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

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



Case Details (Reverse Sorted by Onset Date)

This is page 204 out of 8,010

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VAERS ID: 1735829 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-08
Onset:2021-09-12
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 3 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Autoscopy, Balance disorder, Blood pressure decreased, Blood test, Dizziness, Electrocardiogram normal, Fall, Headache, Heart rate increased, Heart rate irregular, Neck pain, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Arthritis (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra D - 24 hr; citalopram 10 mg; lisinopril 10 mg
Current Illness: none
Preexisting Conditions: obesity
Allergies: penicillin and sulfa
Diagnostic Lab Data: Multiple blood test, EKG all results were good. Made appointment with my regular doctor. He increased my blood pressure meds to 20 mg and I have a follow up appointment on 9/27/21. Feel better after increase in medicine.
CDC Split Type:

Write-up: Began with dizziness, headache and neck pain on 09/12/2021 early evening. Took 1000 mg Tylenol to help with headache and 16 oz of water at 6 pm. Went to bed. Next day still felt dizzy and head pain, relaxed and took 1000 mg Tylenol every 8 hours to help. Went to bed around 9 pm and woke up 5 times to urinate. Each time was very dizzy, fell into the wall the 5th time (did not hit head), unstable. Heart was beating so hard I could feel it in my eyes. Head and neck pain continued. Took a neproxen and drank 6 oz of water and went back to bed. Woke up dizzy around 5:30 am and felt like I was having an out of body experience. Took blood pressure with an Advocate Model SPBP-04 with the following readings: 6:00 am 157/100, pulse 152. Drank a cold glass of water. 6:10 am 148/107, pulse 147. 6:30 am 140/98, pulse 152. Called doctor''s office and they scheduled me to see a floating nurse. Nurse kept me until I could see Dr.


VAERS ID: 1735852 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-10
Onset:2021-09-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Blister, Burning sensation, Herpes zoster, Pain, Pain of skin
SMQs:, Severe cutaneous adverse reactions (broad), Peripheral neuropathy (broad), Hypersensitivity (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pantoprazole 40mg, meloxicam 14mg, Atorvastatin 20mg,, what a day no iron women?s vitamin, D3 10mcg, B12, 500mcg, vitamin E 180 mg, Fluticasone Propionate /Salmeter Diskus Inhalalation Powder 250mcg
Current Illness: Throat and chest pain. When walking.
Preexisting Conditions: Sciatic nerve pain, Psoriasis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: September 12 starting of shingles. Aching, pain in area, burning, needles where blisters forming. September 21 new case of shingles formed on top of and above already out break of shingles. Aching, pain, burning, needles on blisters. All on back of left back side thigh.


VAERS ID: 1735911 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-12
Onset:2021-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: red rash on arm where vaccination given


VAERS ID: 1736058 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-27
Onset:2021-09-12
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Back pain, Chest discomfort, Computerised tomogram abdomen normal, Dyspepsia, Electrocardiogram abnormal, Hypoaesthesia, Lipase increased, Pancreatitis acute
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (narrow), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: Autoimmune. Hashimoto''s disease.
Allergies: no
Diagnostic Lab Data: Lab work-up and CT scan abdomen/pelvis with contrast.
CDC Split Type:

Write-up: Intermittent tingling sensation to left arm for about two weeks. Sunday Sept. 12th, 2021 at 6am. I woke with indigestion issues. I took some nausea medication that I had and I went to work. Was fine at work. When I came home and was making dinner at about 1830 the indigestion returned with an onset of severe back pain and chest discomfort. I layed down for about 10min. then sat back up and started to experience severe left sided chest tightness and numbing of my entire left arm. It lasted about 2min. I then took two Asprin. Left side of chest still felt very heavy. I was scared but decided to wait and call my doctor in the A. M. My doctor''s office suggest that I go to the ER to make sure I was not having a heart attack. That morning I still had some numbing and tingling down the left arm with left sided chest tightness. I arrived to the ER where they did an EKG that should some abnormality. The ER nurse still made me wait in the waiting room for 2hrs. I finally got back to a room where I was seen by PA . He ran some labs and came back and told me that my Lipase was at 706. Pa stated that I had acute pancreatitis. I was shocked as I am not a heavy drinker and maintain a pretty healthy lifestyle. Doctor then recommended a CT scan to make sure nothing else was going on. CT showed normal pancreas. NO INFLAMMATION! Yet lab work stated inflammation of the Pancreas?! A week later I had more blood work and my Lipase showed normal at 52?!


