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From the 7/16/2021 release of VAERS data:

Found 479,813 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 203 out of 4,799

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VAERS ID: 1376713 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Herpes zoster, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Percocet, Tramacet (cent family of drugs)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Three clusters of bumps under chin within 2 hours of dose. By next day clusters behind right ear and down chin. By 9:30pm went to Emergency. Diagnosed with Shingles. Given antiviral meds.


VAERS ID: 1376722 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Injection site erythema, Injection site inflammation, Injection site pruritus, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Itching started in the vaccine area 6 hours after the second dose. The area began to become red, hot, and inflamed. It looked like cellulite. The reddened area is about 2 inches. Yesterday I took Zyrtec at night and today I woke up less red but the itching continues.


VAERS ID: 1376728 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-15
Onset:2021-06-03
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 04119 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Brilinta, metoprolol, lisinopril.
Current Illness: None
Preexisting Conditions: Heart issues. CABG and stents
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe upper arm pain, radiating


VAERS ID: 1376740 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium


VAERS ID: 1376791 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site bruising, Injection site pain, Pain, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Bruising at Injection Site-Mild, Site: Pain at Injection Site-Mild, Systemic: Body Aches Generalized-Mild, Systemic: Fever-Mild, Systemic: Headache-Mild


VAERS ID: 1376808 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Choking, Dyspnoea, Hyperhidrosis, Lacrimation increased, Pain in extremity, Retching, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Lacrimal disorders (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Verapamil , Xanax, adderal, Crestor, vitamin D,C, hydrochloride ( water pill)
Current Illness: High WBC 13.5 just about 3 weeks prior was on steroids WBC went to 10 much lower. That?s all l can think of ( didn?t feel ill)
Preexisting Conditions: Hodgkin?s Lymphoma in 12/2014, COPD ( many side effects from chemotherapy) Printzmetal angina, vassel spasm , carpal tunnel, HPV, minears disease, luncheon plantis ,
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: About 45 minutes after l received my vaccine, my eyes started to water and nose was runny ( most of the entire day! No allergies before this! About 4 hours after vaccine l had a drink of water had was chocking on a sip( couldn?t breathe ( spitting and sweating) couldn?t catch my breath! Very scary. Shortly a few minutes later ( tried to suck on a piece of melted chocolate and could pass throat. Another chocking event occurred. I find by gagging and spitting to get relief and breathe. Heavy feeling in my chest lasted until evening ! Still very sore arm today


VAERS ID: 1376822 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Pyrexia, Rash, Rash erythematous, Rash macular
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Exhaustion, fatigue, low grade fever, diffuse red blotchy rash over stomach, chest, back, shoulders, armpits. Took naproxen, Tylenol and Benadryl. Rash is still ongoing. Other symptoms have resolved.


VAERS ID: 1376823 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site pain, Injection site swelling, Lymphadenopathy, Pain, Rash
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Site: Bruising at Injection Site-Medium, Site: Pain at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Systemic: Allergic: Rash Generalized-Medium, Systemic: Body Aches Generalized-Medium, Systemic: Lymph Node Swelling-Medium.


VAERS ID: 1376867 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Urticaria (rash on face)


VAERS ID: 1376885 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-05-21
Onset:2021-06-03
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram, Condition aggravated, Hydronephrosis, Pneumonia, Surgery, Urinary tract infection
SMQs:, Retroperitoneal fibrosis (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin, metphormin, gabapenton, albuteral, aspirin,
Current Illness: Uti, heart issues
Preexisting Conditions: COPD, heart stints
Allergies: Penicillin, coding, sulfa
Diagnostic Lab Data: Surgery, cat scans, ext..
CDC Split Type:

Write-up: Currently in hospital as of 06/ 05/ 21 kidney blockage/ surgery needed, Uti, pneumonia, possibly more. Daughter also was in hospital with lung problems...got shots at same time.


VAERS ID: 1376896 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in jaw, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Osteonecrosis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Facial swelling, left side, maxillary and mandibular areas. No pain, no redness, no increase in temperature. Mild pain on pressure on the area of swelling. No palpable lymph nodes


VAERS ID: 1376915 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: intense chills and muscular pains for at least 60 hours, diminished quite a bit after 72 hours


VAERS ID: 1376917 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein, Chest pain, Echocardiogram normal, Electrocardiogram ST segment elevation, Electrocardiogram normal, Pericarditis, Red blood cell sedimentation rate normal
SMQs:, Systemic lupus erythematosus (broad), Myocardial infarction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: CLonidine 0.1mg PO QHS Risperidone 2mg P QHS
Current Illness: None
Preexisting Conditions: Attention deficit hyperactivity disorder
Allergies: No known drug or food allergies
Diagnostic Lab Data: Diffuse ST segment elevation on EKG. Echo with normal biventricular function, normal coronary arteries, no pericardial effusion. ESR 11, CRP 2.3.
CDC Split Type:

Write-up: Chest pain that started the evening after he received his second dose of the COVID-19 vaccine (5/3) and persisted for 36 hours. Went to the ER (5/4) where EKG demonstrated ST segment elevation, concerning for pericarditis. He was transferred to our facility and admitted (5/5). Symptoms and EKG consistent with pericarditis, unclear etiology however presumed to be related to COVID vaccine. He was started on treatment for pericarditis with ibuprofen 600mg by mouth three times per day. Chest pain resolved on day of discharge.


VAERS ID: 1376923 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-22
Onset:2021-06-03
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Pericarditis, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Omeprazole 20 mg daily Tylenol 650 mg q6hr PRN
Current Illness: Ulcerative colitis flare treated with prednisone taper for 2 months which he finished taking 2 days before onset of symptoms.
Preexisting Conditions: Ulcerative Colitis GERD
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: chest pain, dyspnea, tachycardia, and acute pericarditis symptom onset 6/3/21, continuous, worsening x 5 days leading to admission to hospital after developing acute pericarditis admitted to hospital on 6/6/21


VAERS ID: 1377041 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-24
Onset:2021-06-03
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

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

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

Write-up: Patient received the COVID vaccine on 5/24/21. On 5/31/21, patient started to experience chills, fever, and cough, which continued to progress until 6/3/21, when patient presented to the ER. He tested positive for COVID in the ER and was noted to be short of breath and satting 88% on room air. Patient was admitted to the hospital on 6/3/21 for COVID treatment (remdesivir and dexamethasone).


VAERS ID: 1377042 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA FB-003C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pharyngeal swelling, Throat irritation, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: SUMAtriptan (IMITREX) 50 Ibuprofen Tylenol
Current Illness:
Preexisting Conditions: migraines
Allergies: Tylenol medroxyprogesterone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient arrived at the covid vaccine site for first dose of moderna. Patient was instructed to wait in the observation room for 30 min due to previous allergic reaction to Tramadol and depo. Allergic reaction to Tramadol includes anaphylaxis and rash. Hives and swelling occur with depo shot. Patient reported her throat was feeling tight and itchy. rapid response called and patient was taken to ED. Vitals BP 156/121, HR 83, 100% SPO2) In ED, patient scoped with +Mild swelling to arytenoid noted though only trace. Patient received diphenhydramine and famotidine and was observed over night before being discharged. Scope introduced into nares after topical 4% lidocaine and phenylephrine were atomized intranasally. No lesions noted in the nose. Epiglottis without obvious lesions, false vocal folds normal, true vocal folds normal, mobile vocal folds bilaterally, no piriform sinus abnormalities b/l and clear supraglottis and glottis. No foreign bodies noted. Airway appears without obvious obstruction, no active bleeding. Mild swelling to arytenoid noted though only trace


