLD, HTN, cataracts and a retinal detachment
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: 63 year old male patient was admitted to the hospital 9/13/2021 for Covid-19 pneumonia after full vaccination with Johnson and Johnson vaccine in April of 2021.


VAERS ID: 1723095 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-17
Onset:2021-09-13
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Diarrhoea
SMQs:, Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (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: ambien omeprazole naproxen oxybutynin metoprolol prolia
Current Illness: none
Preexisting Conditions: rheumatoid arthritis celiac disease gerd insomnia
Allergies: sulfa budesonide
Diagnostic Lab Data: Currently under workup with rheumatology and gastroenterology
CDC Split Type:

Write-up: diarrhea for several weeks joint pain and debility


VAERS ID: 1723133 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Florida  
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 (MODERNA)) / MODERNA 014F21A / 2 LA / IM

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

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

Write-up: VACCINE GIVEN TOO EARLY, GIVEN ON DAY 20


VAERS ID: 1723173 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-21
Onset:2021-09-13
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient was hospitalized due to COVID-19. Patient is fully vaccinated.


VAERS ID: 1723342 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-11
Onset:2021-09-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fluid retention, Hot flush, Pain in extremity, Peripheral swelling, Swollen tongue, Taste disorder
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Taste and smell disorders (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rabeprazole
Current Illness: NA
Preexisting Conditions: Asthma; rheumatoid arthritis
Allergies: Bactrim; Levaquin
Diagnostic Lab Data: NA
CDC Split Type: vsafe

Write-up: After the vaccination, I had hot flashes and a weird taste in my mouth. I also had pain in my arm the next day. My tongue started swelling two days later. I contacted the doctor via telephone and he prescribed prednisone for the swelling on my tongue. My feet have been really swollen and retaining a lot of water but as of today it seems to be getting a little better. After I took the prednisone it helped the swelling on my tongue.


VAERS ID: 1723399 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-19
Onset:2021-09-13
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EQ0161 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Angiogram pulmonary abnormal, Atelectasis, Blood culture, Blood gases abnormal, COVID-19, COVID-19 pneumonia, Cardiomegaly, Computerised tomogram thorax abnormal, Cough, Dyspnoea exertional, Headache, International normalised ratio increased, Lung consolidation, Oropharyngeal pain, Oxygen saturation decreased, PO2 decreased, Painful respiration, SARS-CoV-2 test positive, Walking distance test
SMQs:, Cardiac failure (broad), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Lactic acidosis (broad), Haemorrhage laboratory terms (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), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Allopurinol, finasteride, pravastatin, verapamil, enalapril, warfarin
Current Illness:
Preexisting Conditions: Morbid obesity, hypertension, hyperlipidemia, history of PE and DVT on chronic Coumadin, BPH, gout, CKD stage 3, history of right humerus fracture, history of small bowel obstruction, history of avascular necrosis of the right femur status post surgery, chronic venous insufficiency, hypothyroidism but not on any current medication. Fully vaccinated against COVID-19 with two doses of Pfizer vaccine, last 1 in April; history of elevated PSA, history of colonoscopy and sigmoidoscopy, history of prostate biopsy, history of right hip fracture surgery, history of left inguinal hernia repair, remote tonsillectomy, remote surgery for varicose veins.
Allergies: None
Diagnostic Lab Data: 9/16/21 COVID19: positive 9/16/21 Chest: 1. Cardiomegaly. Right basilar consolidation could represent atelectasis or pneumonia. Correlate clinically. 9/17/21 CTA chest: Findings compatible with COVID-19 pneumonia
CDC Split Type:

Write-up: He went out recently to a football game where most people were not wearing a mask, started to have sore throat, cough and headache going on for about 2-3 days and on 9/17/21 he had dyspnea on exertion and therefore came to emergency room. In the beginning he was saturating well. He did test positive for COVID-19 and the plan was for the ER to send him home after they give him Regeneron. However, when the patient tried to go to the restroom his saturations dropped to 88% on room air. His 1st ABG done in the ER showed a pO2 of 84.7%. I am not sure whether it was on room air or on oxygen, but the 2nd one repeated on room air showed a pO2 of only 58.8, and then the hospitalist service was called for admission. I have started the patient on Decadron and remdesivir since his onset of symptoms is just 2-3 days. His CT of the chest was done in the ER which is showing bibasilar pneumonia/consolidation, so the patient was started on Rocephin and Zithromax which I am going to continue. Blood cultures have already been sent. Sputum cultures have also been ordered. Patient will be admitted as an inpatient with a diagnosis of acute hypoxemic respiratory failure secondary to COVID-19 pneumonia. Pulmonary consult will be obtained in the morning as well. Please note, the patient is already on anticoagulation with Coumadin with INR of 1.8. He takes it for history of PEs and DVTs. Patient denies any chest pain except occasionally when he tries to take a deep breath. He is unable to produce any sputum when he coughs. Says he has chronic right lower extremity swelling, which he attributes after surgery on that leg and the fact that he has had DVT in the right lower extremity as well. Was admitted on 9/17/21. Dexamethasone, remdesivir, vitamin C, vitamin D, ceftriaxone, and azithromycin started.Was placed on 3 L of oxygen via nasal cannula and was saturating well. He denies any significant complaints of breathing. Remained afebrile. Was also treated with remdesivir and Decadron. He continued to remain stable. He did complete 5 day course of remdesivir. Oxygen walk was performed on 09/21/2021. Required no oxygen at rest, 3 L with exertion. Discharged on 9/22/21


VAERS ID: 1723414 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-04
Onset:2021-09-13
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Oral pain, Pruritus, Rash, Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Immediately after the shot, I was fine. I was tired a few hours later, but nothing out of the ordinary. The next morning, I had a soreness or rawness in the upper, back part of my mouth, near the nasal area. It went away by 11am. Sept 13, nine days after my first shot, I noticed what felt like itchiness all over my body, mostly on my back. There was a noticeable rash from the lower left portion of my neck all the way down the full of my back, to my upper buttox. The rash went away by Sept 20th, but there is still some slight itchiness on my arms and legs. It seems to be going away.


VAERS ID: 1723572 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-17
Onset:2021-09-13
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 AR / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Burning sensation, Cough, Dyspnoea exertional, Dysstasia, Eye pain, Fatigue, Feeling abnormal, Flushing, Headache, Impaired work ability, Migraine, Mobility decreased, Nausea, Pyrexia, SARS-CoV-2 test, Sinusitis
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (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: Vitamin D; Magnesium; Selenium; Calcium; Seaweed and or Kelp; Lysine; Potassium; Vitamin C; Vitamin B
Current Illness:
Preexisting Conditions: Hashimoto''s Disease; Scoliosis; ADHD; Insomnia; Sleep Apnea
Allergies: Digestive Intolerance to Scallops; Intolerance to Cigarettes'' smoke
Diagnostic Lab Data: COVID Test 08/23/2021
CDC Split Type: vsafe

Write-up: I woke up on 08/13/2021 with a migraine, nausea and swollen sinuses. My eyeballs and skull hurt. I also had a constricted cough. I blew it off and thought maybe it was the air condition or the fires. I did a nasal wash and took some cough medicine but they didn''t do anything. On the following Tuesday I fell asleep in my recliner and woke up at about 8:30PM burning up with a flush face. I had my thermometer right there and ran a 100.5. I took a picture of the thermometer and sent it to my brother. I went back to sleep and then woke up the next morning and took my temperature. My temperature was elevated at 98.8. Before I went to work I called my boss and ask what the procedure was for coming to work after a fever. I took that Tuesday off and then worked the rest of the week. I still felt like crap. I''m coughing more, I''m fatigued and have a headache. By Friday of the next week I was trying to get ahold of someone on what to do. I was waiting for that Monday 08/23/2021. Everybody was going to be back to work so I didn''t want to go and contaminate everyone. The healthcare physician said I didn''t need a referral and set me up with a zoom call regarding my symptoms. The doctor counted my dates from 08/13 and said based on my symptoms he asked me to get a nasal swab test. He said it was day 13 and was going to move my quarantine out to 21 days unless I feel better. I couldn''t stand up long enough to make food. My neighbors and brother dropped off food for me. Just walking had me winded. I didn''t go out and get my mail for an entire week because going to my front porch would have me winded. I would have to go outside to pick up the food off the porch for me then go sit down because I was so winded. The week before I went back to work was the worst. On 08/25/2021 was the worst. The only time my stomach felt better was after I ate food and that was for about an hour. Then after it would feel like someone was squeezing my stomach. Every few hours I would have a coughing fit. The first few days after work I had to stop stop up this ladder and get my breath to continue going. 09/15/2021 and 09/16/2021 I feel back to myself and a lot better.