VAERS ID: 1736670 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-11
Onset:2021-09-12
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling abnormal, Headache, Hyperhidrosis, Pain in extremity, Pyrexia, Vaccine positive rechallenge
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Tendinopathies and ligament disorders (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: First COVID shot Fever, chills, sweats, sore arm, brain fog, extreme fatigue, headaches, age 50, date 08/11/21, Pfizer
Other Medications: Phentermine
Current Illness: Effects from having had COVID over a year ago - shortness of breath
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills, sweats, sore arm, brain fog, extreme fatigue, headaches


VAERS ID: 1737021 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-05
Onset:2021-09-12
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site reaction, Rash erythematous, Rash papular, 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: metformin, pravastatin, hydrothyclorizide, turmeric, apple cider vinegar pill
Current Illness: none
Preexisting Conditions: diabetes
Allergies: sulfa
Diagnostic Lab Data: none
CDC Split Type:

Write-up: injection site on left arm developed a red rash, kind of like a welt , raised read and sometimes itchy. started day 8 after shot and lasted 12 days.


VAERS ID: 1737383 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-10
Onset:2021-09-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21A / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Chest X-ray, Chest discomfort, Cough, Dyspnoea, Fatigue, Headache, Hypoxia, Laboratory test normal, Lymph node pain, Lymphadenopathy, Mobility decreased, Nasal congestion, Pyrexia, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test negative, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, protonix, lorazepam, gabapentin, flexeril, acyclovir, loratadine, folic acid, advil
Current Illness: I had adverse effects from the first shot, consistent with covid19, but I tested negative.
Preexisting Conditions: Non-sustained v-tach and afib, prolonged QT, hypothyroidism, PTSD, panic attacks, depression, anxiety, osteoarthritis, fibromyalgia, spina bifida occult, Morton''s neuroma, HSV intraoral, interstitial cystitis, distal hernia, herd, lyme disease,
Allergies: CT contrast, hydrocodone, propranolol, toporol, metoprolol, singulair, doxycycline medrol dose pack, prednisone reglan, phenergan, sulfa, levoflaxin, azelastine, paxil, trazadone, citalopram, cymbalta, promethazine, venlafaxine, pine, mold,mildew, mushrooms and peaches
Diagnostic Lab Data: 2 covid swabs, all negative sept 9, 20 2 Chest xrays- normal Labs
CDC Split Type:

Write-up: I have a cough, wheezing, shortness of breath, fatigue, headache, fever off and on, nasal and chest congestion, tightness in chest, hypoxic, nasal running They have progressively gotten worse, I''ve been to ER and to doctor. I''m now on inhalers, breathing treatments, antibiotics, steroids. In addition, on the 2and day after my 2and shot, all of my joints hurt so bad it was hard to even roll over in bed. It lasted for 2 days and then didnt come back until last night. I''ve been to the ER twice and to the doctor twice and have to go back this week for follow up. Also have swollen lymph nodes from the start in my neck, but now have one near right breast/rib so painful and swollen its hard to move my arm.


VAERS ID: 1737573 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-12
Onset:2021-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / IM

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

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

Write-up: patient was here for a flu shot and was given the COVID (moderna) shot by mistake. Patient didn''t have any rxn at the time but did go to an urgent care later in the week. Outcome is unknown


VAERS ID: 1740142 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-12
Onset:2021-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Loss of consciousness, Muscle rigidity, Musculoskeletal stiffness, Near death experience, Pallor, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Arthritis (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:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (if covid prior vaccination: Yes)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101195870