VAERS ID: 1377102 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-05-01
Onset:2021-06-03
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site rash
SMQs:, Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Rash on arm after first vaccination
Other Medications: Daily multi-vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: amoxicillin and ampicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash on left arm near vaccination site that formed 4 weeks later. looks similar to shingles type rash


VAERS ID: 1377112 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-06
Onset:2021-06-03
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH N/A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Constipation, Muscle spasms, Nucleic acid test, SARS-CoV-2 test negative
SMQs:, Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Medications Prior to Admission Medication Sig Dispense Refill Last Dose ? aspirin 81 MG PO Chew Tab take 81 mg by mouth once every other day. 6/4/2021 at Unknown time ? docusate (COLACE) 100 MG PO Cap take 100 mg by mouth as needed for
Current Illness: Aortic stenosis ? Ataxic gait ? Chronic back pain ? CVA (cerebral vascular accident) (CMS/HCC) 2014 Gait abnormality ? Diabetes mellitus, type II (CMS/HCC) ? Erectile dysfunction ? GERD (gastroesophageal reflux disease) ? Heart murmur rheumatic fever as child ? HTN (hypertension) ? Hyperlipidemia
Preexisting Conditions: Aortic stenosis ? Ataxic gait ? Chronic back pain ? CVA (cerebral vascular accident) (CMS/HCC) 2014 Gait abnormality ? Diabetes mellitus, type II (CMS/HCC) ? Erectile dysfunction ? GERD (gastroesophageal reflux disease) ? Heart murmur rheumatic fever as child ? HTN (hypertension) ? Hyperlipidemia
Allergies: Hydrochlorothiazide Swelling, generalized ? Lisinopril Swelling, lips/throat/tongue ? Losartan Swelling, lips/throat/tongue ? Penicillins Hives ? Metformin GI Distress
Diagnostic Lab Data: SARS-COV-2 (COVID-19) by NAA, Micro Order: 1220326914 Status: Final result Visible to patient: Yes Next appt: 06/23/2021 at 01:30 PM in Cardiology (DO) Specimen Information: Nasopharyngeal; Swab 0 Result Notes Ref Range & Units SARS-CoV-2 (COVID-19) by NAA, Micro Not Detected DetectedAbnormal Narrative The SARS-CoV-2 (COVID-19) by NAA test is for in vitro diagnostic use under the FDA Emergency Use Authorization (EUA) for US laboratories certified under CLIA to perform high complexity testing. This test has not been FDA cleared or approved. Methodology: Nucleic Acid Amplification (NAA)/Polymerase Chain Reaction (PCR). Specimen Collected: 06/05/21 12:23 AM Last Resulted: 06/05/21 1:40 AM
CDC Split Type:

Write-up: Medications Prior to Admission Medication Sig Dispense Refill Last Dose ? aspirin 81 MG PO Chew Tab take 81 mg by mouth once every other day. 6/4/2021 at Unknown time ? docusate (COLACE) 100 MG PO Cap take 100 mg by mouth as needed for FOR CONSTIPATION. Past Month at Unknown time ? insulin 70/30 (NovoLOG) (70-30) 100 UNIT/ML SQ Suspension Sliding scale twice daily with meals 6/4/2021 at Unknown time ? latanoprost (XALATAN) 0.005 % OPHTH Solution place 1 Drop into both eyes once every night at bedtime. Past Week at Unknown time ? methocarbamol (ROBAXIN) 750 MG PO Tab take 750 mg by mouth every 8 hours as needed for FOR MUSCLE SPASM. Past Week at Unknown time ? Alirocumab (Praluent) 75 MG/ML SQ Solution Auto-injector inject 75 mg as directed every 14 days. 3 mL 3 5/31/2021 ? amLODIPine (NORVASC) 10 MG PO Tab TAKE 1 TABLET BY MOUTH EVERY DAY 90 Tab 1 Past Week at Unknown time ? Insulin Syringe 31G X 5/16" 0.5 ML XX Misc Twice daily for insulin injections. 100 Each 3


VAERS ID: 1377162 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-03-11
Onset:2021-06-03
   Days after vaccination:84
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Attention deficit hyperactivity disorder, Chest pain, Computerised tomogram abnormal, Cough, Echocardiogram abnormal, Electrocardiogram ST segment elevation, Lung infiltration, Painful respiration, Pericardial effusion, Pericarditis, Pleural effusion, Rales, Ultrasound Doppler
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (narrow), Myocardial infarction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Chief Complaint chest pain History of Present Illness Very pleasant 29-year-old gentleman has lived in the US since 9 years old presents to the emergency room with chest pain. Started around Thursday of last week, has been constant progressively worse sharp and worsened with deep inspiration coughing progressed to the point was so severe that he had to come to the emergency room tonight. He denies fevers or shaking chills or any coryza prodrome. He received the 2 dose Pfizer vaccines February 11 and March 18 and has not had Covid Has been monitoring serially for HIV and this has been negative including this evening In the emergency room was given aspirin initially with concern


VAERS ID: 1377321 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Fatigue, Headache, Pain, Pain in extremity, Vaccination site swelling
SMQs:, Neuroleptic malignant 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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pcp referred her to our hotline for triage. Recommended pt go to Urgent Care asap for w/u and to f/u with her pcp.
CDC Split Type:

Write-up: Pt developed sore arm, Tmax to 102, fatigue and headache ~5 hours post vax, but these symptoms mostly improved within 24 hours. Vax site swelling (Left arm) increased to size of palm of hand and developed pain shooting down legs (R$gL) over the next few days. Today is 5 days post vax.


VAERS ID: 1377349 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / IM

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

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

Write-up: 2nd dose given 10 days early. First dose was administered 5/20/21.


VAERS ID: 1377369 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

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

Write-up: Started breaking out in hives, first on the arm that injection was received in, and the progressed to full body hives. Parents paged Pediatrician on call and gave Zyrtec, which was all they had at home. Benadryl was given around 11:30PM and hives resolved shortly after dosing with Benadryl.


VAERS ID: 1377688 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hyperhidrosis, Tinnitus
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hearing impairment (narrow), 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: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: latex
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: 3:40pm pt. c/o lightheadedness, ringing in ears and getting sweaty. Patient requested water. Water was provided. BP 117/66, HR 66, O2Sat 99% on RA.


VAERS ID: 1377727 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-25
Onset:2021-06-03
   Days after vaccination:129
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough COVID.


VAERS ID: 1377749 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-17
Onset:2021-06-03
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anovulatory cycle, Heavy menstrual bleeding, Intermenstrual bleeding, Menstruation irregular, Polymenorrhoea
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamin, CoQ10
Current Illness: None
Preexisting Conditions: Mitral valve prolapse (no issues/complications)
Allergies: Amoxicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Just over 2 weeks after receiving the vaccine, I experienced an irregular menstrual cycle, characterized as shortened 19 day cycle, arriving 1 week earlier than anticipated. For the past 3 years, all cycles have been 25-27 days without any irregularity. Period characterized by heavy bleeding, which has continued as bright red bleeding several days beyond typical length of period. Consulted with Fertility specialist and Fertility RN via telehealth platforms. Immediately following the vaccine on May 17, I did experience potentially abnormal symptoms (minor bleeding) at the end of my cycle. While trying to conceive, abnormal menstrual cycles and anovulation represent a significant lost opportunity to conceive.


