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From the 11/12/2021 release of VAERS data:

Found 875,292 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 20 out of 8,753

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VAERS ID: 1851109 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metaprolol, dilantin (not for seizures) and synthroid
Current Illness: none reported
Preexisting Conditions: hypothyroidism HTN
Allergies: none known
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patient felt dizzy/ light-headed when walking and after standing. Blood pressure WNL


VAERS ID: 1851126 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7347LA / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Crying, Inappropriate schedule of product administration, Nervousness, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Generalised convulsive seizures following immunisation (narrow), Medication errors (narrow), Hypoglycaemia (broad)

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

Write-up: patient was here with both parents on 11/6/21 around 4:15pm to get both the pfizer covid and flu vaccines. pt had stated he felt a sting after getting the covid vaccine but after getting the flu vaccine, per vaccinating technician, he seemed like he was seizing. i had advised technician to lay him on his side just in case vomiting was to occur but he had come to moments later. when he came to, he immediately hung onto mom and was crying but when asked if he was nervous, he stated he was. i had instructed a technician to call for EMS and they had inspected him upon arrival. they had given them the option to either go to the hospital or go home and monitor for abnormal signs. parents had opted to go home


VAERS ID: 1851157 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Painful respiration
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: med nebulizer, Advair, Cymbalta, Concerta, trazadone
Current Illness: sinus congestion
Preexisting Conditions: Asthma, ADHD, recurrent depression, hx kidney failure
Allergies: Amoxicillin, tetracycline, Penicillin, Dilantin
Diagnostic Lab Data: vital signs taken at time of event.
CDC Split Type:

Write-up: patient complained of chest tightness/ respiratory (not cardiac/ angina type pain per client) c/o slightly light-headed but Los of consciousness, Deanies and radiating arm, jaw shoulder or neck pain. Skin warm and dry to touch, color WNL Pulse ox above 98%


VAERS ID: 1851178 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-18
Onset:2021-11-06
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

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? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Celiac, Diabetes mellitus, HTN, hypercholesteremia,
Allergies: unknown
Diagnostic Lab Data: positive PCR COVID-19 test
CDC Split Type:

Write-up: symptoms


VAERS ID: 1851241 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-26
Onset:2021-11-06
   Days after vaccination:284
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL6249 / 2 LA / IM

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

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

Write-up: Tested PCR positive for COVID 11/6/21 after being fully vaccinated.


VAERS ID: 1851243 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-25
Onset:2021-11-06
   Days after vaccination:254
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Pain, Pyrexia, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillin 500 MG Capsule 4 capsules Orally 1 hour before procedures; Aspirin EC 81 MG Tablet Delayed Release 1 tablet Orally Once a day; Ciprofloxacin HCl 500 MG Tablet 1 tablet Orally two times a day, stop date 09/28/2021; Clobetasol Pro
Current Illness: none
Preexisting Conditions: GERD. Aortic Valve Replacement - 27mm Magna Ease Tissue Valve 6/201 Sleep apnea. Primary osteoarthritis of left knee.= History of total knee arthroplasty, left. Aortic Stenosis. Thrombosed external hemorrhoid. Post-operative atrial fibrillation after AVR (resolved).
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: cough, fever, congestion, body aches. starting on 11/6/21


VAERS ID: 1851266 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Immediate post-injection reaction, Incorrect route of product administration, Injection site pain
SMQs:, Drug abuse and dependence (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Arthritis (broad), Medication errors (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: FeroSuL 325 mg (65 mg iron) tablet TAKE 1 TABLET TWICE A DAY BY ORAL ROUTE. hydroCHLOROthiazide 12.5 mg capsule Take 1 capsule every day by oral route. metoprolol succinate ER 50 mg tablet,extended release 24 hr Take 1 tablet every da
Current Illness: none
Preexisting Conditions: overweight Chiari malformation type I history of bariatric surgical procedure iron deficiency pituitary adenoma rosacea tension-type headache
Allergies: amoxicillin Augmentin mold
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt with shoulder pain due to incorrectly placed vaccine. Vaccine needle mark still visible at time of visit, and was injected into the subacromial space of R shoulder rather than the deltoid muscle. Pt had immediate R shoulder pain that has persisted.


VAERS ID: 1851333 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-04
Onset:2021-11-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bursitis
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Uknown
Current Illness:
Preexisting Conditions: Von Willebrand disease
Allergies: polymyxin B-trimethoprim ophthalmic: skin peeling
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Patient developed subacromial bursitis secondary to vaccination administration


VAERS ID: 1851351 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-04
Onset:2021-11-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / SYR

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

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

Write-up: My son was incorrectly dosed with the Pfizer Covid 19 vaccine. I am waiting for guidance on what to do from Pfizer, the CDC Dept of Health (whether that first dose counts or if they have to repeat the first dose).


VAERS ID: 1851358 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Back pain, Injection site erythema, Injection site induration, Injection site pain, Pain
SMQs:, Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad)

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

Write-up: She has redness, tenderness and induration around injection site with pain radiated down the L UE, axilla and upper back.


VAERS ID: 1851373 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: AMOXICILLIN
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: On 11/06/2021 patient was administered 0.3 ml, Intramuscular of the adult Pfizer Biontech COVID19 vaccine. Mother and Physician where aware of incident at the time. Patient was monitored 15 minutes after injection. Patient did not have any adverse reaction to vaccine. On 11/08/2021 I called Mother and she stated patient is doing well. Patient only complained of pain on the arm of the injection site on day one. Denies fever, fatigue, and headaches. Overall condition, is stable. Our office has taken measures and separated the vaccine for the adults and children. Reviewed Pfizer-Biontech "Standing Orders for Administering Vaccine" and have purchased additional orange round labels to place on syringes.


VAERS ID: 1851378 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-04
Onset:2021-11-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / SYR

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

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

Write-up: My 5 year old daughter was dosed incorrectly at Pharmacy and we are awaiting guidance from Pfizer, the CDC and the Dept of Health as to whether this first dose will count of if she will need to repeat the first dose.