VAERS ID: 1723603 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: California  
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 FD0809 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: No adverse event, Product reconstitution quality issue
SMQs:, Medication errors (broad)

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

Write-up: Patient received a higher concentration dose of Pfizer COVID-19 Vaccine. Dilution of vial was done with 1.3mL of NS. Only this patient affected. Rest of vial was discarded. Patient did NOT experience any adverse S/S during 45-minute observation at field site. No concern by Lead RN for release. Patient verbalized feeling OK before release.


VAERS ID: 1723872 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-15
Onset:2021-09-13
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Confusional state, Dehydration, Hypoxia, Mental status changes, Toxic encephalopathy
SMQs:, Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: o Altered mental status characterized by confusion likely due to dehydration in the setting of COVID-19 o Toxic metabolic encephalopathy secondary to above o Acute hypoxia secondary to COVID-19 pneumonia


VAERS ID: 1724450 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Feeling abnormal, Fibrin D dimer, Full blood count, Headache, Heavy menstrual bleeding, International normalised ratio, Menstrual disorder, Myalgia, Palpitations, Paraesthesia, Paraesthesia oral, Pruritus
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vit D and C
Current Illness: no
Preexisting Conditions: no
Allergies: sulfonamides
Diagnostic Lab Data: 9/17 CBC, d-dimer, INR - wnl Awaiting more labs
CDC Split Type:

Write-up: D1 severe headache, palpitations, achy joint/muscles, fatigue D2 Headache, achy joint/muscle fatigue D3 mild headache, brain fog, tingle/itching face (lips), fatigue, started menstural cycle 4 days early and heavy bleeding D4 - present: mild constant headaches, brain fog, tingling legs and lips, fatigue


VAERS ID: 1724463 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cellulitis, Rash, Vaccination site induration, Vaccination site swelling
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Escitalopram 20 mg
Current Illness: n/a
Preexisting Conditions: depression
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient developed a rash and the vaccination site was swollen and hard. She was diagnosed w/ cellulitis at the ER and got a prescription for Cephalexin and as of 9/22/21 should have started on the antibiotics. We are still waiting to see if there is any improvements.


VAERS ID: 1725343 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-01
Onset:2021-09-13
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Anal incontinence, Diarrhoea, Muscle spasms, Pain in extremity
SMQs:, Pseudomembranous colitis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: TESTOSTERONE CYPIONATE; EFFEXOR; ADDERALL; CLONAZEPAM
Current Illness:
Preexisting Conditions: Comments: No medical history reported.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: inability to control diarrhea; arm pain in left arm; severe painful cramps; diarrhea; This spontaneous case was reported by a consumer and describes the occurrence of ANAL INCONTINENCE (inability to control diarrhea), PAIN IN EXTREMITY (arm pain in left arm), MUSCLE SPASMS (severe painful cramps) and DIARRHOEA (diarrhea) in a 49-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No medical history reported. Concomitant products included TESTOSTERONE CIPIONATE (TESTOSTERONE CYPIONATE), VENLAFAXINE HYDROCHLORIDE (EFFEXOR), AMFETAMINE ASPARTATE, AMFETAMINE SULFATE, DEXAMFETAMINE SACCHARATE, DEXAMFETAMINE SULFATE (ADDERALL) and CLONAZEPAM for an unknown indication. In August 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 12-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 13-Sep-2021, the patient experienced ANAL INCONTINENCE (inability to control diarrhea), PAIN IN EXTREMITY (arm pain in left arm), MUSCLE SPASMS (severe painful cramps) and DIARRHOEA (diarrhea). The patient was treated with PARACETAMOL (TYLENOL) in September 2021 for Pain in arm, at a dose of 1 UNK. At the time of the report, ANAL INCONTINENCE (inability to control diarrhea), PAIN IN EXTREMITY (arm pain in left arm), MUSCLE SPASMS (severe painful cramps) and DIARRHOEA (diarrhea) outcome was unknown.


VAERS ID: 1725356 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Sexual dysfunction
SMQs:, Sexual dysfunction (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Patient can''t perform sexually since he got the shot; This spontaneous case was reported by a consumer and describes the occurrence of SEXUAL DYSFUNCTION (Patient can''t perform sexually since he got the shot) in a 35-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 047c21a) for COVID-19 vaccination. No Medical History information was reported. On 13-Sep-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 SEXUAL DYSFUNCTION (Patient can''t perform sexually since he got the shot). At the time of the report, SEXUAL DYSFUNCTION (Patient can''t perform sexually since he got the shot) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant medications were not provided by reporter. Treatment information was not provided by reporter.


VAERS ID: 1725365 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNK / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Dose administered after improper storage and handling; This spontaneous case was reported by a pharmacist and describes the occurrence of PRODUCT STORAGE ERROR (Dose administered after improper storage and handling) in a 47-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. UNK) for COVID-19 vaccination. No Medical History information was reported. On 13-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Sep-2021, the patient experienced PRODUCT STORAGE ERROR (Dose administered after improper storage and handling). At the time of the report, PRODUCT STORAGE ERROR (Dose administered after improper storage and handling) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Concomitant medications were provided No treatment medications were provided.


VAERS ID: 1725397 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-06
Onset:2021-09-13
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Chills, Nasopharyngitis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VALSARTAN; VITAMIN D 2000
Current Illness: Allergy to antibiotic (Allergic to tetracycline); Allergy to antibiotic (Allergic to clindamycin)
Preexisting Conditions: Medical History/Concurrent Conditions: Blood disorder NOS (that makes her susceptible to Deep vein thrombosis); Fatigue (from January until February); Fever (from January until February)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Cold; shivering, Chills; fever ramped up all day long; horrible joint pain; This spontaneous case was reported by a consumer and describes the occurrence of NASOPHARYNGITIS (Cold), CHILLS (shivering, Chills), PYREXIA (fever ramped up all day long) and ARTHRALGIA (horrible joint pain) in a 69-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 029A21A, #016B21A and #048F21A) for COVID-19 vaccination. The patient''s past medical history included Blood disorder NOS (that makes her susceptible to Deep vein thrombosis), Fever (from January until February) and Fatigue (from January until February). Concurrent medical conditions included Allergy to antibiotic (Allergic to tetracycline) and Allergy to antibiotic (Allergic to clindamycin). Concomitant products included VALSARTAN and CALCIUM CARBONATE, COLECALCIFEROL (VITAMIN D 2000) for an unknown indication. On 06-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 12-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 12-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 13-Sep-2021, the patient experienced NASOPHARYNGITIS (Cold), CHILLS (shivering, Chills), PYREXIA (fever ramped up all day long) and ARTHRALGIA (horrible joint pain). On 13-Sep-2021, CHILLS (shivering, Chills) and ARTHRALGIA (horrible joint pain) had resolved. On 14-Sep-2021, PYREXIA (fever ramped up all day long) had resolved. At the time of the report, NASOPHARYNGITIS (Cold) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) and mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown Route) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown Route), the reporter did not provide any causality assessments. No treatment information provided. It was reported that she might had COVID-19 in January 2021 but there were no available COVID-19 test that time. This case was linked to MOD-2021-320892 (Patient Link).


VAERS ID: 1725451 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-04
Onset:2021-09-13
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Hypertension, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow)

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

Write-up: Extreme High Blood pressure Nausea


VAERS ID: 1725557 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-20
Onset:2021-09-13
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data: Test Date: 20210913; Test Name: Covid 19 Test; Test Result: Positive
CDC Split Type: USPFIZER INC202101219419

Write-up: COVID-19 confirmed by positive COVID-19 test; COVID-19 confirmed by positive COVID-19 test/ Severe Coughing/ a little bit of a headache/ also cannot taste well; This is a spontaneous report from a contactable consumer (patient father). A 19-years-old male patient received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Lot Number: ER2613, Expiration date was not reported) via an unspecified route of administration on 09Mar2021 (at the age of 19 years) as dose 1, single and second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Lot Number: ER2613, Expiration date was not reported), via an unspecified route of administration on 20Apr2021 (at the age of 19 years) as dose 2, single, both for covid-19 immunization. Patient had no medical history and family medical history relevant to events. The patient''s concomitant medications were not reported. Patient did not take any other vaccinations within four weeks prior to the first administration date of the suspect vaccine and no other vaccines on same date of the vaccination. On an unknown date, patient experienced severe coughing and a little bit of a headache and patient decided to get tested for covid-19. The symptoms were still persisting. Patient also cannot taste well. On 13Sep2021, patient got covid-19 confirmed by positive covid-19 test, after both doses of vaccine. Product complaint was reported as yes. Patient did not visit to emergency room or physician office. The clinical outcome for the events was unknown. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1725618 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-11
Onset:2021-09-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye pruritus, Ocular hyperaemia, Periorbital swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Glaucoma (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101233483

Write-up: Extremely itchy eyes; Slight swelling under eyes; Redness of eyes; This is a spontaneous report from a contactable consumer, the patient. A 44-year-old male patient received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FF8839) via an unspecified route of administration in the left arm on 11Sep2021 at 12:00 (at the age of 44-years-old) as a single dose for COVID-19 immunisation. Medical history was not reported. The patient had no known allergies. 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 COVID-19 vaccine. Concomitant medications were not reported. On 13Sep2021 the patient experienced extremely itchy eyes, slight swelling under eyes and redness of eyes. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Therapeutic measures were not taken for the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events extremely itchy eyes, slight swelling under eyes and redness of eyes was not resolving at the time of this report.