VAERS ID: 1377786 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L204 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Hallucination, Headache, Muscular weakness, Pain, Pyrexia, Urine odour abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (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: Baby Aspirin,1 daily. Plavix 75 mg, 1 daily. Bupopion HCL SR 150mg 2 daily. Metphormin HCL 500mg 2 daily. Buspirone HCL 10 MG 2 daily. Carvedilol 25mg 2d daily. Cyclobenzaprine 10 mg 3 times daily. Protonix 40 mg 1 daily. Lipitor 40 mg 1 da
Current Illness: Diabetes Heart ,degenerative disc n neuropathy
Preexisting Conditions: DegenerativHearn sc causing pain n neuropathy. Heart have a stint and internal defibrillator Jan was diagnosed a diabetes
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The day I got it I had Headache body aches fever, chills, urine smelled like sewer fever went up to 104 in the night my legs couldn''t hold me up I was hallucinating and thought I was going to die. Next day Tylnol kept fever to 101. still had Headache and body aches no energy Saturday was washed out n no energy n headache. Sunday a headache n today Monday a headache still and urine still smells bad


VAERS ID: 1377804 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 LA / IM

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

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

Write-up: The day after the patient recieved the vaccine she developed hives and itching all over her body. The patient went to her MD and was given benadryl and has recovered from her hives.


VAERS ID: 1377808 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Condition aggravated, Fatigue, Fibromyalgia, Headache, Migraine, Myalgia, Pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pneumonia vaccine; unknown reaction type
Other Medications: albuterol, xanax, baclofen, zyrtec, cyanocobalamin, pradaxa, pristiq, cardizem, benadryl, neurontin, norco, atarax, mirena, synthroid, emla cream, magnesium, proamatine, singulair, omega-3 fatty acids, prilosec, zofran, phenergan, zocor, tr
Current Illness:
Preexisting Conditions: POTS, syncope, inappropriate sinus tachycardia, branch retinal artery occlusion, intracranial aneurysm, Transient Ischemic Attack, retinocochleocerebral vasculopathy, sick sinus syndrome, other mast cell activation disorder, migraine with aura and with status migrainosus, not intractable; fibromyalgia, disorder of menstruation and other abnormal bleeding from female genital tract; hyperlipidemia, Ehlers-Danlos Syndrome, anaphylaxis, cardiac pacemaker in situ, anxiety, ASCUS favor benign, depression, endometriosis, transient visual loss of left eye
Allergies: Demerol, meperidine, protamine sulfate, reglan, depakote, droperidol, troadol, adhesive bandages, aimovig, ergotamine, fioricet, rice, corn, soy, peanuts, halothane, imitrex, inderal, maxalt, naprosyn, sudafed, valproic acid, cafergot, topamax, amoxicillin, augmentin, cefuroxime, lyrica, midrin, prednisone, hydrocodone (Qualitest), pseudoephedrine
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt reported fatigue, headache, myalgias, and chills. Per appointment, pt is experiencing a fibromyalgia flare, has a migraine, and reports "burning pain on upper arms and lower extremities" to the point that she has been unable to wear clothing that touches her arms due to the pain.


VAERS ID: 1377811 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Erythema, Feeling abnormal, Lip blister, Lip pain, Oral discomfort, Pain in extremity, Paraesthesia oral
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: First vaccine, had a cluster of blisters on the right side. She used an organic lip balm that went away after 2 weeks.
Other Medications: None.
Current Illness: Blisters on lips from first vaccine.
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: She got her vaccine, she had a sore arm/shoulder area but that went away within 24 hours. Then about 2 days later her upper lip had tingling, and then burning, and three different places on her upper lip had clusters of blisters. They were painful sores. Right now three places are red, burning, and she bought an Vibrant Health Gigartina Red Marine Algae ointment that bought in store and the pharmacist told her to get it. It was good for cold sores, chapped lips, and kept putting it on her lips, which did not help. The blisters have finally gone away and has a wound like area in three spots on each corner of her mouth and one in the middle, especially the right side the two are closer in the middle. She said she feels like she is dying, bombarded with these symptoms and you don''t know how to fix it. She wishes that they had studied the vaccines more and that there was a treatment know to treat Herpes Zoster or that these symptoms were out there and what to expect.


VAERS ID: 1377871 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Extra dose administered, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Medication errors (narrow)

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

Write-up: Patient received two doses, one in each arm, of the Janssen COVID19 vaccine on 6/3/2021. Patient mistakenly believed he required two doses, one in each arm. Vaccinator administered the extra dose. He asked the patient if he had received the COVID19 shot before, but the patient misunderstood and said that he had not received the shot before that day. Patient reported lightheadedness and nausea approximately 24 hours after the vaccination. Approximately 72 hours after the vaccination, the patient reported no other side effects and said that he was in good condition.


VAERS ID: 1377873 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 AR / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Echocardiogram normal, Magnetic resonance imaging heart, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Troponin elevation to 12 upon admission with subsequent downtrending over the course of the next two days Echocardiogram with normal cardiac function Cardiac MRI pending at the time of submission
CDC Split Type:

Write-up: After patient''s second dose of Pfizer vaccine, he developed chest pain, consistent with myocarditis. Got his second vaccine on 6/2 and then developed symptoms on 6/3 and 6/4 which prompted ER visit on 6/5. He has been on Ibuprofen ATC.


VAERS ID: 1377903 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: see below
Current Illness:
Preexisting Conditions: vit b12 & D def, HTN, DM, OA, PVD, BPH, depression, hep C, dipolar, schizoaffective disorder,
Allergies: penicillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient recieved first COVID vaccine from clinic on 1/7/21, and second dose was administered as the Janssen vaccine because the facility social worker had filled out the COVID vaccine consent form and stated that the patient had not recieved any COVID vaccine. After Janssen vaccine was administered, another worker at facility said that the patient has already recieved the Moderna dose as their first shot.


VAERS ID: 1377906 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: amlodpine, donepozil, lexapro, KCL
Current Illness:
Preexisting Conditions: alzheimer''s, HTN, heart disease, malnutrition, CKD, depression, NSTEMI, dysphagia, Vit D def
Allergies: penicillins, codeine, erythromycin, demerol, nitroglycerin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient recieved first COVID vaccine from CVS clinic on 1/7/21, and second dose was administered as the Janssen vaccine because the facility social worker had filled out the COVID vaccine consent form and stated that the resident had not recieved any COVID vaccine. After Janssen vaccine was administered, another healthcare worker at facility said that the patient has already recieved the Moderna dose as their first shot.


VAERS ID: 1377909 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-01
Onset:2021-06-03
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 18L0096 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Mumps, Parotitis
SMQs:, Oropharyngeal infections (narrow)

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

Write-up: I presented mumps (parotiditis) on the left side of the face, the inflammation has been reduced after 5 days and the only additional medicine I have tried is the use of botox for a treatment of bruxism


VAERS ID: 1377975 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Esomeprozole 20mg Benazapral/HCTZ Cymbalta 60mg
Current Illness: Tendon repair surgery in foot 7 weeks prior
Preexisting Conditions: Hypertension, Spinal stenosis Bronchitis
Allergies: None
Diagnostic Lab Data: None. I waited it out until today - Monday. Only pain left is STILL in my arm .
CDC Split Type:

Write-up: Red/painful at injection site still to today. Muscular aches, spinal pain and headache, severe for 36 hrs straight. . Constant and sharp. I used cold packs and over the counter pain relief.


VAERS ID: 1378006 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose, Depressed level of consciousness, Dizziness, Electrocardiogram, Emotional distress, Fear, Gaze palsy, Hyperhidrosis, Loss of consciousness, Malaise, Skin warm, Tremor, Urinary incontinence, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Vestibular disorders (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: unknown
Current Illness: denies
Preexisting Conditions: denies
Allergies: patient denies, nkda
Diagnostic Lab Data: Blood Pressure, temp, pulse, EMS did standard EKG, vitals, Bs work up on arival to site.
CDC Split Type:

Write-up: while in post vaccination observation, client thrust head back into the wall, while in a seated position. Became unconscious. Left arm tremor- observed. diaphoretic, skin warm to the touch, sweating. When client became alert and oriented, he was fearful of the situation and began to cry. stating he didn''t know what happened, he was scared, and he was dizzy and didn''t feel well. Patient given emesis bag, given water and Ice pack. He also reports no ability to alert anyone prior he had no physiological indicators of what was about to happen. He urinated himself. He then had the second emesis and EMS alerted and on site to assess patient .