VAERS ID: 1851395 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-03
Onset:2021-11-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Headache, Impaired work ability, Influenza like illness, Nausea, Oropharyngeal pain, Pain in extremity, Rash erythematous, Rash pruritic, Rhinorrhoea, Skin warm
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: I got a sudden BAD red hot itchy rash 3 nights after my injection - Was near injection site, but not on...Felt & still feels like someone hit me with a hammer on my arm. Arm is still slightly red, but no longer is hot/itchy. I also got a Headache 3 hours after shot was administered & woke with cold/flu-like symptoms the following day that kept me home from work with sore throat, runny nose, diarrhea/nausea... Headache lasted approx. 2.5 days. Cold Flu symptoms went away in approx. 10 hours


VAERS ID: 1851411 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Pain in extremity, Peripheral swelling, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Left upper arm swollen, red painful and hot


VAERS ID: 1851599 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3527 / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Headache, Hyperhidrosis, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: body aches, headaches, chills, dizziness, fatigue and sweating


VAERS ID: 1851604 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG3627 / 3 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chills, Extra dose administered, Feeling cold, Headache, Hyperhidrosis, Insomnia, Pain, Renal pain, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Arthritis (broad), Medication errors (narrow), Hypoglycaemia (broad)

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

Write-up: This shot was the absolute worst experience I?ve had from all the Covid shots I?ve received. About 12 hours after receiving the shot, I started experiencing joint pain. Then, I got chills so bad I couldn?t stop shaking. I tried piling blankets on top of me but couldn?t get warm. I was sweating profusely but still couldn?t get warm. My body aches hurt so bad, I couldn?t stop moving. I didn?t sleep all night. The next morning, my head was pounding. The next evening, I had ice pick headaches. Two days later, my joints still ache. My headache has gone away as long as I?m eating Tylenol. My kidneys hurt for 2 full days even though all I was drinking was water. This was the absolute worst experience I?ve had from the Covid shots. Based on this experience, I will not do anymore boosters. This was awful.


VAERS ID: 1851609 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Rash and arm swelling at injection site, nausea, severe fatigue, aches, headaches, age 39, Moderna Covid-19 vaccine, Lot 003A21A
Other Medications: Escitalopram 10MG, Telmisartan Hydrochlorothiazide 80mg-25mg, Yaz 3mg-0.02mg, Cetirizine 10mg
Current Illness: N/A
Preexisting Conditions: Hypertension, Polycystic Ovaries, Anxiety associated with Depression
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm swelling, lymph node swelling on the side of the injection site, headaches, fatigue, aching joints


VAERS ID: 1851615 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 LA / IM

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

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

Write-up: The patient reported large, red spot on her arm the size of a golf ball at the injection site. She reports it being itchy and uncomfortable.


VAERS ID: 1851789 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse drug reaction, Blood pressure increased, Chest pain, Fatigue, Headache, Heart rate increased, Pyrexia, Throat irritation
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: Per patient had fever, headache, and fatigue. But also developed chest pain, increased heart rate and blood pressure. All side effects went away except chest pain/burning in throat. suggested patient to see doctor/ potential otc medications.


VAERS ID: 1851793 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 32030BD / 4 LA / IM

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

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

Write-up: patient felt a little tired and a little sore arm after received the covid Pfizer shot. No major complains after an hour observational period.


VAERS ID: 1851800 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-23
Onset:2021-11-06
   Days after vaccination:228
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ?Sertraline HCl 100 MG Tablet 1 tablet Orally Once a day ?Cryselle-28 0.3-30 MG-MCG Tablet 1 tablet Orally Once a day
Current Illness: none
Preexisting Conditions: anxiety/depression
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: diarrhea, Congestion, Chills, runny nose, body aches, headache. starting 11/6/21


VAERS ID: 1851801 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pyrexia, SARS-CoV-2 test negative
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Mild URI a few days prior with residual cough. Covid negative on rapid test.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: COVID rapid test 11/7/21 - negative
CDC Split Type:

Write-up: Developed fever to 103 F at 8pm. Began Tylenol and Motrin alternating Q3H. Peaked at 105 F 10pm-1am. Defervesced to 100-101 at 1am. Still with low grade fever 48 hours out, continuing Tylenol/Motrin rtc.


VAERS ID: 1851806 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-03
Onset:2021-11-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / N/A LA / -

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Joint lock, Osteoarthritis, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Arthritis (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: Spironolactone
Current Illness:
Preexisting Conditions: Vastavagosyncope, osteoarthritis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Locked up my neck and shoulder, still feels like the needles in my arm, flared up my osteoarthritis so bad I thought I needed to have surgery it''s still going on till I put two and two together


VAERS ID: 1851816 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-15
Onset:2021-11-06
   Days after vaccination:236
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Disorientation, Dyspnoea, Headache, Oropharyngeal pain, Pyrexia, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: Concussion while playing flag football approximately 5 years ago. GI issues prompting colonoscopy early 30s which showed inflammation which improved with antibiotics; no problems since. Mitral valve prolapse.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: presents with 3 days history of sore thorat, headache and runny nose. MiId cough but no expectoration, SOB or fever. He says he feels disoriented but is oriented x 3 and able to hold a normal conversation with no signs of any disorientation. starting 11/6/21


VAERS ID: 1851823 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Headache, Injection site cellulitis, Lymphadenopathy, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine @ 5:00am
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen Left Axillary Lymph Nodes Left elbow pain Left arm weakness Severe headache Cellulitis of injection site


VAERS ID: 1851826 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-10
Onset:2021-11-06
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Headache, Nasopharyngitis, Pain, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad)

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

Write-up: cough, congestion, exposure, mild headache, body aches . he feels like he has a bad head cold with a mild cough. starting 11/6/21


VAERS ID: 1852029 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: asthma
Allergies: penicillin
Diagnostic Lab Data: patient was instructed to see physician, she was going to go to an urgent aid center
CDC Split Type:

Write-up: patients arm was swoolen and red at the injection site and patient stated it was getting worse.


VAERS ID: 1852041 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-23
Onset:2021-11-06
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Computerised tomogram thorax abnormal, Cough, Culture, Dizziness, Dyspnoea, Echocardiogram normal, Fatigue, Fungal test, Leukocytosis, Lung opacity, Myalgia, Neutrophilia, SARS-CoV-2 test negative, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), 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), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Apixaban; Losartan; Vitamin B12
Current Illness: Uncomplicated aortic valve replacement 9/20/2021. Otherwise healthy.
Preexisting Conditions: Coronary artery disease, mild (LAD stent 1996 w/mild in stent restenosis, IFR 0.94).
Allergies:
Diagnostic Lab Data: CT chest on admission with severe diffuse ground glass opacities in every lobe (except right middle lobe). Echocardiogram w/grossly normal LV function. CT from 2 months prior without infiltrates. Fungal serologies pending. Cultures pending.
CDC Split Type:

Write-up: Started w/myalgia and fatigue over days post vaccination. Then developed dizziness, shortness of breath and dry cough 1-2 weeks after the dose. Tested for COVID, negative. Presented to ED w/mild troponin rise to 0.207 and hypoxemia to low 80s. CT chest with diffuse ground glass opacities in every lobe (except right middle lobe). Leukocytosis w/neutrophilia but no fever. Cough is dry, no blood. Cultures pending. Acute hypoxic respiratory failure requiring high flow nasal cannula to keep saturations in mid 90s. No prior history of COPD or lung disease. No ill contacts.