VAERS ID: 1726004 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-12
Onset:2021-09-13
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 UN / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 UN / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, Blood creatinine increased, Blood sodium decreased, COVID-19, Chest X-ray abnormal, Dyspnoea, Glomerular filtration rate decreased, Lung infiltration, Malaise, Metabolic function test, Pollakiuria, Pulmonary vascular disorder, Pyrexia, Renal impairment, SARS-CoV-2 test positive, Urinary tract infection, Urine analysis abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (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 (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, Aspirin, Atorvastatin, Cephalexin, Vitamin D, Desitin, Ferrous sulfate, Lasix, hydralazine, Lantus, Synthroid, Cozaar, nutritional supplements, miralax
Current Illness:
Preexisting Conditions: New onset seizure Peripheral vascular disease Atrial fibrillation History of TIA (transient ischemic attack) Well adult health check Anemia Aortic stenosis Hyponatremia Chronic diastolic heart failure Decubitus ulcer At risk for falls Pulmonary hypertension Type 2 diabetes mellitus Hypercholesteremia Hypertension Retinopathy Coronary artery disease
Allergies: Amiodarone
Diagnostic Lab Data: Chest X-ray 9/18/21: Suspect faint patchy bilateral infiltrates, and mild increased prominence of pulmonary vasculature.
CDC Split Type:

Write-up: Hospitalized 9/18/2021; COVID-19 positive on 9/13/2021; fully vaccinated Patient is a 91-year-old woman with past medical history of diastolic congestive heart failure, aortic stenosis, coronary artery disease, pulmonary hypertension, hypertension, chronic atrial fibrillation not on anticoagulation, history of TIA, seizures, type 2 diabetes and history of chronic hyponatremia due to fluid overload. Presented to the emergency department as she was not feeling well and experiencing generalized weakness and shortness of breath. She got tested positive for COVID on 09/13/2021. In the emergency department patient was febrile at 38.6? F otherwise hemodynamically stable. She was able to breathe comfortably on room air. Her labs were consistent with sodium of 125 and urine analysis was positive for urinary tract infection. Since patient was complaining of urinary frequency over the past few days she was started on IV Rocephin for possible cystitis. In the absence of hypoxia she did not receive Decadron or remdesivir. She received regeneron monoclonal antibody infusion while she was hospitalized here during this admission. Repeat labs showed improvement in sodium levels at 1:30 a.m. however patient''s kidney function was altered with some AKI with creatinine of 1.2 to and GFR of 41. She will need repeat BMP on Monday to reassess her kidney function and sodium levels. Her AKI could be related to fluid overload from the monoclonal antibody infusion that she received. PCP to follow patient''s BMP. She was evaluated at the time of discharge for the need of home oxygen and did not require any oxygen per Pulmonary Rehab. She was discharged home with home care services on 9/19/21.


VAERS ID: 1726172 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Malaise, Menstruation irregular
SMQs:, Fertility disorders (broad), Arthritis (broad)

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

Write-up: Pt stated that she began her period soon after dose and has bleed continuously up to today. Pt states that she is feeling joint pain that is new onset. Pt states an overall malaise. Advised pt to seek medical care immediately regarding adverse events from COVID-Pfizer vaccination.


VAERS ID: 1726178 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-15
Onset:2021-09-13
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Mouth ulceration
SMQs:, Severe cutaneous adverse reactions (broad), Systemic lupus erythematosus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: BLOODY NOSE FOR 2 WEEKS
Other Medications: Metoprolol, Avorvastatin
Current Illness: none
Preexisting Conditions: Heart disease
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: MOUTH ULCER


VAERS ID: 1726509 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-30
Onset:2021-09-13
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient was admitted to the hospital with COVID symptoms and was treated with typical COVID medications. Patient remains in hospital.


VAERS ID: 1726583 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Doxycycline hyclate 100 mg take 1 tab BID Narcan 4 mg/actuation nasal spray PRN Suboxone 8/2 mg SL 1 film BID Vistaril 50 mg take 2 caps TID, may take 1 extra cap @ HS Wellbutrin 300 ER take 1 tab daily
Current Illness: Opioid Use Disorder, Palpitations, Tobacco Use
Preexisting Conditions: Opioid Use Disorder, Palpitations, Tobacco Use
Allergies: no known allergies
Diagnostic Lab Data: Opioid Use Disorder, Palpitations, Tobacco Use
CDC Split Type:

Write-up: patient was given expired vaccine


VAERS ID: 1726660 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-20
Onset:2021-09-13
   Days after vaccination:236
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose12/30/21 2nd dose01/21/21 Diagnosed covid positive:09/15/21 Symptom onset:09/13/21 Exposure:community Symptoms:cough,fatigue,runny nose, HA


VAERS ID: 1726671 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-10
Onset:2021-09-13
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Myalgia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose12/20/21 2nd dose01/10/21 Diagnosed covid positive:09/15/21 Symptom onset:09/13/21 Exposure:home Symptoms:cough,fatigue,muscleaches


VAERS ID: 1726777 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-01-08
Onset:2021-09-13
   Days after vaccination:248
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 UN / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Influenza like illness, Pain, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: staff member did not identify
Current Illness: none identified
Preexisting Conditions: none identified
Allergies: staff member did not identify
Diagnostic Lab Data: vikor PCR test done 9/13/21
CDC Split Type:

Write-up: routine covid testing due to outbreak. Staff member had flu like symptoms and body ache


VAERS ID: 1726826 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-29
Onset:2021-09-13
   Days after vaccination:227
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Diarrhoea, Fatigue, Headache, Myalgia, Pyrexia, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

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

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose01/08/21 2nd dose01/29/21 Diagnosed covid positive:09/13/21 Symptom onset:09/13/21 Exposure:Home Symptoms:fever,cough,fatigue,muscle aches,loss of smell/taste,diarrhea,runny nose,HA


VAERS ID: 1726827 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-02-26
Onset:2021-09-13
   Days after vaccination:199
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Feeling cold, Headache, Rhinorrhoea, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose02/05/21 2nd dose02/26/21 Diagnosed covid positive:09/13/21 Symptom onset:09/13/21 Exposure:travel Symptoms:Cough,fatighue,chills,runnynose,HA


VAERS ID: 1726832 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Unknown  
Location: New York  
Vaccinated:2021-01-28
Onset:2021-09-13
   Days after vaccination:228
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose01/07/21 2nd dose01/28/21 Diagnosed covid positive:09/13/21 Symptom onset: Exposure: Symptoms:Asymptomatic


VAERS ID: 1727002 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-19
Onset:2021-09-13
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 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 unknown


VAERS ID: 1727026 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-11
Onset:2021-09-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 - / SYR

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

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

Write-up: Shingles


VAERS ID: 1727070 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Decreased appetite, Fatigue, Myalgia, Myositis, Nausea, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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), 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? No
Hospitalized? No
Previous Vaccinations: pertussis - 1980s with standard childhood vaccination - fever/crying /swelling per parent report. Pediatrician then tried seria
Other Medications: asa 81 mg qDaily loratadine 10 mg qDaily
Current Illness: none
Preexisting Conditions: BMI - 33
Allergies: pertussis vaccine MSG
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had same symptoms as when I had strain COVID19 in 4/2020; but with vaccine I had more pronounced/higher fevers and worse fatigue/myalgias/myositis. fever to 103.5 lasted until 9/14 when defervesced with RTC tylenol. chills lasted until 9/15 nausea and vomiting/anorexia lasted until 9/14 treated with zofran myalgias/myositis lasted until 9/17-18 treated with RTC tylenol headache lasted until 9/15 and resolved with tylenol fatigue lasted until 9/15


VAERS ID: 1727240 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-02-22
Onset:2021-09-13
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 2 LA / IM

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

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

Write-up: Shingles outbreak, right abdomen and back.


VAERS ID: 1727428 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-06
Onset:2021-09-13
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Pain, Pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (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: Chronic Lung Disease, Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is hospitalized with pneumonia and COVID-19. Patient is having a difficult time breathing, mild cough, and pains. Patient was seen at facility on 09/13/2021 and was there until a bed was available at Hospital where he is currently. Patient is fully vaccinated.