VAERS ID: 1378008 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW 0198 / 2 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Chest discomfort, Electrocardiogram, Hypoaesthesia, Myalgia, Paraesthesia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Minocycline 100mg 1 tablet , 2 x day
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Hospital ER trip - EKG and chest X-ray; blood pressure, oxygen, and pulse - all clear. Released after checked for major issues.
CDC Split Type:

Write-up: Day 2 - fever and muscle aches Day 3 - chest tightness and discomfort; tingling and numbness in both arms and hands


VAERS ID: 1378022 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Agitation, Fear, Loss of consciousness, Muscle contracture
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), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), 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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: vitals, Orientation to time place self
CDC Split Type:

Write-up: patient had post vaccine reaction to the Janssen vaccine. he lost consciousness without warning, his upper extremities were fixed and postured towards his chest. He contracted. He was LOC for an estimate of 15 seconds duration. He reported feeling nothing preluding to the LOC. He was fearful and agitated upon arousal. EMS alerted and patient workup done by EMS. Unknown whether patient refuses or consented to Hospital Observation.


VAERS ID: 1378072 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Syncope
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), Cardiomyopathy (broad), Vestibular disorders (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: AS MY CERTIFIED IMMUNIZING TECH WAS ADMINISTERING THE VACCINE, THE PATIENT''S HEAD LOLLED TO THE SIDE (SYNCOPE). IMMUNIZING TECH STUCK HER ARM OUT TO KEEP PT FROM FALLING FROM CHAIR AND HE REGAINED CONSCIOUSNESS ALMOST IMMEDIATELY (LESS THAN 1 SECOND). PT SAID HE FELT DIZZY AND WE HAD HIM STAY IN CHAIR WITH HIS HEAD BETWEEN HIS KNEES, TAKING DEEP BREATHS. HE WAS WITH HIS MOTHER, WHO SAID HE HAD DONE THIS BEFORE AND SHE DID NOT SEEM ALARMED.


VAERS ID: 1378091 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 RA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Lymph node pain, Lymphadenopathy, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: made doctors appointment
CDC Split Type:

Write-up: Swollen Lymph node in neck on the side of the injection (right side). I noticed on June 3 , two days after the vaccination. I woke up and the node was huge and sore/itchy.


VAERS ID: 1378116 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood test abnormal, Cardiac monitoring, Chest X-ray abnormal, Chest pain, Computerised tomogram normal, Decreased appetite, Electrocardiogram, Fatigue, Feeling abnormal, Heart rate increased, Heart rate irregular, Inflammation, Loss of personal independence in daily activities, Malaise, Mental impairment, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Diagnosis with asthma ten years ago but not on any meds.
Allergies: Seasonal Allergies
Diagnostic Lab Data: They did a EKG, blood work and started an IV on him. One of his blood test came back abnormal and indicating that it could be a clot somewhere and they did a Chest CT Scan and chest x-ray. There wasn''t anything on the CT scan but there was inflammation in the chest. They gave him Ketorolac and fluids. They put him on a heart monitor. They waited til his heart rate was slightly normal. After they sent us home, I still have to monitor his heart rate. She stated that his heart is still a little rapid. He is still tried and feeling a little under the weather. He isn''t eating as regular and not able to really function as well. He states he feel foggy.
CDC Split Type: vsafe

Write-up: It started around 10 PM, he stated with 102 degree fever, body aches, fatigue and he couldn''t even get out of the bed. He was really weak and extremely tired. These symptoms last thur 06/04/2021 and his fever broke. I thought we was out of the woods. Saturday, Jun 05, 2021 he woke up with severe chest pains. He had an irregular heartbeat and rapid heart beat. He fever was back and it was 100.8. I called his PCP and he said to take him to the ER.


VAERS ID: 1378128 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-27
Onset:2021-06-03
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl 25mg once daily for allergies
Current Illness: seasonal allergies
Preexisting Conditions: Hypertension, ADHD, allergies
Allergies: Ampicillin, cephalexin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient had a circular rash around the injection site about 2 & 1/2 inches in diameter that started one week after injection into the left deltoid. Patient was told to apply hydrocortisone cream several times a day, and to take Benadryl capsules. The rash caused itching. The rash has cleared 3 days later. Covid-arm?


VAERS ID: 1378218 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / -

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

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

Write-up: haven''t had a menstrual cycle in over 2 years...in menopause, however after send dose of covid vaccine, passed blood clot and experiencing mild to moderate menstruation. received 2nd dose on Jun 1, started bleeding on June 3 and as of today, still bleeding


VAERS ID: 1378257 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-20
Onset:2021-06-03
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Joint swelling
SMQs:, Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: bilateral ankle swelling, Left more than right


VAERS ID: 1378305 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0032C1A / 2 LA / IM

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

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

Write-up: Pt. received 2nd dose of Moderna vaccine 2 weeks after receiving the first dose on 5/20/2021, the recommended time frame is 28 days between doses. The dose was given during a clinic provided by the Department of Emergency Services and was administered by the nurse. This nurse has tried to contact client with no success, messages have been left on his voicemail.


VAERS ID: 1378334 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

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

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

Write-up: Moderna vaccine was administered 2/18/2021 lot # 031M20A. Client dx with covid on 2/21/2021 and given monoclonal antibodies on 3/2/2021


VAERS ID: 1378381 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

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

Write-up: Headache, drowsy


VAERS ID: 1378419 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Blood pressure increased, Headache, Hypertension, Influenza like illness, Injection site pain, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (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: Lipitor 10 mg daily, mulitvitamin daily
Current Illness: None
Preexisting Conditions: Lower back chronic pain, high cholesterol
Allergies: IV contrast
Diagnostic Lab Data:
CDC Split Type:

Write-up: 06/03/2021 1800 - Headache duration 24 hours. 06/03/2021 1900 - Elevated blood pressure, mild hypertension continues. 06/03/2021 1900 - Pain at injection site rated 6/10, 24 hours duration. 06/04/2021 1500 - Severe flu like symptoms, 24 hours duration. 06/04/2021 2000 - Fever 101.00, 8 hours duration. 06/04/2021 2000 - Nausea 24 hours duration.


VAERS ID: 1378470 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-19
Onset:2021-06-03
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebral infarction
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient vaccinated on 5/19/2021 with the J&J vaccine. Patient came into hospital on 6/3 as stroke alert. Patient given alteplase and was positive for an acute cortical and subcortical infarct lateral right frontal lobe. Patient with no prior history to coming into the hospital.


VAERS ID: 1378478 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

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

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

Write-up: vaccine was administered outside of storage recommendations. patient returned on 6/7/21 to re-vaccinate


VAERS ID: 1378507 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Muscular weakness, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient experienced of weakness and pain in left arm. Left index finger pain upon movement. Patient''s vitals normal otherwise and patient declined to have transported to the hospital by ambulance and transported patient to the Hospital.


VAERS ID: 1378532 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-18
Onset:2021-06-03
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Breakthrough COVID


VAERS ID: 1378786 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

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

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

Write-up: Vaccine given at short interval, only 23 days apart.