VAERS ID: 1852243 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Dyspnoea, Lip swelling, Pain in extremity
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Very sore arm, shortness of breath, weakness, all these have cleared up as of today but there is a swelling in my upper lip on the left


VAERS ID: 1852249 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 1 LA / IM

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

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

Write-up: Patient states that he lost consciousness and fell hitting his head within 24 hours of receiving his first covid shot. He was taken to the ER, but ended up leaving before seeing any doctor because they waited for several hours and just monitored him at home.


VAERS ID: 1853551 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-11-06
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia
SMQs:, 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: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211118628

Write-up: THROBBING/DEEPER PAIN IN HIP JOINT; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: non alcohol user, and non smoker. The patient experienced drug allergy when treated with methyldopa. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1822811 expiry: UNKNOWN) dose was not reported, administered on 04-NOV-2021 for prophylactic vaccination. No concomitant medications were reported. On 06-NOV-2021, the patient experienced throbbing/deeper pain in hip joint. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from throbbing/deeper pain in hip joint. This report was non-serious.


VAERS ID: 1853653 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3230BD / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site erythema, Injection site mass, Injection site pain, Injection site pruritus, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (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: Covid Vaccine Pfizer - first dose
Other Medications: singulair, Zyrtec, Benadryl, Pepcid
Current Illness: seasonal allergies
Preexisting Conditions: MCAS
Allergies: peanuts, shellfish, seasonal allergies, Tylenol, sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache, body aches, low fever, chills, extreme fatigue even 72 hours later. Itchy injection site, large red lump at injection site, pain at the injection site at 72 hours later.


VAERS ID: 1853657 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-25
Onset:2021-11-06
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / UNK RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7377LA / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Ibuprofen, latex
Diagnostic Lab Data: Positive COVID-19 PCR test on 11/6/2021
CDC Split Type:

Write-up: I tested positive for COVID 19 on 11/6/2021 after receiving my COVID booster dose on 10/25/2021. I was fully vaccinated against COVID 19 prior to my booster dose. I am asymptomatic (and have been the duration of my positive diagnosis), but was in close contact with my boyfriend who was positive for COVID 19 and was showing symptoms.


VAERS ID: 1853695 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-11-04
Onset:2021-11-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Neck pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: Propranolol 10 MG, Lexapro
Current Illness:
Preexisting Conditions: Pots, Ptsd
Allergies: Penicillin, Medical tape
Diagnostic Lab Data: Er visit, follow up with pcp two days later
CDC Split Type:

Write-up: Sore painful left side of neck, swelling at the supraclavicular area.


VAERS ID: 1853725 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-12
Onset:2021-11-06
   Days after vaccination:267
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dysstasia, Fall, Speech disorder
SMQs:, Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow)

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

Write-up: around 2:20 AM he got up to go the bathroom when his wife heard him yelling "please help me" then heard a thud which was him falling to the ground. He could not stand up and she could barely understand what he was saying therefore EMS was called.


VAERS ID: 1853731 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-24
Onset:2021-11-06
   Days after vaccination:255
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Confusional state, Cough, Dyspnoea, Hypoxia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: presented with increased confusion, cough, shortness of breath, hypoxia. Medical history is significant for chronic A-fib (on warfarin), CHF (unclear of type from documentation), HTN, hypothyroidism, hypocalcemia, neuropathy, insomnia, chronic pain, "edema". She resides at a skilled nursing facility and tested positive for COVID-19 on the morning of 11/5. Vaccine given at an outside facility. No Lot# noted


VAERS ID: 1853735 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-25
Onset:2021-11-06
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Lymphadenopathy, Pruritus, Rash, Skin burning sensation, Skin warm, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trazodone, Hydroxychloroquine Buspar, Duloxetine, Gabapentin, Levocetirizine,
Current Illness: N/A
Preexisting Conditions: Lupus, Fibromyalgia
Allergies: Penicillin, Mold Seasonal Allergies
Diagnostic Lab Data: Dose 1:03/10/2021 040A21A Dose 2:04/07/2021 025B21A
CDC Split Type: vsafe

Write-up: Immediately after getting the 3rd dose of my vaccine I had a swollen Lymph node under my left arm. I felt fine after that but two weeks after getting it I got a rash on my right forearm. I had what looked like 3 bites. When I looked with 15 minutes they were all over my arm. 30 minutes my back, chest and upper body were covered. Within two hours It was all over my body except for my face. I had the welts for three days total but it was moving from one place to the other. On the third day it was on my face also and on the roof of my mouth. The welts were very itchy, hot to the touch like blisters. My skin felt like a sunburn. I took a lot of pictures. I took some Benadryl and Tylenol as well as oatmeal baths which seemed to help. On the fourth day I woke up and they were all gone. It has been just a few days but it has not come back so far.


VAERS ID: 1853742 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-05
Onset:2021-11-06
   Days after vaccination:93
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / UNK LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E21A / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Asymptomatic COVID-19, Hypotension, SARS-CoV-2 test positive, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: from his nursing home with concerns of weakness, hypotension, and tachycardia, also found to COVID-19 positive. He appears to be asymptomatic from this and has been previously vaccinated so we will simply monitor for the time being. Patient had the moderna vaccine on 10/27


VAERS ID: 1853787 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-31
Onset:2021-11-06
   Days after vaccination:279
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Chest discomfort, Cough, Ear discomfort, Ear pain, Headache, Nasal congestion, Sinus congestion, Sneezing
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Hypersensitivity (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ?Multi Vitamin - Tablet 1 tablet Orally Once a day ?Sronyx 0.1-20 MG-MCG Tablet TAKE 1 TABLET BY MOUTH EVERY DAY Oral
Current Illness: none
Preexisting Conditions: none
Allergies: Amoxicillin: rash - Side Effects
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache, nonproductive cough, loss of taste, loss of smell, ear pain, , sinus congestion, nasal congestion, chest tightness, sneezing, ear fullness. starting on 11/6/21


VAERS ID: 1853815 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-23
Onset:2021-11-06
   Days after vaccination:228
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Diarrhoea, Headache, Pain, Pyrexia, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ?Folic Acid 1 MG Tablet 2 tablet Orally once a day ?Methotrexate 2.5 MG Tablet 4 tablets Orally once a week ?Multiple Vitamin Tablet 1 tablet Oral once a day ?Vitamin D 1,000 unit 1 tablet Oral once a day ?Orencia 250 MG Solutio
Current Illness: none
Preexisting Conditions: Rheumatoid Arthritis End stage knee DJD, bilateral. History of nephrolithiasis. HTN.
Allergies: Codeine: sick - Side Effects
Diagnostic Lab Data:
CDC Split Type:

Write-up: body aches, headache, cough, congestion, fever 100, chills, diarrhea starting on 11/6/21


VAERS ID: 1853830 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chills, Hyperhidrosis, Pain, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: THE RIGHT ARM WHERE I RECEIVED THE VACCINE BECAME VERY SWOLLEN AND SORE. HAD ACHES AND PAINS. TOOK MY TEMPERATURE AND IT WAS OVER 100 DEGREES. I ALSO HAD THE SWEATS AND CHILLS.