Write-up: unconscious; I was almost dying; become extremely stiff; become extremely red; rigid; shaking; I was extremely pale; This is a spontaneous report from a contactable consumer reported for himself. A 19-years-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration, administered in Arm Right on 12Sep2021 11:15 AM (Batch/Lot number was not reported) (at the age of 19-years-old) as DOSE 1, SINGLE for covid-19 immunisation. Medical history included covid-19 from an unknown date, the patient got covid prior vaccination. There were no Known allergies. There were no concomitant medications. There were no other medications in two weeks. There was no other vaccine in four weeks. The patient stated as soon as he got the shot on 12Sep2021 11:15 AM he immediately became unconscious. Not even the slow beginning to faint. His mother said as soon as he pushed the plunger his eyes rolled back and he fell forward out of his chair. After about a minute, according to his mom and the (Name) pharmacist, he started to become extremely stiff and started to become extremely red and rigid, and started shaking according to the pharmacist and his mother. He felt like he was almost dying. He had problems with needles as a kid. But this was nothing to do with anxiety or feeling anxious. He felt completely calm going into the shot. After he woke up he was extremely pale. And had to sit for a prolonged time until he could walk. The patient did not get covid tested post vaccination. There was no treatment received for the events. The outcome of the events was resolving. The lot number for the vaccine [BNT162B2] was not provided and will be requested during follow-up.


VAERS ID: 1740873 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-03
Onset:2021-09-12
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blister, Candida infection, Dysphagia, Feeding disorder, Herpes virus infection, Lip blister, Oropharyngeal blistering, Pain, Pruritus, Tongue blistering, Weight decreased
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily allergy pill OTC.
Current Illness: Completed shingles (Shingrix) vacination ( 2 dose series) in April 2021, 5 months prior to covid vaccination.
Preexisting Conditions: Headaches.
Allergies: Penicillin.
Diagnostic Lab Data: Went to urgent care , got antivirals (Valtrex) on 9/22, they confirmed it was herpes virus, had thrush, went to nurse practitioner 9/24 and got lidocaine to numb mouth, used for 3 days , on antivirals for 12 days, that course of treatment will end 9/30.
CDC Split Type:

Write-up: 9 days after the vaccine dose she woke up with small liquid cell blisters over lips, groin, armpits, torso, itched and painful as the days went on, got more painful, spread to throat, tongue and mouth by 9/15, could not eat or swallow, lost 15 pounds.


VAERS ID: 1740947 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-09
Onset:2021-09-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: Redness and swelling to clavicle area


VAERS ID: 1741255 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-11
Onset:2021-09-12
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 2 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Condition aggravated, Migraine, Vaccine positive rechallenge
SMQs:

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: Hep B vaccine tingling and numbness (no migraines)
Other Medications: None
Current Illness: Migraine following Dose 1
Preexisting Conditions: Migraine
Allergies: Hep B vaccine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe migraine after first and second dose of Modern COVID-19 vaccine. Increase in frequency in migraines following the Moderna vaccine. Pre-vaccine, frequency was 1 migraine approximately every 2-4 months and since the vaccine, frequency is 2-4 migraines per month.


VAERS ID: 1741315 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Extra dose administered, Fatigue, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd Pfizer dose
Other Medications: Lisinipril 10mg with HCTZ 12.5mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Low grade fever(99.9), fatigue, achy for 24 hrs


VAERS ID: 1741646 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-04-02
Onset:2021-09-12
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: DM2, HTN, HLD, fibromyalgia
Allergies: aloe vera, coconut oil, codeine, sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: hospitalization with covid after being fully vaccinated


VAERS ID: 1741674 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-29
Onset:2021-09-12
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: swing flu
Other Medications: Dextrin, multi vitamin, vitamin d, centrode
Current Illness:
Preexisting Conditions: COPD, auto-immune issues
Allergies: exquilla
Diagnostic Lab Data: Covid-19 test
CDC Split Type: vsafe

Write-up: I was tired and had a headache. I had body ache. I went to the ER on the 19th of Sept. On the 18th, tested positive for Covid-19.


VAERS ID: 1741794 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8468 / 3 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (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: Lisinopril, Atorvastatin.
Current Illness:
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Soreness at the injection site, pain in arm, currently going on 17 days. Has taken Ibuprofen and Tylenol for soreness.