VAERS ID: 1378790 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

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

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

Write-up: Vaccine given at short interval, only 23 days


VAERS ID: 1378793 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

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

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

Write-up: Mixed series; first dose was Pfizer, second was Moderna.


VAERS ID: 1378801 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Oropharyngeal pain
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: clobetasol 0.05% soln, ketoconazole 2% shampoo, diltazem 30mg, tretinoin 0.05% cream, synthroid 75mcg , pantoprazole 20mg, ibuprofen 800mg
Current Illness: No. Not applicable per patient
Preexisting Conditions: Acid reflux, hypertension, hypothyroidism,
Allergies: sulfa drugs
Diagnostic Lab Data: Patient went to urgent care to check for signs of infection and she said none found.
CDC Split Type:

Write-up: Patient reported sore throat and cough. She doesn''t feel good


VAERS ID: 1378804 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

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

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

Write-up: Mother of the parent provided incorrect date of birth. Patient not eligible to receive the vaccine.


VAERS ID: 1379023 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Cough, Headache, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Dehydration (broad)

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

Write-up: Patient experienced severe tachycardia and mild headache, cough and weakness.


VAERS ID: 1379300 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0080 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Hyperhidrosis, Seizure, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient fainted/passed out a few minutes after receiving the vaccine. Mom stated patient had a little seizure. Patient retain consciousness after 1-2 minutes and did not recall what happened. She felt hot/sweaty and had minor vomiting. 911 was called. They arrived and left without any major concerns.


VAERS ID: 1379320 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Throat tightness, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Melitonin
Current Illness: UTI - unknown at the time of vaccination.
Preexisting Conditions:
Allergies: Latex and adhesive
Diagnostic Lab Data:
CDC Split Type:

Write-up: Ten minutes after shot she began complaining of tightness in throat and chest. Monitored for 45 min and then began throwing up at 7 pm. Vomited rest of evening and all the next day. Went to ER and given an injection of epinephrine. Sent home. Continued to vomit and went back into ER and admitted to hospital.


VAERS ID: 1379531 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), 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:
Other Medications: na
Current Illness: none
Preexisting Conditions: none
Allergies: nka
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patient experienced syncope, fainted 5 minutes after recieving vaccinefor 1 minute then came back conscious


VAERS ID: 1379732 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure fluctuation, Chest pain, Disorientation, Dizziness, Dyspnoea, Electrocardiogram normal, Fatigue, Headache, Musculoskeletal stiffness, Neck pain, Pain, Pallor, Pyrexia, Slow response to stimuli, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (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: none
Allergies: none
Diagnostic Lab Data: normal ECG done by Fire Dept EMT BP was fluctuating while being checked at home by EMT
CDC Split Type:

Write-up: Pt was given his 2nd dose of Pfizer vaccine at pharmacy on 6/3/21 at 1:20pm. Minutes after the vaccine pt developed headache, stiffness of neck, dizziness, fatigue and SOB. Epipen was brought out but never administered, pt was there for about 45 min. Was sent home and took Advil 400mg. Was playing badminton with lots of running 30-45 min prior to vaccine. No other vaccines given in the past year. Since the vaccine, pt has had fever up to 102. Continued headache, neck stiffness. 1st night 6/3/21- bad headache, throbbing headache all around head but worse back right side and then "spikes" on left side (like someone was hitting him with an axe) and fell asleep d/t sever pain, trouble breathing in the next few days 2nd night 6/4/21- neck pain and stiffness was really bad, he looked pale and almost disoriented. Had fever. Slow to respond. Would get rush of bad headache if he moved his neck too fast. Afraid he would fall down if he moved too fast. 3rd night 6/5/21 - (called 911) chest pain, difficulty breathing, vomited stomach acid, pain radiated down chest to the left, pain only when breathing in and went away the next AM 6/7/21 Chest still feels sore on Left side. Biggest issue right now is headache.


VAERS ID: 1380660 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Georgia  
Vaccinated:0000-00-00
Onset:2021-06-03
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Off label use, Product use issue
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol
Preexisting Conditions: Comments: Patient had no known allergies ,not experienced any acute illness, No previous reactions post vaccination, not received any other covid 19 vaccine and NO covid positive
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210607566

Write-up: VACCINE ADMINISTERED TO A 16 YEAR OLD; OFF label Use; This spontaneous report received from a pharmacist concerned a 16 year old male. The patient''s weight was 210 pounds, and height was not reported. The patient''s concurrent conditions included non alcoholic, and other pre-existing medical conditions included patient had no known allergies ,not experienced any acute illness, no previous reactions post vaccination, not received any other covid 19 vaccine and no covid positive. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 204A21A,expiry: 23-JUN-2021) dose was not reported, administered on 03-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 03-JUN-2021, the subject experienced vaccine administered to a 16 year old accidentally. On 03-JUN-2021, the subject experienced off label use. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the vaccine administered to a 16 year old accidentally and off label use was not reported. This report was non-serious.


VAERS ID: 1380674 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-06-03
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK - / -

Administered by: Other       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:
CDC Split Type: USJNJFOC20210608445

Write-up: ADMINISTRATION OF EXPIRED JNJ VACCINE; This spontaneous report received from a pharmacist concerned a 37 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 207A21a, expiry: 23-JUN-2021) dose was not reported, administered on 03-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 03-JUN-2021, the subject experienced administration of expired JNJ vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administration of expired JNJ vaccine was not reported. This report was non-serious. This report was associated with product quality complaint : 90000181676


VAERS ID: 1380676 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Arkansas  
Vaccinated:0000-00-00
Onset:2021-06-03
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Body temperature, Lethargy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergy to antibiotic; Blood pressure high; Fractured cervical spine (Broke his neck in 2012); Spinal fracture (Broke his back in 2012)
Preexisting Conditions: Comments: Patient got disabled from physical injuries. Patient was not able to keep up the metabolic energy with exercise. Patient was steadily getting better from the injuries.
Allergies:
Diagnostic Lab Data: Test Date: 20210603; Test Name: Body temperature; Result Unstructured Data: 100.1 F
CDC Split Type: USJNJFOC20210608652

Write-up: FEELING KIND OF LETHARGIC; FEELING VERY ANXIOUS; FEVER; This spontaneous report received from a patient concerned a 47 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included azithromycin allergy, high blood pressure, broke back, and broke neck, and other pre-existing medical conditions included patient got disabled from physical injuries. patient was not able to keep up the metabolic energy with exercise. patient was steadily getting better from the injuries. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808609, and expiry: 09-JUN-2021) dose was not reported, administered on 03-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 03-JUN-2021, the subject experienced feeling kind of lethargic. On 03-JUN-2021, the subject experienced feeling very anxious. On 03-JUN-2021, the subject experienced fever. Laboratory data included: Body temperature (NR: not provided) 100.1 F. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from fever on 03-JUN-2021, had not recovered from feeling kind of lethargic, and the outcome of feeling very anxious was not reported. This report was non-serious.


VAERS ID: 1380679 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Oregon  
Vaccinated:0000-00-00
Onset:2021-06-03
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had no known allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210608926

Write-up: VOMITING; This spontaneous report received from a pharmacist concerned a 24 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included the patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 207A21A and expiry: 23-JUN-2021) dose was not reported, administered on 03-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 03-JUN-2021, the subject experienced vomiting. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from vomiting on 03-JUN-2021. This report was non-serious.