VAERS ID: 1728699 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-17
Onset:2021-09-13
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ED 8448 / UNK - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abortion spontaneous, Blood test, Exposure during pregnancy, Pregnancy test positive, Ultrasound scan, Uterine dilation and evacuation
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow), Normal pregnancy conditions and outcomes (narrow)

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
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: Bloodwork, ultrasound, surgical procedure needed.
CDC Split Type:

Write-up: Took 1st vaccine without knowing I was pregnant. 1 week later, had a positive pregnancy test. GYN/OB office advised me to wait until I was 8 weeks pregnant to have my first prenatal appointment. On Sept 13th, I found out at MD office, there was no heart beat, only yolk present. Which indicated a miscarriage. I needed and D&E procedure which was performed on 9/23/21.


VAERS ID: 1728789 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-24
Onset:2021-09-13
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Ear pain, Erythema, Otitis media
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: I drink one packet of Emergen-C Immune daily.
Current Illness: N/A
Preexisting Conditions: Asthma
Allergies: Phenergan, Compazine, Zithromax, Reglan, Amoxicillin, Penicillin, Prozac
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Left ear started hurting on 9/13/2021. I took Tylenol and it helped a little. On 9/14/2021 my ear hurt a lot more so I went to Urgent Care. The Dr. said my left ear looked red and diagnosed me with Left Otitis Media and prescribed 100 mg twice daily of Doxycyline and to take Motrin or Tylenol for pain/discomfort.


VAERS ID: 1728854 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-11
Onset:2021-09-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash, Rash vesicular
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: After I received the Pfizer vaccine, I developed severe painful, blistery rashes all over both hands, palms , wrist & forearm? This lead me to urgent care and I had to be prescribed antibiotic cream.


VAERS ID: 1729073 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Neuralgia, Paraesthesia, Product administered at inappropriate site
SMQs:, Peripheral neuropathy (narrow), Drug abuse and dependence (broad), Guillain-Barre syndrome (broad), Medication errors (narrow), Sexual dysfunction (broad)

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

Write-up: Patient states the pharmacist who administered the vaccine gave it too low on her arm. She pointed to halfway between her shoulder and her elbow and the spot the vaccine was given. Patient states she has been experiencing nerve pain ever since including numbness and tingling.


VAERS ID: 1729324 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Full blood count, Heart rate increased, Influenza virus test, Pain, Pyrexia
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), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine 2.5 mg, Paxil 20 mg, Celebrex 200 mg, Omeprazile 40 mg, Ferrous Sulfate 325 mg
Current Illness: None
Preexisting Conditions: GERD, Reynauds, Anxiety
Allergies: Sulfa
Diagnostic Lab Data: CBC and flu test 9-14-2021
CDC Split Type:

Write-up: Shortness of breath, elevated pulse, dizziness, fever, and body aches


VAERS ID: 1730281 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Decreased appetite, Feeling abnormal, Headache, Nausea, Pain, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data: Test Date: 20210914; Test Name: Body temperature; Result Unstructured Data: Fever up to 101 degrees F
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: No appetite; Very painful body aches; Felt really crappy; A little nausea; Fever up to 101 degrees F; Headache; Sore arm; This spontaneous case was reported by an other health professional and describes the occurrence of DECREASED APPETITE (No appetite), PAIN (Very painful body aches), PAIN IN EXTREMITY (Sore arm), FEELING ABNORMAL (Felt really crappy) and NAUSEA (A little nausea) in a 25-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 048F21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included COVID-19 in March 2021. On 13-Sep-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 PAIN IN EXTREMITY (Sore arm) and HEADACHE (Headache). On 14-Sep-2021, the patient experienced DECREASED APPETITE (No appetite). 14-Sep-2021, the patient experienced PAIN (Very painful body aches), FEELING ABNORMAL (Felt really crappy), NAUSEA (A little nausea) and PYREXIA (Fever up to 101 degrees F). The patient was treated with PARACETAMOL (TYLENOL) in September 2021 for Fever, at an unspecified dose and frequency; IBUPROFEN in September 2021 for Fever, at an unspecified dose and frequency and MENTHOL (BIOFREEZE PAIN RELIEVING) in September 2021 for General body pain, at an unspecified dose and frequency. At the time of the report, DECREASED APPETITE (No appetite), PAIN (Very painful body aches), PAIN IN EXTREMITY (Sore arm), FEELING ABNORMAL (Felt really crappy), NAUSEA (A little nausea) and HEADACHE (Headache) outcome was unknown and PYREXIA (Fever up to 101 degrees F) was resolving. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 14-Sep-2021, Body temperature: 101 (High) Fever up to 101 degrees F. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported.


VAERS ID: 1730312 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-09-13
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 2 RA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Second dose is non Moderna Vaccine; This spontaneous case was reported by a nurse and describes the occurrence of INTERCHANGE OF VACCINE PRODUCTS (Second dose is non Moderna Vaccine) in an 18-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Co-suspect product included non-company product TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE) for COVID-19 vaccination. No Medical History information was reported. On 13-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 received second dose of TOZINAMERAN (PFIZER BIONTECH COVID-19 VACCINE) (Intramuscular) 1 dosage form. On 13-Sep-2021, the patient experienced INTERCHANGE OF VACCINE PRODUCTS (Second dose is non Moderna Vaccine). On 13-Sep-2021, INTERCHANGE OF VACCINE PRODUCTS (Second dose is non Moderna Vaccine) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. The patient did not had any adverse reaction or symptoms. No concomitant medications were reported. No treatment information was reported.


VAERS ID: 1730493 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-08
Onset:2021-09-13
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 1 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Polymerase chain reaction, SARS-CoV-2 test positive, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210913; Test Name: PCR; Test Result: Positive ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC202101219151

Write-up: lack of efficacy- fully vaccinated with CV19 + via PCR on 15Sep2021.; lack of efficacy- fully vaccinated with CV19 + via PCR on 15Sep2021.; This is a spontaneous report from a contactable other healthcare professional. A 32-year-old female patient received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, solution for injection), via intramuscular route, administered in arm left on 08Apr2021 (Lot Number ER8729 and expiry date was not reported, at the age of 31-year-old) as single dose and second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, solution for injection), via intramuscular route, administered in arm left on 29Apr2021 (Lot Number ER8736 and expiry date was not reported, at the age of 32-year-old) as single dose for COVID-19 immunization. The patient medical history and concomitant medications were not reported. It was unknown if the patient received any other vaccines within 4 weeks prior to the COVID vaccine. It was unknown whether the patient was diagnosed with COVID-19 prior to vaccination. Since the vaccination, the patient had been tested for COVID-19. On 13Sep2021, the patient underwent COVID test post vaccination, PCR (Nasal Swab) which was positive. It was unknown if patient received treatment for AE. It was reported lack of efficacy- fully vaccinated with CV19 + via PCR event reported on 15Sep2021. Device Date was 16Sep2021. Outcome of the event was recovering. No follow-up attempts are possible. No further information is expected.; Sender''s Comments: Based on the temporal relationship the causal role between the events Vaccination failure and SARS-CoV-2 test positive cannot be fully excluded. However the possibility of Covid being an intercurrent condition cannot be ruled out.


VAERS ID: 1730716 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 - / OT
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Previously received a complete series of a non-WHO approved vaccine; Moderna vaccine were inadvertently given past the vaccine beyond-use-date (i.e. past 30 days at fridge temperature) of 05-Sep-2021; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Moderna vaccine were inadvertently given past the vaccine beyond-use-date (i.e. past 30 days at fridge temperature) of 05-Sep-2021) and INTERCHANGE OF VACCINE PRODUCTS (Previously received a complete series of a non-WHO approved vaccine in a 19-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007C21A) for COVID-19 vaccination. Co-suspect product included non-company product COVID-19 VACCINE INACT W.VIRION NIV-2020-770 ([COVID-19 VACCINE INACT W.VIRION NIV-2020-770]) for COVID-19 vaccination. No Medical History information was reported. On 13-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient received first dose of COVID-19 VACCINE INACT W.VIRION NIV-2020-770 ([COVID-19 VACCINE INACT W.VIRION NIV-2020-770]) (unknown route) 1 dosage form. On 13-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Moderna vaccine were inadvertently given past the vaccine beyond-use-date (i.e. past 30 days at fridge temperature) of 05-Sep-2021). On an unknown date, the patient experienced INTERCHANGE OF VACCINE PRODUCTS (Previously received a complete series of a non-WHO approved vaccine ()). On 13-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Moderna vaccine were inadvertently given past the vaccine beyond-use-date (i.e. past 30 days at fridge temperature) of 05-Sep-2021) had resolved. At the time of the report, INTERCHANGE OF VACCINE PRODUCTS (Previously received a complete series of a non-WHO approved vaccine had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment details were reported. The date of manufacture of vaccine was reported as 12-Mar-2021. The date that the vial was 30 days in the refrigerator was 05-Sep-2021. This case was linked to MOD-2021-320340, MOD-2021-320812, MOD-2021-320833, MOD-2021-320902, MOD-2021-321000, MOD-2021-321030, MOD-2021-321058, MOD-2021-321061, MOD-2021-321072, MOD-2021-321076, MOD-2021-321086, MOD-2021-321106 (Patient Link).