VAERS ID: 1853850 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 RA / IM

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

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

Write-up: vaccine was given on 11/6/21 that expired on 11/5/21


VAERS ID: 1853861 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Extra dose administered, Fall, Fatigue, Hyperhidrosis, Migraine, Nausea, Neuralgia, Photophobia, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vyvanse, sertraline
Current Illness:
Preexisting Conditions: Sleep apnea
Allergies: Avocado, pecans, macadamia nuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 11:00 PM, 12 hours after the booster,, l became very nauseous and dizzy. I stood up to go to the restroom to vomit, and immediately collapsed and almost lost consciousness. Stuck on the floor, I began to feel intense shooting nerve pain in both of my arms, and broke out into an extremely intense sweat. I became hypersensitive to light, and felt like I was going to faint if I moved. I dialed emergency number. At the ER, I was treated with an anti-inflammatory injection, and with an injection of a migraine medication. I slowly began to feel better, and the next day had just a fever and fatigue.


VAERS ID: 1853870 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Pain, 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Duloxetine bupropion omeprazole met Forman locality pramine
Current Illness:
Preexisting Conditions: Asmatha
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chills ache fever


VAERS ID: 1853872 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-04
Onset:2021-11-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Fall, Feeling abnormal, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Dementia (broad), Accidents and injuries (narrow), Hypertension (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: 1st Moderna vaccination-1 week later terrible itching on left arm right below where shot was given
Other Medications: calcium , complex B , glucosamine
Current Illness: none
Preexisting Conditions: none
Allergies: penicillin, quinalones
Diagnostic Lab Data: none
CDC Split Type:

Write-up: All of a sudden (Sat.)fell in a fog, couldn''t get my mind to clear, then fell from chair. After my son arrived and sat me up took my BP. It was in the high 170s over high 90s. it stayed that way until 5:30 finally started dropping. I could talk, squeeze my hand, nothing else seemed wrong. by Sunday BP was in the 146/88 range. I reported it to my doctor on Monday. Today (Tuesday) it was 136/80 more my normal range. I could not think of anything different happening to me other than getting my Moderna BOOSTER on Thursday.


VAERS ID: 1853885 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Cough, Dyspnoea, Paraesthesia, Pruritus
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Bipolar disorder, arthritis
Allergies: Latex, vicodin, iodine, imitrex, Depakote, B12 injections
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tingling all over, itching all over, shortness of breath, cough due to shortness of breath


VAERS ID: 1853893 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Electrocardiogram normal, Headache, Interchange of vaccine products, Myalgia, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Methylphenidate ER 54mg Tablet Extended Release, 24hr Montelukast Sodium 10mg Tablet Lo LoestrinFe Cetirizine Hydrochloride Tablets, 10 mg Cranberry Supplement, 500mg Women''s Daily Multivitamin B12, 1000 mcg
Current Illness: None
Preexisting Conditions: I have asthma. And I''m currently in Physical Therapy for lower back pain.
Allergies: Allergic to Pineapple. Allergic to Augmentenand Spiriva.
Diagnostic Lab Data: 11/7/2021 - EKG.
CDC Split Type:

Write-up: I received Pfizer for my first and second COVID19 vaccines and received Moderna for my booster shot. The evening of my shot (11/5/2021) I only experienced arm pain. The morning of 11/6/2021 I experienced arm pain, muscle and joint pain, headache, fever, and chest pain from movement. On 11/7/2021 I went to a Clinic due to chest pain. The provider did not believe I was having a cardiac issue but recommended I go to get an EKG to be safe. I went and they performed an EKG and the EKG results were normal. As of 11/9/2021, I am still experiencing moderate chest pain from movement.


VAERS ID: 1853909 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Hypoaesthesia, Pruritus, Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), 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: Daily vitamins
Current Illness: No
Preexisting Conditions: None
Allergies: Bananas
Diagnostic Lab Data:
CDC Split Type:

Write-up: At the time that symptom started I had itchiness and hives going across my chest and my palms of my hands were itchy. The itchiness in hives spread across my entire back and stomach. At this point I had taken Benadryl at home. I noticed my chin was starting to go numb and I felt Some slight itchiness in the back of my throat. I went to the emergency room at my local hospital, got triage and taken back right away to see an emergency doctor. At this point my skin had redness all over from head to toe in the itchiness was all over my body. After being assessed the doctor had prescribed me prednisone, Pepcid, and an epi-injection. After I was given the Epi injection I was monitor for an hour and a half and emergency room to make sure that my heart rate did not spike and that my symptoms were relieved, which they were.


VAERS ID: 1853939 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ASPIRIN, VITAMIN C, ROUTINE MEDICATIONS FOR BLOOD PRESSURE
Current Illness: N/A
Preexisting Conditions: High Pressure
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: RASH, ITCHINESS


VAERS ID: 1853962 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Lymphadenopathy, Pain, Pain in extremity, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine
Other Medications: Baclofen 10mg
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left arm pain, axillary adenopathy, fever 106, hands numbness, bodyaches


VAERS ID: 1853965 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Flushing, Hyperhidrosis, Insomnia, Lethargy, Nausea, Pain, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Allergic: Rash Generalized-Severe, Systemic: Body Aches Generalized-Severe, Systemic: Chills-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Flushed / Sweating-Severe, Systemic: Nausea-Severe, Systemic: Unable to Sleep-Severe


VAERS ID: 1853977 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-11-03
Onset:2021-11-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 3 LA / IM

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

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

Write-up: Patient tested positive on 11/8/21. Doses on 2/25, 3/18, of Pfizer and Booster on 11/3 of Moderna.