VAERS ID: 1742390 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-09-08
Onset:2021-09-12
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Hypoaesthesia, Lymphadenopathy, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: nerve tonic for anxiety - calcarea, ferrum phosphoricum, kali phosphoricum, magnesia phosphorica, natrum phosphoricum sertraline 137.5mg nightly cranberry supplement
Current Illness: no
Preexisting Conditions: anxiety disorder headache disorder
Allergies: none
Diagnostic Lab Data: no tests/labs
CDC Split Type:

Write-up: left sided numbness (starting approx 12 hours after injection, resolved within 24 hours), fever resolved within 24 hours, seen in Urgent Care today for supraclavicular lymphadenopathy (worsening)


VAERS ID: 1742534 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Angiogram, Cerebrovascular accident
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Wellbutrin Armour thyroid
Current Illness: None
Preexisting Conditions: Hypothyroidism Arthritis
Allergies: Pcn - rash
Diagnostic Lab Data: CTA head and neck
CDC Split Type:

Write-up: I had a stroke


VAERS ID: 1743702 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-12
Onset:2021-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC182 / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Overdose, Rheumatoid arthritis
SMQs:, Drug abuse and dependence (broad), Arthritis (narrow), Medication errors (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: RA (RA)
Preexisting Conditions: Medical History/Concurrent Conditions: Penicillin allergy (known_allergies: Penicillin); Sulfonamide allergy (known_allergies: Sulfa)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101206673

Write-up: RA flare"bonus" period; Inappropriate schedule of vaccine administered; product=COVID 19, lot =EN6202; other_vaccine_same_date_lot =ER8730, other_vaccine_same_date_dose =2; other_vaccine_same_date_lot =FC182, other_vaccine_same_date_dose =1; This is a spontaneous report from a contactable consumer (patient). A 51-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection; lot number FC182 and expiry date not reported), via an unspecified route of administration, on 12Sep2021, as dose 1, single, and then second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection; lot number ER8730 and expiry date not reported) via an unspecified route of administration, on 12Sep2021, as dose 2, single and then third dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection; lot number EN6202 expiry date not reported) via an unspecified route of administration, administered in Arm Left, on 12Sep2021 11:00, as dose 3, single, all for covid-19 immunisation at the age of 51-year-old from Pharmacy or Drug Store. Medical history included ongoing rheumatoid arthritis (RA), penicillin allergy and sulfa allergy. Patient was not pregnant at the time of vaccination. Patient received unspecified medications within 2 weeks of vaccination. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. The patient was scheduled with inappropriate schedule of vaccine on 12Sep2021 11:00 and had overdose. The patient experienced RA flare "bonus" period on 14Sep2021. Patient received no treatment due to the event. The patient was not recovered from the event.


VAERS ID: 1743737 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-09
Onset:2021-09-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Investigation, Myocarditis, Pericarditis, SARS-CoV-2 test
SMQs:, Systemic lupus erythematosus (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: METOPROLOL; PAXIL [PIROXICAM]
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data: Test Date: 20210912; Test Name: I was diagnosed; Result Unstructured Data: Test Result:pericarditis; Test Date: 20210912; Test Name: Nasal swab; Test Result: Negative ; Comments: Nasal swab
CDC Split Type: USPFIZER INC202101213361

Write-up: myocarditis; pericarditis; This is a spontaneous report from a non-contactable consumer (patient). A 33-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration, administered in Arm Left on 09Sep2021 10:00 (Batch/Lot number was not reported) as single dose (at the age of 33-years-old) for COVID-19 immunization. Medical history included none. The patient was not pregnant. No known allergies. Not diagnosed with COVID prior to vaccination. No other vaccines in four weeks. Concomitant medications included metoprolol and piroxicam (PAXIL [PIROXICAM]). The patient reported that, "On Sunday night I was diagnosed with pericarditis but was unconfirmed. Went to the ER and was confirmed with myocarditis." The event started on 12Sep2021 04:15 AM. Adverse event resulted in Doctor or other healthcare professional office/clinic visit, Emergency room/department or urgent care, Hospitalization. The patient was hospitalized for 1 day. The patient underwent lab tests and procedures which included investigation: pericarditis on 12Sep2021, SARS-CoV-2 test: negative on 12Sep2021 (Nasal swab). Therapeutic measures were taken as a result of the event which included Tylenol and colchicine and indomethacin. The outcome of the event was not recovered. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1744140 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-01
Onset:2021-09-12
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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