VAERS ID: 1730744 (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: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: previously received a complete series of COVID-19 vaccine; Administration date of Moderna vaccine past the BUD; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Administration date of Moderna vaccine past the BUD) and INTERCHANGE OF VACCINE PRODUCTS (previously received a complete series of COVID-19 vaccine) in a 21-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007C21A) for COVID-19 vaccination. No Medical History information was reported. On 13-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 13-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Administration date of Moderna vaccine past the BUD). On an unknown date, the patient experienced INTERCHANGE OF VACCINE PRODUCTS (previously received a complete series of COVID-19 vaccine). On 13-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Administration date of Moderna vaccine past the BUD) had resolved. At the time of the report, INTERCHANGE OF VACCINE PRODUCTS (previously received a complete series of COVID-19 vaccine) had resolved. Not Provided For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medications were not provided. Treatment information was not provided. This case was linked to MOD-2021-320876.


VAERS ID: 1730931 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-09
Onset:2021-09-13
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: COVID Test; Test Result: Positive ; Result Unstructured Data: positive
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Tested positive for covid; This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 (Tested positive for covid) in a 26-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 09-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 13-Sep-2021, the patient experienced COVID-19 (Tested positive for covid). At the time of the report, COVID-19 (Tested positive for covid) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: positive (Positive) positive. No concomitant medication details were provided. No treatment medication details were provided.


VAERS ID: 1730939 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-10
Onset:2021-09-13
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Dysphagia, Feeling abnormal, Feeling of body temperature change, Influenza, Insomnia, Limb discomfort, Malaise, Nausea, Oxygen saturation, Pain in extremity, Peripheral coldness
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Ulcerative colitis.
Allergies:
Diagnostic Lab Data: Test Name: oxygen saturation; Result Unstructured Data: Result : oxygen level would go down to 92
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Hot and cold flashes; Couldn''t sleep; Forcing food down; Just didn''t have the energy; Left arm felt like I was kicked by a donkey,pressure on boht arms and radiates to my right arm; [third dose] really kicked my butt; nauseous; Worst flu that I''ve ever had; Getting really cold in the extremities in my fingers and toes; Felt icky; Arm was really sore; This spontaneous case was reported by a consumer and describes the occurrence of MALAISE ([third dose] really kicked my butt), PERIPHERAL COLDNESS (Getting really cold in the extremities in my fingers and toes), FEELING ABNORMAL (Felt icky), INFLUENZA (Worst flu that I''ve ever had) and FEELING OF BODY TEMPERATURE CHANGE (Hot and cold flashes) in a 44-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 048F21A, 044A21A and 007M20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Ulcerative colitis. On 10-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 17-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 13-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 13-Sep-2021, the patient experienced PERIPHERAL COLDNESS (Getting really cold in the extremities in my fingers and toes), FEELING ABNORMAL (Felt icky) and PAIN IN EXTREMITY (Arm was really sore). On 14-Sep-2021, the patient experienced INFLUENZA (Worst flu that I''ve ever had). On an unknown date, the patient experienced MALAISE ([third dose] really kicked my butt), FEELING OF BODY TEMPERATURE CHANGE (Hot and cold flashes), INSOMNIA (Couldn''t sleep), DYSPHAGIA (Forcing food down), ASTHENIA (Just didn''t have the energy), LIMB DISCOMFORT (Left arm felt like I was kicked by a donkey,pressure on boht arms and radiates to my right arm) and NAUSEA (nauseous). At the time of the report, MALAISE ([third dose] really kicked my butt), PERIPHERAL COLDNESS (Getting really cold in the extremities in my fingers and toes), FEELING ABNORMAL (Felt icky), INFLUENZA (Worst flu that I''ve ever had), FEELING OF BODY TEMPERATURE CHANGE (Hot and cold flashes), INSOMNIA (Couldn''t sleep), DYSPHAGIA (Forcing food down), ASTHENIA (Just didn''t have the energy), LIMB DISCOMFORT (Left arm felt like I was kicked by a donkey,pressure on boht arms and radiates to my right arm), PAIN IN EXTREMITY (Arm was really sore) and NAUSEA (nauseous) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Oxygen saturation: 92 (Low) Result : oxygen level would go down to 92. Concomitant product was not provided by the reporter. No treatment information was provided.


VAERS ID: 1731431 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-01
Onset:2021-09-13
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dermatitis, Erythema, Pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), 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: Oral contraceptive, Welbuterin, 400 MG magnesium, vitamin D3, inhaler on occasion
Current Illness: None
Preexisting Conditions: Asthma
Allergies: None
Diagnostic Lab Data: No tests. Emailed my Healthcare team. They confirmed it was a side effect and I was told to take benadryl. Nothing else they can do. Not sure how long symptoms will last.
CDC Split Type:

Write-up: Unbearable itchiness of the left breast and nipple. Tattoo in area raised and inflamed. Redness and pain from scratching uncontrollably.


VAERS ID: 1731502 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-01
Onset:2021-09-13
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine, aspirin, atorvastatin, calcium acetate, cefadroxil, clopidogrel, dexamethasone, docusate sodium, doxazosin, famotidine, furosemide, insulin glargine, losartan, metoprolol tartrate, neosporin topical, vitamin D.
Current Illness:
Preexisting Conditions: anemia in CKD, anxiety, arthritis, asthma, BPPV due to bilateral vestibular disorder, bilateral hearing loss, obesity, cataract, CKD (end stage, on dialysis), CAD, diabetes, chronic edema of right lower extremity, HTN, GERD, osteoarthrosis, hypercholesterolemia, legal blindness, malignant melanoma of ankle, osteoporosis,
Allergies: acarbose, morphine, lisinopril
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received full vaccination series for the Moderna COVID-19 vaccine. Pt subsequently still became ill with covid and needed treatment. She began having symptoms of COVID on 9/9/2021 and tested positive for the virus on 9/13/2021. Pt presented 9/16/2021 to outside ED, transferred here due to lack of closer facilities that could both treat COVID and had inpatient dialysis. Discharged from this hospital on 9/22/2021.


VAERS ID: 1731532 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-03-03
Onset:2021-09-13
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Diagnosed and Hospitalized with COVID


VAERS ID: 1731617 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-28
Onset:2021-09-13
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: alendronate, atorvastatin, calcium, cartia, lisinopril, metformin, metoprolol, multivitamin, trazodone, venlafaxine, warfarin.
Current Illness:
Preexisting Conditions: anxiety, arrhythmia, arthritis, afib, hx breast cancer, chronic anticoagulation, depression, DM type 2, GERD, hyperlipidemia, HTN, OCD, osteopenia, urinary retention, varicose veins of lower extremities with inflammation.
Allergies: Sulfa abx
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt fully vaccinated with the Pfizer vaccine against COVID 19, on 3/7/2021 and 3/28/2021. Pt tested positive for covid on 9/13/2021. Presented to our ED on 9/20/2021 and admitted to the hospital. Found to have COVID-19 bilateral pneumonia, and sepsis. Still hospitalized.


VAERS ID: 1731942 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Back pain, Gastrointestinal disorder, Myalgia, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Hives around heat starting the following day, lasted about 6 days Back and muscle pain starting about day 4 that''s still ongoing. Same as stomach and gastrointestinal issues


VAERS ID: 1731987 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 RA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Dyspnoea, Pruritus, Skin warm, Swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: G6PD
Allergies: All allergies related to G6PD and amoxicillin.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Heat in neck that resulted in swelling, itching and difficulty breathing for 4 hours, occured within a minute post vaccination. I had no confidence in the Medical Staff as I was told "I haven''t encountered this before so I don''t know what to do unless you will need an Epipen."


VAERS ID: 1732319 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pyrexia, Vomiting projectile
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Intractable projectile vomiting x 12 hours Fever for 36 hours


VAERS ID: 1732793 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-14
Onset:2021-09-13
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shingles outbreak.