VAERS ID: 1853982 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chest pain, Chills, Extra dose administered, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever chills and bodyaches initially. days later having chest pain with activity has happened multiple times while exercising since vaccine booster


VAERS ID: 1853995 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Injection site pain, Injection site swelling, Lymphadenopathy
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Site: Pain at Injection Site-Severe, Site: Swelling at Injection Site-Severe, Systemic: Joint Pain-Medium, Systemic: Lymph Node Swelling-Medium


VAERS ID: 1854014 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ? SUDAFED 10MG 1X DAILY ? WELLBUTRIN XL TABS 300MG 1X DAILY ? LISINOPRIL/HCTZ 20/12.5 1X DAILY ? PANTOPRAZOLE S
Current Illness: none
Preexisting Conditions: High blood pressure high cholesterol Osteoporosis chronic pain
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm that shot was given in swollen, red, itchy and somewhat painful near injection site


VAERS ID: 1854048 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow)

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

Write-up: Site: Itching at Injection Site-Mild, Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Additional Details: Patient called 11/8/2021 to report adverse effects starting in the afternoon on 11/6/2021 after her booster dose.


VAERS ID: 1854051 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Chills, Diarrhoea, Mobility decreased, Nausea, Pain, Pain in jaw, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Osteonecrosis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Abdominal Pain-Medium, Systemic: Body Aches Generalized-Mild, Systemic: Diarrhea-Medium, Systemic: Nausea-Mild, Systemic: Shakiness-Mild, Additional Details: Pt had convulsive chills that lasted 45 minutes, jaw hurt, nausea, diarrhea, couldn''t raise arm for 1 hour. Symptoms lasted 10 hours


VAERS ID: 1854102 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / UN

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

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

Write-up: Fever 102, normal symptoms, body aches, sore arm.


VAERS ID: 1854173 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-28
Onset:2021-11-06
   Days after vaccination:101
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test, Blood thyroid stimulating hormone increased, Hypothyroidism
SMQs:, Hypothyroidism (narrow), Hyperthyroidism (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Centrum silver for Women, Bayer 81mg aspirin, Biotin, Atorvastatin, Exedrin
Current Illness:
Preexisting Conditions: Sleep apnea, Atrial fibrillation, cholesterol - managed with medicine.
Allergies:
Diagnostic Lab Data: 11/6/2021 blood test
CDC Split Type:

Write-up: Elevated TSH (Thyroid hormone). detected with blood test two months after last vaccination. Blood test ordered due to several symptoms related to hypothyroidism.


VAERS ID: 1854224 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Fatigue, Pain, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: Fever 100.0, chills, severe shaking, severe body aches, fatigue and vomiting. Took Tylenol and Motrin. Symptoms not quite resolved as of today.


VAERS ID: 1854226 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Eyelid oedema, Headache, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin, Osteo bi-biflex
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: I have not consulted a doctor. Self treatment includes topical application of hydrocortisone, cold pack for 2 days, now using warm compress. Also taking Tylenol during the day and a Benadryl at night.
CDC Split Type:

Write-up: Began Saturday with headache over right side of head, rash across right side of forehead, began on Sunday and has multiplied in same are over last 2 days. On Monday fluid began collecting in upper right eyelid.


VAERS ID: 1854278 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-26
Onset:2021-11-06
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EC00176 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood glucose increased, COVID-19 pneumonia, Chest X-ray abnormal, Condition aggravated, Diabetes mellitus, Eating disorder, Lung opacity
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Infective pneumonia (narrow), 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Advair Diskus, albuterol, amlodiPINe, betamethasone valerate clotrimazole clotrimazole-betamethasone cyproheptadine donepezil esomeprazole famotidine glipiZIDE Glucagon Gvoke HypoPen hydroCHLOROthiazide insulin glargine JANUVIA lo
Current Illness: N/A
Preexisting Conditions: Hypoxia, hypoglycemia, diabetes type 2, cancer, dementia, hyperlipidemia, Acute renal failure.
Allergies: N/A
Diagnostic Lab Data: See 18
CDC Split Type:

Write-up: 11/6 Pt to ED via EMS with c/o high blood sugar. Hx of diabetes and hasnt eaten in 2 weeks. Pt chest x-ray showed bilateral basilar interstitial airspace opacity, left more than right. 11/8 Dx COVID Pneumonia, Steroids and anticoagulation to be started.


VAERS ID: 1854282 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051F21A / 3 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Cough, Disorientation, Dyspnoea, Immediate post-injection reaction, Interchange of vaccine products, Nausea, Pallor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Medication errors (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Client had received 2 doses of Pfizer COVID 19 vaccine in past. Requested Moderna for booster dose. Client received dose during a mass clinic. Client immediately after injection had difficulty breathing. Was injected with 0.3 mg of epinephrine. Breathing improved within minutes. EMS was called. After 3 minutes, began gasping, became disoriented, coughing, palor and nausea. Administered 0.15mg of epinephrine due to all that was available. EMS arrived within minutes and client was taken by ambulance to nearest hospital.


VAERS ID: 1854287 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered, Injection site pain, Injection site swelling, Lymphadenopathy
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: .5 ml administered instead of .25 ml; Patient had only minor reaction, including pain and swelling of site and some temporary swelling of lymph nodes


VAERS ID: 1854311 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-04
Onset:2021-11-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Breast pain, Injection site pain, Lymphadenopathy
SMQs:, Extravasation events (injections, infusions and implants) (broad), Lipodystrophy (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: Carvedilol 25 mg x 2 Atorvastain 40 mg Imipramine HCL 50mg x 2 Estradiol 0.5 mg Levothyroxine 50mcg Vitamin D Calcium D3 1000
Current Illness: None
Preexisting Conditions: None
Allergies: Albuterol Lisinopril Demerol Cephalexin Gentamicin Sulfate Sulfamethoxazole
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Swollen lymph node in left armpit. Intense pain underarm and along left breast. Pain on inside left arm down past elbow.


VAERS ID: 1854324 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5618 / 3 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Immunisation, No adverse event, 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received a dose of Pfizer (0.2mL dose, 10mcg) in error. Medical Director, contacted immediately. Per CDC guidelines for administration errors, MD called for an adult dose of Pfizer (0.3mL dose, 30mcg) to be injected into opposite arm. Pt monitored in observation area following administration and had no immediate adverse reaction.


VAERS ID: 1854339 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-03
Onset:2021-11-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Audiogram abnormal, Condition aggravated, Deafness unilateral, Ear discomfort, Tinnitus, Tympanometry
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metforman, aldactone, losarten, metapropal, HCTZ, vit D, Vit C, benadryl, atorvastaten
Current Illness: none
Preexisting Conditions: PCOS, hx of endometrial cancer, ASNHL, tinnitus, cardiac stent,
Allergies: none
Diagnostic Lab Data: audiogram and tympanogram 11/08/2021 Started on Prednisone high dose for 21 days taper on 11/08/2021
CDC Split Type:

Write-up: 3 days after the vaccine booster in my Left arm, I woke with sudden Rt sided hearing loss. Had audiogram done and compared to prior done 3 years ago, with noted significant 30 dB low freq HL. Also, significant increased tinnitus on the Rt. Feeling of ear fullness on the Right.