Write-up: Shingles on right trunk near bra line


VAERS ID: 1744430 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-06
Onset:2021-09-12
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Chills, Cough, Dyspnoea, Fatigue, Headache, Myalgia, Pyrexia, SARS-CoV-2 test positive, Wheezing
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: PCR collected on 9-13-2021, positive on the 18th
CDC Split Type:

Write-up: Fever, chills, muscle aches, cough, wheezing, shortness of breath, headache, fatigue, loss of taste and smell


VAERS ID: 1744535 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-12
Onset:2021-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145B4 / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Chills, Injection site pain, Migraine, Pain, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D
Current Illness: COVID 19 (Delta) and Pneumonia the beginning of August
Preexisting Conditions:
Allergies: NA
Diagnostic Lab Data: No tests
CDC Split Type:

Write-up: Went to bed around 830pm woke up around 10 with a migraine, chills, body aches, felt like someone was sitting on my chest, upper arm where shot was administered was super sore. Dealt with that all night and barely slept. Next morning still had a migraine and body aches worse than when I had Covid the prior month. Took an 800mg Ibuprofen and dealt with the pain all day. Went to bed and tossed an turned but got more sleep than the night before. Tuesday wasn''t too bad arm was still sore and still had a migraine. Wednesday my left elbow ached all day through Thursday. Felt like my arm was in a vice.


VAERS ID: 1744593 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-08
Onset:2021-09-12
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048FZA / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray normal, Chest pain, Computerised tomogram normal, Computerised tomogram thorax, Dyspnoea, Feeling hot, Hypoaesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril
Current Illness: none
Preexisting Conditions: high blood pressure
Allergies: none
Diagnostic Lab Data: Chest x-ray, Chest CT, ECO. checked for blood clots, everything came back normal
CDC Split Type:

Write-up: 4 days after shot: shortness of breath, numbness, chest pain. Feeling hot but no fever. still continuing as of 9/29/2021


VAERS ID: 1745134 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-04
Onset:2021-09-12
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstruation delayed
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft 100 mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Menstrual Cycle, which is on time to almost the hour, was 3 days late and started in the middle of the night. Woke up covered in blood (through clothes and covered bed) with significant clots. Cycle lasted 3 days longer than usual and was significantly heavier than average.


VAERS ID: 1745291 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-24
Onset:2021-09-12
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Computerised tomogram head, Cough, Diplopia, Dizziness, Dyspnoea, Dyspnoea exertional, Electrocardiogram normal, Exposure to SARS-CoV-2, Gait disturbance, Gaze palsy, Haemoglobin decreased, Metabolic function test, Neutrophil count normal, Platelet count increased, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive, Troponin, Upper-airway cough syndrome, Vision blurred, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Chlorpheniramine Maleate (ALLERGY PO) take 3 Tablets by mouth as needed. 9/12/2021 Unknown time guaiFENesin (MUCUS RELIEF PO) take 2 Tablets by mouth as needed. 9/12/2021 Unknown time
Current Illness: COVID-19 ? Hypertension ? PCOS (polycystic ovarian syndrome)
Preexisting Conditions: COVID-19 ? Hypertension ? PCOS (polycystic ovarian syndrome)
Allergies: No Known Allergies
Diagnostic Lab Data: Contains abnormal data SARS-COV-2 (COVID-19) by NAA, Micro Status: Final result Visible to patient: Yes (seen) Next appt: None Specimen Information: Nasopharyngeal; Swab 0 Result Notes Ref Range & Units SARS-CoV-2 (COVID-19) by NAA, Micro Not Detected Detected Abnormal Narrative The SARS-CoV-2 (COVID-19) by NAA test is for in vitro diagnostic use under the FDA Emergency Use Authorization (EUA) for laboratories certified under a regulatory authority to perform high complexity testing. This test has not been FDA cleared or approved. Methodology: Nucleic Acid Amplification (NAA)/Polymerase Chain Reaction (PCR).
CDC Split Type:

Write-up: This is a 27y.o. female with medical history of PCOS and HTN, COVID detected Sep 3rd. A 27-year-old female presents to the emergency department via private vehicle complaining of Corona virus concern. Patient states she was at a party 3 days ago and then had a friend told her to get tested due to her positive test. Patient has been vaccinated with Moderna. Patient then noticed the next day she had postnasal drip, congestion, a slight cough, and shortness of breath with exertion. The patient has a history of allergies and thinks this might be that. The patient is not complaining of any nausea vomiting, sore throat, abdominal pain, or diarrhea. Patient she has had some fevers and chills but has not had an accurate reading at home. Patient present in 9/12/2021 ED for blurred vision, double vision x 1 day, She also noticed dizziness and unsteady gait since.. Patient continues to endorse disconjugate gaze with the left eye seeming dysfunction independently of the right. She is also experiencing blurry vision. ED course: troponin < 0.01, BMP grossly WNL, WBC 12.5, Hgb 10.2, Neutrophils 7.9, Plt 499, CT head no acute concerns. EKG sinus, MRI brain /orbit ordered, Neurology consult,


VAERS ID: 1745408 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-23
Onset:2021-09-12
   Days after vaccination:81
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Decreased appetite, Diarrhoea, Dyspnoea, Fluid intake reduced, Headache, Hypoxia, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: alot
Current Illness: Anxiety disorder ? Arthritis ? Bipolar disorder (CMS/HCC) ? BPH (benign prostatic hyperplasia) ? Depression ? Diabetes mellitus, type II (CMS/HCC) ? Dyslipidemia ? GERD (gastroesophageal reflux disease) ? H/O TB (tuberculosis) 1952 possible ? Headache ? History of chemotherapy last 10-28-19 ? History of ETOH abuse ? Hypertension ? Neuropathy feet ? Overactive bladder ? Postoperative nausea and vomiting ? Rectal cancer 12/2017 chemo/radiation ? TB lung, latent 04/2019 possible; completed treatment course 10/2019 - ? Urinary incontinence
Preexisting Conditions: Anxiety disorder ? Arthritis ? Bipolar disorder (CMS/HCC) ? BPH (benign prostatic hyperplasia) ? Depression ? Diabetes mellitus, type II (CMS/HCC) ? Dyslipidemia ? GERD (gastroesophageal reflux disease) ? H/O TB (tuberculosis) 1952 possible ? Headache ? History of chemotherapy last 10-28-19 ? History of ETOH abuse ? Hypertension ? Neuropathy feet ? Overactive bladder ? Postoperative nausea and vomiting ? Rectal cancer 12/2017 chemo/radiation ? TB lung, latent 04/2019 possible; completed treatment course 10/2019 ? Urinary incontinence
Allergies: No Known Allergies
Diagnostic Lab Data: Patient complaining of HA, not eating or drinking for the last 5 days. He also noted shortness of breath and diarrhea. Once admitted he was noted to be hypoxic and placed on supplemental O2 at 4 L/min. Therapy was started with dexamethasone 6 mg/day. When seen in the room the patient was difficult to understand due to his accent and masking. He was wearing nasal oxygen at 4 L/min but not yet on a pulse ox monitor. He has no previous history of Covid infection. After testing positive in the emergency room he was placed on dexamethasone. Nursing was asked to remove his nasal oxygen during their intake and confirm hypoxia. His SPO2 dropped immediately into the 80s and did not recover until supplemental O2 was replaced. Patient was seen in November 2019 for possible pneumonia enteritis and abnormal CT scan. He was also noted that his QuantiFERON gold was positive and treated for LTBI
CDC Split Type:

Write-up: Acute respiratory failure due to COVID-19 (CMS/HCC) Assessment & Plan Symptom onset: 9/13/2021 Test date: 9/18/2021 Elderly male who received 2 doses of Moderna vaccine, last on 6/23. Symptoms consistent with mild to moderate Covid infection with hypoxemia. Following discussion with the patient will initiate therapy with Dexamethasone and Remdesivir COVID steroid recommendations are for 10 days duration or stopped on discharge, whichever comes first. Remdesivir is a typical 5 day IV duration, however can be stopped earlier if recovery is unexpectedly rapid Prophylactic Lovenox dosing, monitor d-dimer for 2500 level where empiric therapeutic dosing is indicated, refer to BH covid treatment guidelines Monitor closely for progression to advanced O2 management devices. Discussed expectations of care Encourage incentive spirometry and self proning