VAERS ID: 1732794 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-01
Onset:2021-09-13
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Lymph node pain, Lymphadenopathy, Pharyngitis streptococcal, Streptococcus test negative
SMQs:, Agranulocytosis (broad), Oropharyngeal infections (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec and rosuvastatin
Current Illness: None
Preexisting Conditions: Asthma and seasonal allergies high cholesterol
Allergies: Penicillin
Diagnostic Lab Data: They did a rapid strep it came back negative only one stripe and insisted I had strep I don?t even have tonsils.
CDC Split Type:

Write-up: Severe swollen glands and lymph nodes in my neck under my ears and back of my head. They can be seen without touching my skin and they were very painful


VAERS ID: 1732802 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-08
Onset:2021-09-13
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

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

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

Write-up: Pt said he felt he was losing his hearing in his left ear. recommended to go see a physician. Pt goes to urgent department and gets a rx for antibiotic ear drops. Called back to check on pt, but no answer


VAERS ID: 1732824 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Back pain, Erythema, Feeling hot, Rash
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient received first dose of vaccine on Sunday 9/12/21, and states that his face felt "hot, warm, and red." On Monday 9/13/21 he said his face was still "warm and hot" and his shoulder, and "middle back to upper shoulder" was aching. Patient thought he developed a rash on his left wrist that "looked like poison ivy, but went away after a while." Patient also said he was feeling weak, but felt fine when he reported these events to the pharmacy.


VAERS ID: 1732832 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-27
Onset:2021-09-13
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Chlorthalidone; Sildenafil; daily Vitamin; Triamcinolone; Clobetasol
Current Illness: none
Preexisting Conditions: essential hypertension; GERD; eczema both hands; BPH; anxious mood; asympatomatic cholelithiasis
Allergies: latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient called into clinic to report symptoms started 9/13/21, and tested positive 9/20/21.


VAERS ID: 1733175 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Feeling abnormal, Hypoaesthesia, Injection site discomfort, Injection site pain, Injection site reaction, Musculoskeletal stiffness, Nasopharyngitis, Neck pain, Pain, Paraesthesia oral, Rash macular, Sleep disorder
SMQs:, Peripheral neuropathy (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Got shot at around 6pm. Stuck around pharmacy for 20 min and felt fine and went home. I felt great. My arm didn''t even hurt. I made dinner and ate and sat down to watch television. Around 9-930pm my shoulders started to really ache. The back of my neck as well. I started to feel cold like chills. I decided to go lay in bed. Around 10:00pm, I could feel a sensation where the injection was that moved around different parts of my body. It went from my arm to my shoulders, to my neck, to my entire back, to under my rib cage, my stomach. My body ached so bad! I did not have a fever the entire time. I tried to sleep but I couldn''t because things were happening that scared me. From 11:00 pm until 4:00am it felt like a cement block was wrapped around my neck. Weighing me down. I had severe chills, body aches and although I could breathe, it felt like i was breathing from a straw. I wasn''t struggling but it was super weird. I also felt like I was getting a slight cold in my throat and nose. I could not move my neck. It felt like a car tire was placed around my neck. Seriously. Around 1am my throat under my chin was completely numb. Inside and out. My lips were slightly tingling. I laid in bed messaging my daughter who was out of town. At one point I thought about the ER, then I decided I wanted to die at home because that is how bad I felt. Around 4am the aches and chills lessened and was I finally was able to fall asleep. I woke up around 7am and felt bad. I called in to my jobs and I ended up sleeping on and off all day. My neck was stiff all day. Although the cement black feeling went away. I had slight body chills and aches but by that evening, I was able to function. My arm did have a red splotch around the injection site. It began to hurt at the injection site the third day. I am totally fine now. Very nervous about a second dose at this point.


VAERS ID: 1733305 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-11
Onset:2021-09-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Keratomileusis, Retinal haemorrhage, Retinal tear, Ultrasound eye
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (broad), Corneal disorders (narrow), Retinal disorders (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: Glucosamine, vitamin d3, multivitamin, motrin
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa
Diagnostic Lab Data: Ultrasound of right eye, laser surgery of right eye
CDC Split Type:

Write-up: Severe headache for 2 days then spontaneous retinal tear with hemorrhage


VAERS ID: 1734037 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-08-15
Onset:2021-09-13
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: head ache / massive headache; This spontaneous case was reported by a consumer and describes the occurrence of HEADACHE (head ache / massive headache) in a 42-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 050E21A and 059E21A) for COVID-19 vaccination. No Medical History information was reported. On 15-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 12-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 13-Sep-2021, the patient experienced HEADACHE (head ache / massive headache). On 14-Sep-2021, HEADACHE (head ache / massive headache) had resolved. No concomitant treatment was provided. No treatment medication was provided. The patient had reported started maybe one day after got the second dose, had a head ache on the 13th and then on the 14th figured it would have go away by now.


VAERS ID: 1734087 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Amnesia, Balance disorder, C-reactive protein normal, Chest X-ray normal, Computerised tomogram head, Confusional state, Dizziness, Full blood count normal, Gait disturbance, Loss of consciousness, Metabolic function test, Pain, SARS-CoV-2 test negative, Syncope, Troponin normal
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: YAZ, metformin
Current Illness:
Preexisting Conditions: DM, PCOS
Allergies: latex, natural rubber
Diagnostic Lab Data: 9/13/21 cmp, tropo, crp, upt, cbc, ct head, covid swab, cxr, all with no significant findings
CDC Split Type:

Write-up: complaining of dizziness unsteadiness on her feet and episode of syncope . Patient states felt body aches, and the morning of presentation to the ER went to the bathroom to get ready for work and passed out does not remember the event but does remember afterwards feeling unsteady on her feet confused and having dizziness. pt with symmetric strength and normal sensation on exam but with loss of balance and unsteady gait with ambulation.


VAERS ID: 1734091 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / SYR

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

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

Write-up: painful tender lymphadenopathy of R axilla, R biceps, R inguinal beginning day of 2nd vaccine and worsening over the week prior to ED visit. pt received steroids for outpt treatment.


VAERS ID: 1734179 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Unknown  
Location: Virginia  
Vaccinated:2021-09-10
Onset:2021-09-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / UNK LA / -
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: C-reactive protein, Dyspnoea, Hypersensitivity, Red blood cell sedimentation rate, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HYDROXYCHLOROQUINE; SULFASALAZINE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Fibromyalgia; Rheumatoid arthritis
Allergies:
Diagnostic Lab Data: Test Name: C-reactive protein; Result Unstructured Data: Test Result:0.4; Test Name: Sedimentation Rate; Result Unstructured Data: Test Result:11
CDC Split Type: USPFIZER INC202101204760

Write-up: I had a allergic reaction that I break out in hives; I had a allergic reaction that I break out in hives; had a little bit of difficulty in breathing; This is a spontaneous report from a contactable Nurse. A 31-years-old patient of an unspecified gender received bnt162b2 (BNT162B2) at age of 31 years via an unspecified route of administration, administered in Arm Left on 10Sep2021 (Batch/Lot Number: EW0164) as DOSE NUMBER UNKNOWN, SINGLE for covid-19 immunisation and methylprednisolone acetate (METHYLPREDNISOLONE ACETATE), injection via an unspecified route of administration on 13Sep2021 (Batch/Lot number was not reported) as an unspecified dose for an unspecified indication. Medical history included fibromyalgia and rheumatoid arthritis. Concomitant medications included hydroxychloroquine (HYDROXYCHLOROQUINE) and sulfasalazine (SULFASALAZINE). On 13Sep2021 patient reported that "I had a allergic reaction that break out in hives and "I had a little bit of difficulty in breathing. All events with outcome of unknown. The patient reported that "bit of difficulty in breathing was not to the point that I have got I called the ambulance but I got 25mg Benadryl intramuscular and I got Solumedrol both as treatment. Patient underwent lab tests and procedures which included c-reactive protein: 0.4, red blood cell sedimentation rate: 11. Clinical course: patient received "COVID 19 shot on the 10th of September which is Friday. Today I went to my orthopedics and got methyl prednisolone injection in my ''wrist''. 5 min after leaving my orthopedic I had allergic reaction". I have a question the methyl Medrol the oral and the injection are they different or no?".; Sender''s Comments: Based on the information available, a possible contributory role of the suspect BNT162B2 and methylprednisolone acetate cannot be excluded for the reported events urticaria, hypersensitivity and dyspnoea occurred in a plausible temporal relationship. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.


VAERS ID: 1734541 (history)  
Form: Version 2.0  
Age: 0.08  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Bradycardia, Cerebral cyst, Cerebral haematoma, Cerebral thrombosis, Choking, Cyanosis, Exposure via breast milk, Gastrointestinal tube insertion, Intensive care, Lethargy, Oxygen saturation decreased, Poor feeding infant, Suck-swallow breathing coordination disturbance, Ultrasound head abnormal
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Neonatal exposures via breast milk (narrow), Neonatal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (broad), Hypoglycaemia (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:
Other Medications: multivitamin
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: Head ultrasound.
CDC Split Type:

Write-up: Mother of infant received 2nd dose of Pfizer 9/21. Mother actively breast feeding infant. 24 hours after mother receiving 2nd vaccination, infant had significant bradycardia (drop in heart rate), desaturation ( low oxygen in the blood causing infant to turn blue). Infant was a previous 31 weeker adjusted to 36 weeks and discharge was pending at time mother received 2nd vaccination. After the initial episode, infant required a feeding tube due to feeding difficulties and lethargy. Infant was monitored in NICU with continued episodes of feeding difficulties associated with choking, inability to coordinate suck/swallow/breath, and bradycardic events. Head ultrasound was completed to show multiple cysts/hematomas (blood clots) present on the brain that were not present prior to vaccination. Infant was transferred to higher level of care for neurological evaluation. Due to absence of hematomas prior to vaccination and no evidence of head trauma, and the known vaccination side effects of potential blood clots; this shall be considered an adverse event.