VAERS ID: 1854344 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939903 / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Injection site erythema, Injection site oedema
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Carvidopa-Levadopa, Calcium Carbonate-Vitamin D, Acetaminophen, Voltaren Gel, Pantoprazole, Torsemide, Klor-Con, Osteo Bi-Flex, Multivitamin, Aorvastatin, Toprol XL, Ferrous Sulfate, Ascorbic Acid, Apixaban, Amiodarone
Current Illness:
Preexisting Conditions: Heart Failure, Osteoarthritis, Stenosis of Carotid Artery, Atrial Fibrillation, Essential Hypertension, Restless Leg Syndrome, Anemia, Hypothyroidism, GERD
Allergies: Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Resident presented with a 6"x4" red, fluid-filled area to left inner bicep on left arm, received orders from the doctor for Benadryl 25 mg 1 table every 8 hours routine x 3 days, and Benadryl 1-1.0% apply to left bicep daily PRN for 3 days.


VAERS ID: 1854356 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-03
Onset:2021-11-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8020 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Blood test, Chest X-ray, Chest pain, Dyspnoea, Echocardiogram, Myalgia, Myocardial necrosis marker, Myocarditis, Pain in extremity, Pericarditis, Pyrexia, SARS-CoV-2 test, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin
Diagnostic Lab Data: Heart enzyme blood tests, regular blood tests, covid 19 tests, chest X-rays, heart ultrasound all performed at Hospital in on November 6th 2021 and November 7 2021.
CDC Split Type:

Write-up: Wednesday November 3rd 2 pm (after 2nd shot) arm hurting. Thursday November 4th, joint muscle pain full body. Thursday night fever/chills. Friday November 5th minor chest pains, slight fever. Saturday November 6th 4 am major chest pain, unable to breathe. Went to emergency room. Diagnosed as pericarditis myopericarditis due to 2nd covid shot. High levels of troponin released by heart due to inflammation of heart lining and possible muscle damage.


VAERS ID: 1854382 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-31
Onset:2021-11-06
   Days after vaccination:279
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA #039K20A, #039K / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: interstitial lung disease, dementia, hypothyroidism ,esophagitis, congestive heart failure
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: covid +, O2 2L via nasal cannula


VAERS ID: 1854403 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 3 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dyspnoea, Headache, Heart rate increased, Mobility decreased, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament 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: Breo Elipta 100/25, 10 mg potassium, 10 mg singulair, 500 mg vitamin C, 15 mg buspirone 2 daily, 150 mg Wellbutrin. Xopenex as needed. multivitamins
Current Illness: Non-COVID respiratory infection 2 weeks prior
Preexisting Conditions: Moderate persistent Asthma, Obstructive Sleep Apnea
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Symptoms began with headache and possible fever (no temp taken but had consistent symptoms) waking up Nov. 6. Chest pain, both in center of the chest and feeling like someone was pressing down on collarbone developed that afternoon around 2-3 PM. Shortness of breath developed shortly after and heart rate measured by a fitness tracker watch was a bit elevated around 100-120 bpm at rest compared to the normal 80-90. I called my primary care physicians on call for urgent issues around 5 PM. They were hesitant to send me to the ER with COVID spreading in the community but told me to set a very low trigger threshold for going in. I did not end up visiting the ER as the chest pain and shortness of breath resolved about 8 hours after symptoms started. The fever went away overnight Nov 6-7. The headache went away during the afternoon of Nov. 7. Chest pain was worse laying down than standing up and neither that or the headache went away with 500 mg tylenol every 6 hours. Chest pain and headache kept me in bed or lying on the couch most of the day.


VAERS ID: 1854461 (history)  
Form: Version 2.0  
Age: 10.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EF5127 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Ecchymosis, Erythema, Limb discomfort
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Dad reported pts arm had some reddness and pt was reporting arm discomfort. Pt had mild localized eccymosis. We gave 12.5mg benadryl PO and applied ice pack to arm. Redness did not progress and pt did not have any other symptoms develop. Dad took pt home after being educated on follow up treatment and what else to watch for.


VAERS ID: 1854472 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Condition aggravated, Disturbance in attention, Dizziness, Fatigue, Feeling abnormal, Feeling hot, Headache, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Celexa 20 mg, Bactrim for uti
Current Illness: Uti
Preexisting Conditions: Migraines, chronic fatigue
Allergies: Latex, bees, inderol, demerol, viciden, percocet, cipro,
Diagnostic Lab Data: Na
CDC Split Type:

Write-up: Full body weakness, dizzy, thought i was going to collapse or pass out.. extreme fatigue, warm unpleasant tingling throughout the body, difficulty concentrating. Almost called for ambulance decided to wait it out. Did report to doctor via email. By tues feeling ok just weak and headache


VAERS ID: 1854499 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Hypoaesthesia, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trokendi, Magnesium, Multivitamin, Vitamin B2, Vitamin B12, Probiotic, Fish Oil, Allegra Allergy, Vitamin D3, Frova, Fiorinal, Wellbutrin, Flonase, Diclofenac sodium, Methocarbamol, Verapamil, Cefixime, Fluconazole, Celpodoxime Proxetil, an
Current Illness: Abdominal Cramping, cold symptoms.
Preexisting Conditions: Migraines, IBS, Fibromyalgia, Osteopenia, Allergic rhinitis, GERD, Dyspareunia, Chronic sinusitis of both maxillary sinuses, Primary osteoarthritis of right shoulder, overweight.
Allergies: Anoprox, Contrast Dye Tramadol, Codeine, Ampicillin, Adheseive Tape, Cymbalta, Lyrica, Neurontin.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness, numbness, tingling in arm


VAERS ID: 1854531 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Band sensation, Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Demyelination (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: Moderna on 1/6/2021 & on 2/2/2021
Other Medications: tylenol extra-strength 1000mg po q6hrs.
Current Illness: n/a
Preexisting Conditions: MTHFR, digestive issues
Allergies: sulfa, latex, nuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: redness, swollen arm at injection site about 3x it''s normal size/ hot and red raised band at bottom of injection site


VAERS ID: 1854640 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site pain, Nausea, Pruritus
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: itching (6hrs after injection- onset within 15min) pain at injection site (4 days) nausea (on 2nd day) headache (4 days)