VAERS ID: 1380680 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-06-03
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Dizziness, Dyspnoea, Headache, Myalgia, Nausea, Pain, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), 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: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: Patient did not have any relevant medical history. Patient had no known drug allergies. Patient was not pregnant at the time of reporting.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210609100

Write-up: HEADACHE; NAUSEA; LIGHT HEADEDNESS; SHORTNESS OF BREATH; BODY ACHES; LEG ACHES; FEVER; BACK ACHE; MUSCLE ACHES; This spontaneous report received from a patient concerned a 25 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included non alcohol user, and non smoker, and other pre-existing medical conditions included patient did not have any relevant medical history. patient had no known drug allergies. patient was not pregnant at the time of reporting. The patient received covid-19 vaccine (suspension for injection, intramuscular, and batch number: 201A21A expiry: 20-JUN-2021) dose was not reported, administered on 03-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 03-JUN-2021, the subject experienced back ache. On 03-JUN-2021, the subject experienced shortness of breath. On 03-JUN-2021, the subject experienced body aches. On 03-JUN-2021, the subject experienced leg aches. On 03-JUN-2021, the subject experienced fever. On 03-JUN-2021, the subject experienced muscle aches. On 04-JUN-2021, the subject experienced light headedness. On 04-JUN-2021, the subject experienced headache. On 04-JUN-2021, the subject experienced nausea. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from fever, back ache, leg aches, light headedness, shortness of breath, headache, muscle aches, body aches, and nausea. This report was non-serious.


VAERS ID: 1380682 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-06-03
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Pyrexia, Sedation
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210603; Test Name: Body temperature; Result Unstructured Data: 37.77 deegre Celcius
CDC Split Type: USJNJFOC20210609290

Write-up: KNOCKOUT; FEVER; This spontaneous report received from a patient via a company representative concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 02-JUN-2021 for prophylactic vaccination. The batch number was not reported. The company is unable to perform follow-up to request batch and lot numbers. No concomitant medications were reported. On 03-JUN-2021, the subject experienced knockout. On 03-JUN-2021, the subject experienced fever. Laboratory data included: Body temperature (NR: not provided) 37.77 deegre Celsius. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the fever and knockout was not reported. This report was non-serious.


VAERS ID: 1380688 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Colorado  
Vaccinated:0000-00-00
Onset:2021-06-03
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       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:
CDC Split Type: USJNJFOC20210611871

Write-up: EXPIRE DOSE GIVEN; This spontaneous report received from a pharmacist concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 03-JUN-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 03-JUN-2021, the subject experienced expire dose given. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of expire dose given was not reported. This report was non-serious.


VAERS ID: 1380690 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Washington  
Vaccinated:0000-00-00
Onset:2021-06-03
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19 immunisation
SMQs:, 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: USJNJFOC20210611915

Write-up: REVACCINATION WITH DIFFERENT COVID-19 VACCINE; This spontaneous report received concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, intramuscular, batch number: Unknown) dose was not reported, administered on 03-JUN-2021 for prophylactic vaccination. The batch number was not reported and has been requested. Concomitant medications included bnt 162 for prophylactic vaccination. On 03-JUN-2021, the subject experienced revaccination with different covid-19 vaccine. The action taken with covid-19 vaccine was not applicable. The outcome of revaccination with different covid-19 vaccine was not reported. This report was non-serious.


VAERS ID: 1381350 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Ohio  
Vaccinated:0000-00-00
Onset:2021-06-03
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Hyperhidrosis, Nausea, Pallor, Seizure
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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:
Current Illness: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: Patient had no known drug allergies. Patient had no drug abuse or illicit drug usage. Patient had no medical history.
Allergies:
Diagnostic Lab Data: Test Date: 20210603; Test Name: Blood pressure measurement; Result Unstructured Data: Not reported
CDC Split Type: USJNJFOC20210607494

Write-up: SEIZURE; DIAPHORESIS; PALE; NAUSEOUS; This spontaneous report received from a patient concerned a 27 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included no alcohol use, and non smoker, and other pre-existing medical conditions included patient had no known drug allergies and patient had no drug abuse or illicit drug usage. Patient had no medical history. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808609, expiry: 31-OCT-2021) frequency 1 total, dose was not reported, administered to left arm on 03-JUN-2021 at 14:37 p.m. for prophylactic vaccination. No concomitant medications were reported. On 03-JUN-2021, events occurred within 3 minutes post-vaccination- seizure, diaphoresis. After seizure-like activity, patient was nauseated and pale. The reporter began cool compress, BP monitoring (Blood pressure measurement) result not reported, called EMS (emergency medical services), and gave water and snacks. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from seizure, diaphoresis, pale, and nauseous on 03-JUN-2021. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210607494-Covid-19 vaccine ad26.cov2.s-Seizure. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


VAERS ID: 1381356 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Wyoming  
Vaccinated:0000-00-00
Onset:2021-06-03
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Bipolar disorder; Borderline personality; Cigarette smoker; Marijuana use; Memory loss
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure dropped (Medication causes her to drop her blood pressure which resulted to seizure.); Pulse decreased (Medication causes her to drop pulse which resulted to seizure.); Seizures; Comments: Patient had no known allergies. The patient did not have any drug abuse/illicit drug use.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210611850

Write-up: GRAND MAL SEIZURE; This spontaneous report received from a parent concerned a patient of 19-year-old female. The patient''s weight was 210 pounds, and height was 170 centimeters. The patient''s past medical history included seizures, drop blood pressure, and pulse drop, and concurrent conditions included borderline personality, bipolar disorder, cigarette smoker, non-alcohol user, marijuana user, and memory loss, and other pre-existing medical conditions included patient had no known allergies. The patient had no drug abuse/illicit drug use. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 207A21A, and expiry: UNKNOWN) dose was not reported, 1 total administered on 03-JUN-2021 to right deltoid for prophylactic vaccination. No concomitant medications were reported. On 03-JUN-2021, at 7 pm the patient complained of being very tired, she felt that she was passing out and nauseated. At 3 am in morning (04-JUN-2021), patient started to have a grand mal seizure, lied on the floor, totally confused, her eyes went all over the place, she did not remember all the people around her. Based on description patient had memory loss, she could not remember the last 3 years of her life and she was on year between 2017 and 2018. Patient had a history of seizure last 2017 when she was on a psychotropic medication (Topamax) which she was taking because of her bipolar disorder. Medication which was taken for bipolar disorder causes her to drop her blood pressure and pulse which resulted to seizure. Patient was planning to visit doctor. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from grand mal seizure. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0:20210611850-COVID-19 VACCINE AD26.COV2.S-Grandmal seizure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: MEDICAL HISTORY, UNDERLYING DISEASE


VAERS ID: 1381398 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-06-03
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021649241

Write-up: Woke up this morning with top lip swollen; woke up this morning with fingertips swollen; This is a spontaneous report from a non-contactable consumer or other non hcp (patient) via Pfizer sponsored prgram. A male patient of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Formulation: solution for injection, Batch/Lot Number unspecified, expiration date unspecified), via an unspecified route of administration on an unspecified date as 1ST DOSE, SINGLE DOSE for covid-19 immunization. The patient medical history and concomitant medications were not reported. On 03Jun2021, the patient woke up in morning with top lip swollen, with fingertips swollen. The patient was due for his second dose Pfizer Covid 19 Vaccine on 03Jun2021 (today). Patient wanted to know if he should get the second dose Pfizer Covid Vaccine today, 03Jun2021 or not. Reporter seriousness was unspecified. The outcome of the events was reported as unknown at the time of report. No follow-up attempts are possible. No information about lot/batch number cannot be obtained.