VAERS ID: 1734883 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-01
Onset:2021-09-13
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Gingival pain, Gingival swelling, Lip blister, Lip swelling, Oral mucosal blistering, Oral mucosal erythema, Pain, Toothache
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Gingival disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Levothyroxine 137mcg daily, Omeprazole 40mg daily, Metoprolol Succ ER 50mg daily, Orencia Infusion once monthly (last infusion 09/23/2021), Xarelto 20mg daily, Sucralfate 2 grams four times daily, Tramadol 100mg three times daily, B-12 Subl
Current Illness: none
Preexisting Conditions: Hypothyroid, AFib, Rheumatoid Arthritis, osteoarthritis, Aortic valve stenosis
Allergies: Statin drugs, Adhesive tape, Sulfa drugs
Diagnostic Lab Data: No tests or treatments ordered; I am to see him again on 10/14/2021 for re-evaluation, after I have completed round of above prescribed medicaitons.
CDC Split Type:

Write-up: Noticed swelling, blisters, pain,and redness to lips and oral mucosa including gums. Felt pain in roots of teeth. Went to ENT, Received Amoxicillin 875mg BID x 14 days and Fluconazole 100mg as directed for 14 days. Also instructed to use Aquaphor lip repair balm as needed daily for irritation. Physician felt this could be a fungal or bacterial infection but was unsure of diagnosis. Treating prophylactically as above.


VAERS ID: 1735145 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-04
Onset:2021-09-13
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amnesia, Memory impairment
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Allergic to advil
Diagnostic Lab Data: None taken at the moment but will be visiting my doctor soon.
CDC Split Type:

Write-up: Started experiencing short term memory loss frequently about a week after the vaccine. This has never happened to me before. I am constantly forgetting things, and noticed it?s things that has happened within a year up to a few minutes ago.


VAERS ID: 1735301 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-12
Onset:2021-09-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear discomfort, Pain in extremity, Pharyngeal swelling, Sinus headache, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt reported adverse effects after 1st Moderna vaccine (administered on 9/12/21). Pt said he does not have a headache. However, he developed a sore arm for 1 week which has resolved. In addition, pt felt like his throat was closing up/felt swollen 1 day after vaccine (symptoms have improved per pt), and right ear feels plugged up. Pt said he has been using Nascort and OTC antihistamine that helps with sinus headache (pt does not know the name of the product). I recommended pt to continued using those products, since pt thinks it has been helping improve his symptoms. I left a message with pt''s PCP to inform of pt''s adverse reaction after 1st Moderna vaccine. Pt said he thinks his symptoms are improving, but wasn''t sure if should get the 2nd Moderna dose. 2nd dose should be okay, since pt did not have anaphylaxis. However, informed pt to follow-up with PCP if symptoms do not improve and see what the provider recommends for the pt. In addition, recommended pt to go the ER if pt''s throat closed up or if he felt like he couldn''t breath.


VAERS ID: 1735456 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-10
Onset:2021-09-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Multiple sclerosis, Psoriasis
SMQs:, Optic nerve disorders (broad), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CBD oil, Vitamin D3, R-alpha lipoic acid, Krill oil, B vitamin complex
Current Illness:
Preexisting Conditions: Multiple Sclerosis; Psoriasis
Allergies: Allergic to: Penicillin; contact dermatitis with Downy & Tide laundry products and some unknown hair products, etc.
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3 days following injection I experienced increasing systemic inflammation triggering symptoms of Multiple Sclerosis (sensation changes, weakness, and pain), Psoriasis (scalp and face) and associated Psoriatic arthritis (joint swelling, pain and tenderness especially in the hands/fingers). History with no symptoms of MS for over 1 year and no symptoms from psoriatic arthritis for over 4 years leading up to the vaccination. Some pain has begun to fade as of today.


VAERS ID: 1735530 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Chest pain, Cough, Diarrhoea, Dyspnoea, Electrocardiogram normal, Erythema, Nausea, Palpitations, Pharyngeal paraesthesia, Pruritus, Pyrexia, Tachycardia
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: With dose #1 of Moderna blood pressure dropped to 73/32 2 hours after receiving the vaccine. With Moderna dose #2 ran 104.3f fe
Other Medications: Montelukast, Tramadol, Rozerem, Vyvanse, Gastrocrom, Motegrity, Zofran, Flovent HFA, Xopenex HFA, Plaquenil, Anaspaz, Midodrine, Claritin, Zyrtec, Voltaren Gel, Corlanor
Current Illness: Sinus Infection
Preexisting Conditions: Ehlers-Danlos Syndrome, Asthma, seasonal allergies, Hyperandrogernic POTS, IgG deficiency/Hypogammaglobulinemia, poly arthralgia, ANA positive, esophageal aperistalsis, atrial septal defect/aneurism
Allergies: Acetaminophen, citalopram, lamotrigine, etomidate, zipresidone Hcl, clarithromycin, peanut, cefdinir, doxycycline Hcl, sulfamethoxazole-trimethoprim, rosins, latex, gabapentin, levofloxacin, topiramate, Immune Globulin (human)(IgG), Dermabond, Albuterol
Diagnostic Lab Data: Labs 09/13/2021 (ER visit after using EpiPen) Magnesium 1.9mg/dL (range 1.6-2.6 mg/dL) Sodium 141MMOL/L (range 137-147MMOL/L) Potassium 4.1MMOL/L (range 3.5-5.1 MMOL/L) Chloride 105 MMOL/L (range 98-110 MMOL/L) Glucose 105 MMOL/L ( range 10-100 MMOL/L) Blood Urea Nitrogen 16 MG/DL (range 7-25 MG/DL) Creatinine 0.98MG/DL (range 0.4-1.00 MG/Dl) Calcium 9.5 MG/DL (range 8.5-10.6 MG/DL) Total Protein 6.7 G/DL (range 6.0-8.0 G/DL) Total Bilirubin 0.9 mg/DL (range 0.3-1.2 MG/DL) Albumin 4.5 G/DL (range 3.5-5.0 G/DL) Alk Phosphate 45 U/L (range 25-110 U/L) AST (SGOT) 20 U/L (range 7-40 U/L) CO2 24 MMOL/L (range 21-30 MMOL/L) ALT (SGPT) 13 U/L (range 7-56 U/L) Anion Gap 12 (range 3-12) White Blood Cells 15.9 K/UL (range 4.5-11.0 K/UL) RBC 4.19 M/UL (range 4.0-5.0 M/UL) Hemoglobin 12.5 GM/DL (range 12.0-15.0 GM/DL) Hematocrit 36.8% (range 36-45%) MCV 87.9 FL (range 80-100FL) MCH 29.8 PG (range 26-34 PG) MCHC 33.9 G/DL (range 32.0-36.0 G/DL) RDW 13.4% (range 11-15%) Platelet Count 282 K/UL (range 150-400 K/UL) MPV 8.1 FL (range 7-11FL) Neutrophils 84% (range 41-77%) Monocytes 8% (range 24-44%) Eosinophils 1% (range 0-5%) Basophils 1% (0-2%) Absolute Neutrophil Count 13.52 K/UL (range 1.8-7.0 K/UL) Absolute Lymph Count 1.27 K/UL (range 1.0-4.8 K/UL) Absolute Monocyte Count 0.93 K/UL (range 0-0.80 K/UL) Absolute Eosinophil Count 0.08 K/UL (range 0-0.45 K/UL) Absolute Basophil Count 0.08 K/UL (range 0-0.20 k/UL) MDW (Monocyte Distribution Width) 15.3 (range <20.7) Lactic Acid POC 0.3 MMOL/L (range 0.5-2.0 MMOL/L) Creatinine, POC 1.0 MG/DL (range 0.4-1.00 MG/L) D-Dimer 254 ng/mL FEU (range <500 ng/mL FEU) Troponin 0.00 NG/ML (range 0.00-0.05 NG/ML) Multiple EKGs also obtained
CDC Split Type:

Write-up: Started within 1 hour of vaccine (pt. Has history of delayed anaphylactic reactions) with severe diarrhea, abdominal pain, nausea, tachycardia, tingling in back of throat and cough. Called the on-call physician with the clinic where the vaccine was received. Was instructed to take an extra Zyrtec/take bedtime dose early. Progressed (aver an hour) to worsening cough, body itching, chest redness, SOB (83% O2 saturation?taken @ home), chest pain. Used EpiPen auto-injector and went to the ER. Due to ER being over capacity had to wait in the waiting room for a while. An EKG was obtained and results were abnormal. Was treated/observed in the ED and then discharged home. Symptoms of chest pain, heart palpitations and SOB with exertion in addition to low-grade fever are still unresolved (as of 9/26/2021). Allergic reactions completely resolved over a period of 48 hours.