VAERS ID: 1854654 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Eye movement disorder, Hyperhidrosis, Hypotonia, Lethargy, Pallor, Slow response to stimuli
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Father didn''t report
Current Illness: No
Preexisting Conditions: Father didn''t report
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Between 10-20 seconds after patient received first Covid vaccine (Pfizer), this RN heard patient''s father called for her name "Patient, are you OK?" RN went to patient''s chair and found patient was on the floor with her head bending backward. Patient was lethargic, awake but slow to respond. Patient looked pale and was sweating. This RN carried patient to EMS Room. Ice pack was applied to patient back, head and neck. Patient drank water, she refused snack. Patient reported that she had lunch. Dad and brother were sitting next to the patient at Table 7 and told RN that "Patient eyes was open but not moving when she was sliding off the chair." 14:35 - BP = 88/55, P=80, O2Sat= 100% on RA, R=20. 15:00 - BP = 78/36, P=56, R=26, O2Sat 87-88%, patient was pale and reported difficulty breathing. RN/floor leader advised father to either call 911 or take patient to ER. Father preferred to take patient to the ER. Father was very pleasant. 1512: BP=84/50, P=74, R=18, O2Sat =100% on RA. Patient was smiling, skin was pink and said that "I''m ok". This RN escorted patient to the car with her father and brothers.


VAERS ID: 1854670 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Chest pain, severe


VAERS ID: 1854752 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-04
Onset:2021-11-06
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Polymerase chain reaction
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: Cycle threshold 24.2 on 11/6/21
CDC Split Type:

Write-up: Hospitalization due to COVID-19 Reported per Janssen COVID-19 Vaccine EUA


VAERS ID: 1854781 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Fear of injection, Hyperhidrosis, Pallor, Tinnitus
SMQs:, Neuroleptic malignant syndrome (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: lightheaded after flu shot 2020
Other Medications: none
Current Illness:
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received dose 1 of the Pfizer COVID vaccine (lot FK5127) at approximately 1600. At 1607, patient reported feeling sweaty and hearing "raining" in his ears. PHN and PHN approached noting patient appeared pale. Vital signs: O2 99%, blood pressure 90/62, respirations 20, pulse 94. Patient''s mother reported patient had no allergies, took no medication, and no current medical conditions but was hospitalized at age 2 due to pneumonia. PHN offered Benadryl but the patient''s mother declined. PHN educated on remaining for 30min monitoring from time of symptom report, to follow up with provider, and ER precautions. Patient''s mother reported the patient had eaten prior to arrival and the patient was anxious about needles. Mother reported that after the flu shot in 2020 the patient felt lightheaded but no other similar reaction. At 1620, patient reported symptoms had improved. PHN noted patient''s color had returned. Vital signs: O2 99%, pulse 88, blood pressure 82/40, respirations 20. At 1640, vital signs: blood pressure 84/40, O2 98%, pulse 78, respirations 20. Patient stood up slowly, monitored by PHN. At 1644, patient left walking with steady gait accompanied by mother.


VAERS ID: 1854787 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bone pain, Chest pain, Dyspnoea, Hypoaesthesia, Peripheral swelling, Vaccination complication
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Osteonecrosis (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin, TOVIAZ, LISINOPRIL, MOTILIN
Current Illness: Unknown
Preexisting Conditions: 2 pancreas transplants, type 1 diabetic, autonomic neuropathic neuropathy
Allergies: Unkown
Diagnostic Lab Data: Na.
CDC Split Type:

Write-up: Patient got vaccine 10:30 am and by 10:30 pm patient developed what she called covid arm. There was a bump the size of a walnut. Shortly after hands went numb and extreme crushing bone pain was seen. Chest pains were also seen which knocked the wind out of her. 3 days after the shot bump is the size of an orange.


VAERS ID: 1854795 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: HX of CA
Allergies: Shellfish - anaphylaxis, severe Wool - hives, itching, mild-moderate
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was in observation after receiving 1st dose Covid vaccine when throat began to swell and she started having difficulty swallowing. VSS: SpO2 98%, HR 82, 118/78, RR 20, T 98,6 temporal. 50mg of diphenhydramine administered PO @ 1531. EMS called and arrived to check pt. Pt refused transfer to hospital.


VAERS ID: 1854803 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-10-15
Onset:2021-11-06
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

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

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

Write-up: Shingles outbreak and joint pain


VAERS ID: 1854816 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Lymphadenopathy, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: carvediloL 6.25 mg Tabs, SUMAtriptan 100 mg Tabs, sertraline 50 mg Tabs, sertraline 25 mg Tabs, buPROPion 300 mg tablet, Synthroid 175 mcg Tabs, loratadine 10 mg Tabs, Etonogestrel-Ethinyl Estradiol 0.12-0.015 mg/24 hr PV RING
Current Illness: Bronchitis/sinus infection
Preexisting Conditions: Hashimotos, high blood pressure
Allergies: Sulfa, benzoyl peroxide
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling and redness at injection site. Painful and warm at injection site. Swelling in arm pit/bicep area. Red ring around bicep approximately 1-2 inches below injection site swelling.


VAERS ID: 1854827 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-11-03
Onset:2021-11-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Axillary pain, Chest discomfort, Chest pain, Dyspnoea, Electrocardiogram, Hypoaesthesia, Muscle twitching, Oedema peripheral, Paraesthesia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Dyskinesia (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin 600mg 3x a day; amlodipine 5mg 2 tabs 1x a day; Rosuvastatin 5mg 1x a day; Omeprazole 20MG 1x a day; Nervive Nerve Health supplement 1x a day; Losartan 100mg 1x a day; Sildenafil 20mg as needed; Melatonin 10mg 1x a day; Vitamin
Current Illness: none
Preexisting Conditions: Neuropathy in feet
Allergies: none
Diagnostic Lab Data: All they did was an EKG, BP and Pulse for Triage 8-Novemebr
CDC Split Type:

Write-up: Had swelling under left arm and twitching in both arms after first dose on 13 October. Had tightness and pain in chest starting from left arm pit area across chest. Had trouble breathing and also tingling numbness in left arm and fingers after second dose recived on 11/3. Went to emergency room on 8 November with above symptoms, ended up leaving after 5 hours because they had not taken me in for treatment after TRIAGE. I was triaged and sent back to waiting room.