VAERS ID: 1381754 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Chest pain, Echocardiogram normal, Electrocardiogram repolarisation abnormality, Feeling abnormal, Myocarditis, Troponin I increased
SMQs:, Torsade de pointes/QT prolongation (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (narrow), Conduction defects (narrow), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Troponin I: Initial 3.66 ng/ml (ULN 0.03 ng/ml). CRP 22.6 mg/L (<8.1 mg/L) ECG with repolarization anomaly. Echo with no pericardial effusion and normal heart function. Troponins slowly resolving over 24 hours: 3.53; 2.62; 2.01
CDC Split Type:

Write-up: Patient developed sudden onset of chest pain which was diagnosed as myocarditis. Feeling a little bad on 6/2/2021 with some mild chest pain on that date. Took ibuprofen. Woke up suddenly on 6/3/2021 with severe chest pain. Called pediatrician and was going to wait for them to open; however, it was so severe that they took him to the Emergency Department.


VAERS ID: 1381824 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PAA165969 / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event, Product preparation 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: unkown
Current Illness: unkown
Preexisting Conditions: unkown
Allergies: no
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient undiluted dose of Pfzier vaccine. The 6 dose vial was not diluted, and the full contects of the undiluted dose was administered IM in her right deltoid. No adverse reaction experienced immediately following administration. Follow up report from patient today (6/4/21) at noon and at 7:28 Pm is that she feels fine and is not experiencing any adverse reaction.


VAERS ID: 1381858 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-08
Onset:2021-06-03
   Days after vaccination:56
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: supplements: iron, B12, calcium for allergies: Flonase and Allegra
Current Illness: none
Preexisting Conditions: none
Allergies: Penicillin and Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: shingles outbreak - relatively minor


VAERS ID: 1381883 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Echocardiogram, Laboratory test
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: transgender male- assigned female at birth. Takes testosterone , levsin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 24 hours after shot patient began experiencing chest pain, worse with leaning forward. Being evaluated for pericarditis. Treating w NSAIDs. Echo and labs pending.


VAERS ID: 1381922 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-05-27
Onset:2021-06-03
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Eye pain, Fatigue, Headache, Herpes zoster, Paraesthesia, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

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

Write-up: 6/2/21 A 1/2 inch long bump/rash appeared on the right side of my scalp. It didn''t itch or hurt. 6/3/21 I woke up with a headache on the right side of my head. Felt like a sinus headache, behind my eyes and sinus cavity. 6/4/21 Still had headache and bump on scalp. The right side of my face from my forehead to my eyelids had a painful burning sensation when even lightly touched, almost like a pins and needles feeling but painful. A linear rash appeared on my right middle forehead. 6/4/21 1:20 Doctor diagnosed shingles. By 3pm I had started a 7 day course of Valacyclovir 1 GM 3 times a day. By evening my head hurt to the point of taking 800mg Ibuprofen for relief every 8 hours. Extreme fatigue for the next 3 days. 6/5/21 Head pain continued, with rash spreading throughout right side of scalp and down right side of face, even on eyelids. 6/7/21 Symptoms began to lessen, but head pain in spurts. 6/8/21 Visit to Ophthalmologist at 11:20 am. No lesions on eye. Prescribed Steroid eye drops 2x a day for 1 week. No pain in eye. Head pain almost gone. Energy returning.


VAERS ID: 1381935 (history)  
Form: Version 1.0  
Age:   
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 2021-06-07
   Days after onset:4
Entered: 2021-06-08
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Other       Purchased by: Other
Symptoms: Hypoaesthesia, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: patient stated when she went home she started to notice swelling in face + numbness in her left side. Took benadryl + completely resolved in 48 hours


VAERS ID: 1381949 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Fall, Gaze palsy, Seizure, Syncope, Tinnitus, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hearing impairment (narrow), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Seizure-Mild, Systemic: Tinnitus-Mild, Additional Details: Patient received 2nd dose and withing approximately 5 minutes, her eyes rooled back and her body went limp. She came too withing 1 minute and was ok for approximately 2-3 minutes. Then her eyes rolled in the back of her head and she experienced slight convulsions of her extremities. she came too once again within 1 minute. she was confued initailly when she came too, but pretty quickly was fully awae of her surroundings.


VAERS ID: 1381968 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-03-10
Onset:2021-06-03
   Days after vaccination:85
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blast cells, Myelofibrosis
SMQs:, Haematopoietic cytopenias affecting more than one type of blood cell (broad), Blood premalignant disorders (narrow)

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

Write-up: Patient has h/o essential thrombocythemia. Following vaccination, he developed immature white blood cells with signs of progression to myelofibrosis.


VAERS ID: 1381972 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Lymphadenopathy, Musculoskeletal chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine, Low-OgestrelTabs
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: None as of yet
CDC Split Type:

Write-up: Swollen lymph nodes under left arm , Arm of injection is L arm. In addition Rib pain across chest with pain while taking a deep breath


VAERS ID: 1382016 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Private       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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: morbilliform rash following 2nd dose of MMR at age 4
Other Medications: None
Current Illness: None
Preexisting Conditions: Scoliosis
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient woke up with chest pain, worsened by position changes and with inspiration. Saw pediatrician who suggested Tylenol for symptom relief. Pain subsided somewhat with 500mg Tylenol. Later changed to 400mg ibuprofen 400mg three times daily. No associated shortness of breath, palpitations, syncope.


VAERS ID: 1382043 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / N/A LA / IM

Administered by: Other       Purchased by: ?
Symptoms: 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), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt. passed out after vaccination. BP: 113/60; FS 103; HR 72; Sat 98%


VAERS ID: 1382129 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Flushing, Hyperhidrosis, Pallor, Skin warm, Vision blurred
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Patient received 2nd dose of Pfizer vaccine today. The patient''s mother asked for assistance as daughter was "having a reaction." Vitals/assessment at this time: 62, 16, 82/54, 99% on room air. Patient looks pale, diaphoretic, says "my vision is blurry". Questioned mother and patient, mother said "this is the first time this has happened." When asked about if she had anything to eat, she said she had not eaten breakfast. OJ given. Patient awake, alert, oriented X3. Sitting in chair. Skin warm to touch/ looks flushed. Vitals Reassessment- 72, 92/59, 95% room air. Repeat vitals taken x 2. Patient noted feeling better. Patient drank all orange juice, moving extremities, talking, walking with steady gait. Home with parent.


VAERS ID: 1382165 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, ibuprofen, Lexapro 10
Current Illness:
Preexisting Conditions:
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: lymphs inflamed body aches, arms, stomach and groin


VAERS ID: 1382196 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-03-04
Onset:2021-06-03
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cellulitis, Dizziness, Malaise, Myalgia, Rash, Sinusitis, Stasis dermatitis, Urinary tract infection
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tramadol 50 mg, Estradiol 0.01%, pantoprazole 40 mg, potassium chloride 10 meq, carvedilol 25 mg, tizanidine 2 mg, gleevec 400 MG, amlodipine 5 mg, may have been taking clonidine 0.1 mg and furosemide 20 mg and hydralazine 25 mg and nifedip
Current Illness:
Preexisting Conditions: HTN, CML
Allergies: unknown
Diagnostic Lab Data: patient went to urgent care, visited dermatologist, had hospital admission
CDC Split Type:

Write-up: stated a little of everything going on, not feeling good, UTI and sinus infection, had last covid vaccine on March 4, was on 4 different kinds of HTN meds that were being adjusted, woke up Thursday AM 6/03 with dizziness, went to ER, Stated concern about symptoms after taking covid injection 5 wks after second dose, had second dose March 4 of Moderna injection for covid, received in left arm, soreness in muscle very little that lasted one day, stated on April 18 LLE cellulitis and went to urgent care, rash to chest 3 days after taking tetracycline, was told she had statis dermatitis by doctor, stated went away after 1-2 days of using hydrocortisone and compression stocking, HTN meds changed one week before rash