VAERS ID: 1745696 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-08
Onset:2021-09-12
   Days after vaccination:66
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: POS COVID19 9/15/21
CDC Split Type:

Write-up: BREAKTHROUGH/PREVIOUSLY VACCINATED


VAERS ID: 1746398 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-08
Onset:2021-09-12
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Extra dose administered, Vaccine positive rechallenge
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Same symptoms, Pfizer vaccine on 3/21/21
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Penicillin, rocephin, Bactrim, crawfish, shrimp
Diagnostic Lab Data:
CDC Split Type:

Write-up: 72 hours after shot and initial symptoms (fever, chills, etc); began vaginal bleeding, not at scheduled time of menses. Bleeding has continued since and is still occurring as of 9/29/2021.


VAERS ID: 1749709 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-03-28
Onset:2021-09-12
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: ceclor, amoxicillin
Diagnostic Lab Data: Rapid antigen test (positive for COVID 19) 13 sept 2021, BioFire COVID-19 (PCR) test
CDC Split Type:

Write-up: Contracted COVID 19. Fever over 102, headache, muscle aches, coughing, loss of taste, loss of smell, fatigue. **I''m not sure this really qualifies as an Adverse Event. the only reason I''m submitting this form is because when the CDC called me as part of the "v-safe" program & I told them I contracted COVID-19, the representative I spoke with recommended that i log onto the VAERS website to submit a report**


VAERS ID: 1749745 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-12
Onset:2021-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SYR

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

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

Write-up: 2/10 constant chest pain that has persisted for about 3 weeks.


VAERS ID: 1749820 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-09-09
Onset:2021-09-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, biltiazen, tambacor, lantus, humalog, prednisone , lasix, klor-con, minipress, colcrys, saroquel, fynphroid, bydureon, pristiq, neurontin, lamictal, flexeril, tomamax, imitrex, estradiol
Current Illness:
Preexisting Conditions: Bipolar, PTSD
Allergies: Lisinopril, losartan, metforman, lithium, coconut, bellpeppers, grapefruit
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: I experienced my pulse going from 120''s to the 140''s and medication could no longer keep it down.


VAERS ID: 1749851 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-07
Onset:2021-09-12
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / N/A UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: Started having typical side effects of headache three days following date of receiving vaccine. Side effects resolved for two days, then on 9/12/21 she began developing chest pain in upper right area of chest, headache and shortness of breath. Her side effects have not resolved. She reports she is someone who never gets sick, states the last time she had a fever was in the year of 1991. She does not have a primary care physician. Has not spoken with a provider concerning her symptoms/side effects. Is concerned about coverage for going outside of network (does not want to see provider at Legacy, is worried it is contradicting after stating she was "forced to take this vaccine" to see a provider).


VAERS ID: 1750383 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood cholesterol increased, Blood test, Condition aggravated, Extra dose administered, Fatigue, Gastrectomy, Laboratory test abnormal, Somnolence, Swelling, Tinnitus, Weight decreased
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Dementia (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hearing impairment (narrow), Lipodystrophy (broad), Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bariatric Fusion multivitamin capsules, Protonix, Tylenol
Current Illness: None
Preexisting Conditions: Bariatric, High cholesterol
Allergies: Morphine, Statin''s, Tramadol
Diagnostic Lab Data: Labs cameback normal except for colesterol, (9/16/2021)Blood work.
CDC Split Type: vsafe

Write-up: Tinnitus and swelling the size of tennis ball. Swelling lasted for 4day and Tinnitus is ongoing. Tiredness, drowsy and is ongoing. Benedryl, Tylenol, B-12 injection once a month. Helped about a week but still tired. 75lbs. lost since April(Gastric Sleeve) and cholesterol was down but after the 3rd shot jumped 75points.