VAERS ID: 1735578 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA A2F21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cellulitis, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Vertigo from car accident in 2019
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: ?covid arm? developing into cellulitis in my arm. Headache for 11 days fever of 103 for about 30 hrs Received cephalexin 500 mg for 10 days to treat arm.


VAERS ID: 1735675 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-15
Onset:2021-09-13
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Dyspnoea, Fatigue, Malaise, SARS-CoV-2 test positive, Seizure like phenomena
SMQs:, Anaphylactic reaction (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: HISTORY OF MARFAN SYNDROME, AORTIC VALVE REPLACEMENT, tavr, HTN, HYPERLIPDEMIA, VENT TACHYCARDIA.
Allergies: NO KNOWN ALLERGIES
Diagnostic Lab Data: 9/13/21 COVID-19 SARSAgFIA = DETECTED
CDC Split Type:

Write-up: 9/14/21 SEEN IN ER AT MEDICAL CENTER WITH EIZURE LIKE ACTIVITY. MOVED TO CURRENT ADDRESS A FEW WEEKS AGO AND SINC ETHAT TIME REPORTED WEAKNESS, FATIGUE, DYSPNEA, MALAISE. ADMITTED TO INPATIENT STATUS . ON 9/20/21 DISCHARGED HOME TO FOLLOW UP WITH CARDIOLOGY.


VAERS ID: 1736147 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-03
Onset:2021-09-13
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Encephalitis, Fatigue, Magnetic resonance imaging head abnormal, Mental impairment, Seizure
SMQs:, Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lexapro 5mg daily Yasmin 3-0.3mg once daily
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: MRI brain - diffuse enhancement and T2/Flair in hippocampus
CDC Split Type:

Write-up: Pt with seizures and encephalitis 10 days after 2nd COVID vaccine. No source of encephalitis was found, although workup continues. Pt is recovering but still has extreme fatigue and decreased functioning including decreased mental stamina.


VAERS ID: 1736255 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: 12 year old patient receiving a dose of the Moderna COVID19 vaccine; This spontaneous case was reported by a pharmacist (subsequently medically confirmed) and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (12 year old patient receiving a dose of the Moderna COVID19 vaccine) in a 12-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 062e21a) for COVID-19 vaccination. No Medical History information was reported. On 13-Sep-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 PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (12 year old patient receiving a dose of the Moderna COVID19 vaccine). On 13-Sep-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (12 year old patient receiving a dose of the Moderna COVID19 vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant medications were not reported by the reporter Treatment drugs were not reported by the reporter; Sender''s Comments: This case concerns a 12 year-old male patient with no reported medical history, who experienced the unexpected event of Product administered to patient of inappropriate age. The event occurred on the day of the first dose of mRNA-1273 vaccine. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.


VAERS ID: 1736674 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-11
Onset:2021-09-13
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, COVID-19, Hepatocellular carcinoma, SARS-CoV-2 test positive, Spontaneous bacterial peritonitis
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal perforation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Liver malignant tumours (narrow), Non-haematological malignant tumours (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ALdactone 100 mg daily Bumex 2 mg daily Rifaxamin 550 daily Zinc 220 ER daily Lactulose 30 mL daily Levocarnitine 330 mg TID Levothyroxine 88 mcg daily MVI daily Nitroglycerin 0.4 mg SL PRN Trental 400 mg ER TID Propranolol 20 mg BID SErtra
Current Illness: SBP Pleural effusion
Preexisting Conditions: Chronic liver disease/ascites Chronic venous insufficency Hepatic encephalopathy Esophageal varices Anxiety Hypothyroidism Diabetes
Allergies: Cephalexin Levofloxacin Bactrim
Diagnostic Lab Data: 9/13 - Covid swab + for COVID 19
CDC Split Type:

Write-up: Pt with hx of cirrhosis , SBP dx on 8/7 and recent dx of hepatocellular carcinoma found during admission on 7/14. Pt d/c on 8/7 with hospice and then returned to ED with increased abdominal discomfort, N/V; found to have COVID 19 + respiratory swab during routine testing. Pt was already current with hospice upon admission - admitted for symptom control and palliative care.


VAERS ID: 1736863 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-03
Onset:2021-09-13
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diagnosed Blood Clots 10-11 days after receiving vaccine.


VAERS ID: 1737014 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-01
Onset:2021-09-13
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NA / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NA / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Chest X-ray, Confusional state, Diarrhoea, Fall, Lethargy, Oxygen saturation decreased, Platelet count decreased
SMQs:, Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NA
Current Illness:
Preexisting Conditions: Parkinson disease
Allergies: Atorvastatin, Donepezil
Diagnostic Lab Data: CXR, Platelets 130
CDC Split Type:

Write-up: Presented to ER on 9/13/2021 for diarrhea, confusion, was discharged and returned to ER on 09/18/2021 after falling. Wife states pt. has become more lethargic, weak. Admitted due to weakness, O2 sats low pt. started on O2


VAERS ID: 1737086 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-26
Onset:2021-09-13
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acoustic stimulation tests, Ear pain, Ear swelling, Nerve injury, Tinnitus
SMQs:, Angioedema (broad), Accidents and injuries (narrow), Hearing impairment (narrow), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Had hearing test at E.N.T on September 24, 2021. Was prescribed prednisone
CDC Split Type:

Write-up: Received 1st shot August 26,2021 and on September 13th noticed my right ear hurting and can''t hear very good. Had my second shot on September 16,2021. Company made it mandatory for employees to get the shots to keep their jobs. I saw a E.N.T on September 24,2021 and told me I have nerve damage in my right ear. Dr. said the vaccine can''t make you lose your hearing. I have had hearing test at work for 17 years and had excellent results until getting this vaccine. Ear pain,ringing, and feel swelling in right ear.


VAERS ID: 1737093 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-10
Onset:2021-09-13
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / UNK RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Antinuclear antibody, Blepharospasm, Blood thyroid stimulating hormone, C-reactive protein, Hypoaesthesia, Muscle spasms, Muscular weakness, Neuropathy peripheral, Paraesthesia, Rash, Red blood cell sedimentation rate, Vitamin B12
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune 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: Medrol dose pack 4mg - last dose taken on 9/6/2021
Current Illness: Seasonal allergies - sinus/eustachian flare up
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: The following lab results were ordered by Dr. and resulted on 9/24/2021 Erythrocyte Sedimentation C- Reactive Protein Ana Reflex Profile Vitamin B12 TSH Reflex MRI of Brain -- scheduled for 9/29/2021
CDC Split Type:

Write-up: On Day 1 -9/10/21 following my first dose of Pfizer I experienced tingling and numbness down my right arm that reached to my fingers but I didn''t think much of it due to a similar sensation I had in the past from a rhomboid injury. On Day 3 - 9/13/21 I began to experience twitching under my right eye. On Day 4 - 9/14/21 The twitching continued but progressed into tingling and numbness on the right side of my face. I also developed a rash on both of my cheeks. On Day 5 - 9/15/21 The symptoms continued to be present and I began to feel the tingling in numbness in my right arm again so I was advised to go to Urgent Care where it was confirmed that I was experiencing inflammatory neuropathy and likely a result from the vaccine. I was prescribed Prednisone at 20 mg to be taken twice orally for 3 days. Symptoms began to subside following my first dose but fully returned by the end of my prescription. On day 10 - 9/20/21 I went to see a neurologist, because my symptoms were still ongoing. By this time the spasms and numbness and tingling in my legs had not yet presented itself. Dr diagnosed me with an autoimmune inflammatory response to the vaccine. On day 11 - 9/21/21 My symptoms progressed to the top of my head on the right side and both of my legs, very faintly on the left leg and predominantly more noticeable on the right leg and eventually only noticeable on the right leg. It felt as if my legs were asleep and the right leg felt very weak as if I could fall at any moment. I also started to experience involuntary muscle spasms in my right leg and throughout the right side of my body (upper body and ribcage). The symptoms have been ongoing to date 9/27/21


VAERS ID: 1737198 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Vial was diluted with 0.8 mL. Patient present for follow-up appointment on Sept 23, 2021. No adverse effects noted.


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