VAERS ID: 1382265 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain, Colitis, Computerised tomogram abnormal, Dizziness, Gastrointestinal haemorrhage, Haematochezia, Nausea, Thrombosis, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal haemorrhage (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Vestibular disorders (broad), Noninfectious diarrhoea (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: POLYETHYLENE GLYCOL
Diagnostic Lab Data: PATIENT REPORTED HAVING A CT SCAN DONE AT SECOND ER VISIT ON 6/6/21 WHICH REVEALED COLITIS AND GI BLEED.
CDC Split Type:

Write-up: PATIENT DEVELOPED SEVERE ABDOMINAL PAIN, N/V, FEELING FAINT LESS THAN 24 HOURS AFTER ADMINISTRATION (THE NIGHT OF 6/3/21). ON 6/4/21 PATIENT WENT TO ER AND WAS GIVEN IV FLUIDS. ON 6/5 PATIENT PASSED BLOOD CLOTS IN STOOL THAT BECAME MORE SEVERE ON 6/6/21. 6/6/21 PATIENT RETURNED TO ER AND WAS DX WITH COLITIS AND A GI BLEED. PATIENT STATES A KNOWN ALLERGY TO POLYETHYLENE GLYCOL - TOOK BENADRYL BEFORE RECEIVING EACH DOSE OF PFIZER VACCINE PER THE GUIDANCE OF HER PRIMARY CARE PHYSICIAN. PATIENT HAD NO REACTION TO FIRST DOSE.


VAERS ID: 1382276 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Chest X-ray normal, Electrocardiogram normal, Heart rate increased, Laboratory test normal, Neck pain
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Arthritis (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: Topimax
Current Illness: None
Preexisting Conditions: Epilepsy
Allergies: Amoxillian and Penicillian
Diagnostic Lab Data: EKG, chest xray, and lab work all completed due to my symptoms. All results came back normal and the ED physician stated the high pulse was connected to the vaccine.
CDC Split Type:

Write-up: I woke up with severe pain in my neck and across my shoulder blades(upper back.) Not long after this, my Fit bit signaled a prolonged period of high pulse. My resting heart rate peaked over 135 and stayed about 110 for 6 hours.


VAERS ID: 1382294 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-01
Onset:2021-06-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain, Adnexa uteri pain, Gastric dilatation, Tenderness, Uterine pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific dysfunction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Woke up in the middle of the night with intense abdominal cramping, which felt like intense menstrual cramps. Stomach became distended and very tender. Continued for several days and I can still feel tenderness and swelling around uterus, as well as pain in ovaries.


VAERS ID: 1382336 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient received Covid vaccination and sat down afterward to wait. Within 10 to 15 minutes, patient fainted. She then had a seizure. We called 9-1-1. Patient stopped seizing and was alert by the time EMT''s arrived. They checked patient, and allowed patient to leave and go home with a parent. No further problems/seizures were reported to have occurred.


VAERS ID: 1382363 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal
SMQs:, Anticholinergic syndrome (broad), Dementia (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Felt ''funny'', slightly dizzy Initial Treatment: Arrived at clinic alone and riding bike. Gave water, juice, and snacks prior to vaccine. 4:20 Vitals: BP 110/80 HR 102 O2Sat 98 Skin Signs: Warm and dry Follow up Treatment: Water, snacks, laying down Doing well on discharge. Dad''s friend came to get son (cleared upon phone call with Dad). Stable and no symptoms on discharge.


VAERS ID: 1382496 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Arthralgia, Condition aggravated, Diarrhoea, Eye pain, Fatigue, Headache, Malaise, Myalgia, Nausea, Pyrexia, Rheumatoid arthritis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Eosinophilic pneumonia (broad), Arthritis (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Biotin, Vitamin D, Vitamin E, Metformin, Minocycline, Duloxetine, Omeprazole, Docusate Sodium, Hyoscyamine, Methocarbamol (as needed), Dicyclomine, Cyclobenzaprine, Irbesartan
Current Illness: high blood pressure, recently no longer diabetic/pre-diabetic
Preexisting Conditions: Rheumatoid arthritis, fibromyalgia, chronic pain, anxiety, depression.
Allergies: Sulfa drugs, zpack (Zithromax), wheat, gluten, sugar
Diagnostic Lab Data: none needed
CDC Split Type:

Write-up: Moderate (RA) pain flared in multiple joins approximately 6-7 hours after injection (given on 6/3). This is unusual because I typically do not get pain in a lot of joints at one time. Individual knuckles on fingers, wrists, hip, neck, shoulder, knees and ankles. Morning after injection (approx. 16 hours): joint and muscle aches, low grade fever (99; I typically am at 97.4-97.8), moderate malaise and fatigue. Headache, eyes ached, mild nausea, stomach upset and diarrhea. Could not stay awake. Symptoms subsided greatly 30-32 hours after vaccination. Fatigue persists, but is minor; goes away with short rest.


VAERS ID: 1382505 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / SC
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect route of product administration
SMQs:, Drug abuse and dependence (broad), Medication errors (narrow)

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

Write-up: My daughter''s second vaccine was given subcutaneously rather than in the muscle. I was not with her for the first vaccine, but I learned the same person administered it. I am concerned about two things: 1. Will my daughter develop the full immune response to the vaccine or will she be more vulnerable to COVID-19? 2. Is there a way to follow up with the pharmacy to ensure vaccines are being administered properly to others in the community?


VAERS ID: 1382594 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-30
Onset:2021-06-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow)

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

Write-up: Mild persistent lightheadedness, frequent feeling of nausea and occasional vertigo. Started 06/03/21, still persists.


VAERS ID: 1382600 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Bilateral lip swelling


VAERS ID: 1382655 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-16
Onset:2021-06-03
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine
Current Illness:
Preexisting Conditions: Thyroid disease
Allergies: nitrofurantoin, sulfa, codeine
Diagnostic Lab Data: covid 19 positive on 6*8/2021
CDC Split Type:

Write-up: Patient received 2 doses of Pfizer covid vaccine on 3/19/2021 and 4/16/2021. She tested positive for covid on 6/8/2021. Her symptoms started on 6/3/2021 and included fever, cough, chills, loss of taste/smell, diarrhea, headache, and congestion/runny nose.


VAERS ID: 1382689 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-06
Onset:2021-06-03
   Days after vaccination:89
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angina pectoris, Chest pain, Dyspnoea, Full blood count, Metabolic function test, Specialist consultation, Troponin
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow)

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

Write-up: shortness of breath, chest pain, angina


VAERS ID: 1382696 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chest pain, Dizziness, Fatigue, Headache, Injection site erythema, Injection site pain, Injection site swelling, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: after 4 days after got vaccine till now, feel chest pain, heart pain sometimes during the 2 days after got vaccine: Dizziness and weakness. Injection site pain (in your arm). Tiredness. Headache. Muscle pain. Fever. Injection site swelling. Injection site redness. Nausea.


VAERS ID: 1382709 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-31
Onset:2021-06-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal distension, Arthralgia, Joint swelling, Menstruation delayed, Pain in extremity, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Fertility disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multiple vitamin with Iron, B-complex, Vitamin C, Vitamin D, Zinc, probiotic, and Omega 3''s.
Current Illness: None.
Preexisting Conditions: None.
Allergies: Cipro, Vicodin, and latex.
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3 days after getting 1 dose of Pfizer vaccine I started I had pain in my left arm and was losing feeling from the injection site into my fingers--tingly feeling. Joint pain in both hands--this subsided about 10 days afterwards. 13 days afterwards, my abdomen swelled--normal waist is 27--went up to 30/31 inches. 15 days afterwards (today) ankles swollen and tingly in both feet but the left worse than the right. Period is also 10 days late as of today--I was regular before the vaccine.


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