VAERS ID: 1854844 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymphadenopathy, Migraine, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: -Fever (100.4) - 24 hours -Nausea (8pm Saturday - 11am Sunday) -Body aches (8pm Saturday - 6pm Sunday) -Migraine (8pm Monday - Currently ongoing as of 11/9/2021) -Lymphadenopathy (Sunday - all day)


VAERS ID: 1854920 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-11-04
Onset:2021-11-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Dyspnoea, Pyrexia, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: paliperidone, Buspirone, Divalproex 500 mg, Amanatadine
Current Illness: none
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT FEELING DIFFICULTY IN BREATHING, CHEST CONGESTION AND COUGHING A LOT AFTER 2 DAYS OF FEVER.


VAERS ID: 1854948 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Cough, Crying, Dysphonia, Dyspnoea, Lymphadenopathy, Oropharyngeal pain, Pain in extremity, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Kid stated he had a sore throat earlier in the week prior to vaccination, but stated he did not have a sore throat for 48 hours prior.to vaccination.
Preexisting Conditions: N/A
Allergies: Hives to Amoxicillin
Diagnostic Lab Data: No treatment was sought since he calmed down and was no longer dyspneic after the ibuprofen.
CDC Split Type:

Write-up: My son received the vaccine and complained of a sore throat within 2 hours. Woke me up six hours post vaccine, crying and struggling to breathe. He had inspiratory dyspnea and a harsh, raspiness to his breathing and voice. I calmed him down, and his forehead temperature was 102.6. I have him Ibuprofen and he was able to sleep. He had a sore left arm and stated his right axilla hurt. When touched, it felt slightly swollen. He was febrile for 24 hours. He had a soft nonproductive cough after the event - would only cough a couple times a day.


VAERS ID: 1855045 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939905 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Hypersomnia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (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: diltiazem 240 mg, rivaroxaban
Current Illness: no
Preexisting Conditions: irregular heartbeat and blood pressure
Allergies: no
Diagnostic Lab Data: no
CDC Split Type:

Write-up: Became very exhausted tired all the time and just sleep a lot. She stated that becomes so said to she have the shakes


VAERS ID: 1855106 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Bladder pain, Body temperature increased, Dysuria, Gingival swelling, Headache, Malaise, Pollakiuria, Urine analysis
SMQs:, Angioedema (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: low grade temp and general unwell feeling from other COVID vaccine
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 11/8/21 - urinalysis showed no UTI
CDC Split Type:

Write-up: Temperature ranging from 99.6 to 100.2, headache, low back pain, general unwell feeling, UTI symptoms (pain in bladder, frequency increased of urinating, pain when urinating - felt like a UTI but I was tested by Kaiser and it came back as not a UTI and then symptoms went away on 11/9/21), and swollen gums.


VAERS ID: 1855107 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8027 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Estradiol 1MG tablet daily OTC: Probiotic (Synbiotic 365) 1 tablet daily OTC: Omega 3 500MG (Mega Red) 1 tablet daily OTC: Collagen Peptide powder 20g (Vital Proteins) 1 serving daily
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfer based antibiotics
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Intense itching starting from a few hours after injection still persisting on day 3


VAERS ID: 1855303 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH3527 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Headache, Loss of personal independence in daily activities, Myalgia, Photopsia
SMQs:, Rhabdomyolysis/myopathy (broad), Dementia (broad), Eosinophilic pneumonia (broad), Retinal disorders (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Age 46; 2008; tetanus; unknown brand. Severe muscle pain/weakness, chills and fatigue.
Other Medications: Citalopram; Fish Oil
Current Illness: None
Preexisting Conditions: Mild depression
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Severe muscle and joint pain, incapacitated, unable to do or complete any function other than up to bathroom, severe headache with flashing lights and shapes. Symptoms lasted 36 hours.


VAERS ID: 1855306 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Extra dose administered, Fatigue, Headache, Injection site erythema, Injection site inflammation, Injection site pain, Injection site pruritus, Injection site warmth, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Blood pressure medication Nexium
Current Illness: N/A
Preexisting Conditions: Hypertension Sleep Apnea
Allergies: Sulpha
Diagnostic Lab Data: Saw doctor on 11/09/2021 to rule out cellulitis in arm. She recommended antihistamines and topical steroids as well as cold compresses. She concluded that I had a true allergy to one of the ingredients in the vaccine and recommended I choose a different manufacturer in the future.
CDC Split Type:

Write-up: Fever (102), body aches, headache, diarrhea; fatigue; ?red? upper arm (inflamed, hot, painful, itchy) around injection site


VAERS ID: 1855310 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid 150mcg, Prolesec 20mg
Current Illness: H. Pylori treatment
Preexisting Conditions:
Allergies: Viocodin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain, swelling and red rash at injection site. This is day 4 and it?s still red and starting to itch.


VAERS ID: 1855313 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Insomnia, Pain, Pyrexia, Tremor, Vaccination complication
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol tartrate
Current Illness: No illness
Preexisting Conditions: High blood pressure regulated by metoprolol
Allergies: Darvon, opioids
Diagnostic Lab Data: None, Did not seek medical assistance. I do have an appointment scheduled with my NP Nov. 22, 2021.
CDC Split Type:

Write-up: Adverse reaction to J&J booster: Severe chills; shaking for 11 hours; no sleep; aches; fever; fatigue for 2 days. I had no reaction to the J&J vaccine, only reaction to booster.


VAERS ID: 1855328 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-11-03
Onset:2021-11-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS K45Z2 / 1 RA / IM

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

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

Write-up: Significant nose bleed multiple times; stopped after 10 min the first time and ~5 min following days with tissue


VAERS ID: 1855330 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 RA / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient was given a vaccine on 11/6/ 21 that expired on 11/5/21.


VAERS ID: 1855332 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Chills, Contusion, Cough, Dyspnoea, Erythema, Fatigue, Headache, Myalgia, Pain in extremity, Peripheral swelling, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna #2 Covid vaccine: low grade temp, fatigue, muscle/joint aches, mental sluggishness/dizziness as well as localized pain/s
Other Medications: Amlodipine; Carvedilol; Wellbutrin; Nexium; Diflunisol; modafinil.
Current Illness: None.
Preexisting Conditions: Hypertension; osteoarthritis; GERD.
Allergies: Nickel.
Diagnostic Lab Data: Covid 19 PCR 11/08/2021 @ 10:30AM negative.
CDC Split Type:

Write-up: Shortness of breath, congestion/cough, low grade temp, chills, headache, joint/muscle aches, fatigue, arm pain/swelling/bruising/redness.


VAERS ID: 1855344 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 RA / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Patient given a vaccine on 11/6/2021 that expired 11/5/2021.


VAERS ID: 1855352 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-11-06
Onset:2021-11-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 RA / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pt was given a vaccine on 11/6/21 that expired on 11/5/2021


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