VAERS ID: 1752050 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-12
Onset:2021-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Dyspnoea, Loss of consciousness, Respiratory arrest, Respiratory distress, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Respiratory disorder NOS (Event verbatim: already had respiratory issues before)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101222405

Write-up: anaphylactic reaction; lost consciousness; She did stop breathing and came to right away, she was just out; vomiting; difficulty breathing; Respiratory distress-specifically had difficulty breathing; has a hard time with breathing and running out of breath a lot quicker; This is a spontaneous report from a contactable consumer (patient). A 46-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; Lot Number: FE3592), via an unspecified route of administration in left arm on 12Sep2021 in the afternoon (at the age of 46-years-old) as dose 2, single for COVID-19 immunization. Medical history included respiratory issues (already had respiratory issues before). Historical vaccine included BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; Lot Number: FC3181), via an unspecified route of administration in right arm on 08Aug2021 (at the age of 46-years-old) as dose 1, single for COVID-19 immunization and had a little bit of issues with the first one, but she already had respiratory issues before. The patient previously received H1N1 vaccine for Influenza immunization about 10 years ago and ended up in the ICU with neuropathy and myopathy. This was probably when it first came out about 10 years ago and she has complications due to that. The patient''s concomitant medications were not reported. Patient received no other vaccines on the same day. The patient experienced anaphylactic reaction, lost consciousness, she did stop breathing and came to right away, she was just out, vomiting, difficulty breathing, respiratory distress-specifically had difficulty breathing; has a hard time with breathing and running out of breath a lot quicker on 12Sep2021. The events resulted in emergency room and physician office visit. It was reported that with second dose, within 15-20 minutes patient experienced vomiting and lost consciousness, difficulty breathing, and the ambulance was then called. She did stop breathing and came to right away, she was just out. She does remember being in the back of the ambulance and going to the hospital and they treated her with medication there to slow things down. Patient was there a couple of hours and discharged home since there was not anything more, they can do for her. She has not improved at all and was still being monitored and has a hard time with breathing and running out of breath a lot quicker. Still has breathing issues. The events required medical intervention. In the emergency room, they treated her to slow things down. Multiorgan involvement included respiratory: Respiratory distress; specifically had difficulty breathing; has a hard time with breathing and running out of breath a lot quicker. Potential anaphylactic reaction was reported to be recovering, but still has breathing issues. Patient was taking medications prior to the event being reported (details not reported). Patient still has not improved at all and is still being monitored. Outcome of events was resolving. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1752095 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-05
Onset:2021-09-12
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210912; Test Name: Covid; Test Result: Positive ; Comments: A week later they both tested positive for Covid
CDC Split Type: USPFIZER INC202101227463

Write-up: received the first dose of the Pfizer BioNTech Covid 19 vaccine on 05Sep2021/A week later they both tested positive for Covid; This is a spontaneous report from a contactable consumer or other non hcp (husband) reported for patient (wife). A female patient of an unspecified age received bnt162b2 (BNT162B2 PFIZER-BIONTECH COVID-19 mRNA VACCINE, solution for injection, Batch/Lot number: UNKNOWN), via an unspecified route of administration on 05Sep2021 as dose 1, single for COVID-19 immunisation. The medical history and concomitant medications of the patient were not reported. The patient received the first dose of the pfizer biontech covid 19 vaccine on 05sep2021/a week later they both tested positive for covid on 12Sep2021. The event resulted in the emergency room visit. The caller stated the patient was scheduled for second dose on 26Sep2021, could she push back the appointment? Not let them schedule it past 42 days. The Regeneron pharmacist said they had to restart the series. Caller asked was there any information on how the second dose may feel after having Covid? Will there be an interaction with the antibodies? The patient underwent lab tests and procedures which included sars-cov-2 test: positive on 12Sep2021. Therapeutic measures were taken as a result of event that included patient was given Regeneron antibody infusion, to help fight off the virus in the emergency room on 12Sep2021 and was released from the emergency room after the infusion. Caller stated he had read conflicting information if she should get the vaccine on that date, after having Covid and the Regeneron infusion. The outcome of the event was reported as unknown. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101225810 same reporter/product/event, different patient


VAERS ID: 1752863 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-04
Onset:2021-09-12
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine, Mydayis
Current Illness: None
Preexisting Conditions: None
Allergies: Latex/adhesive skin reactions only
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Rash on bilateral shins. Started as 5 red spots, Progressed over 48 hours to form one large area of redness to right distal knee/shin and one small area of redness on left ankle.


VAERS ID: 1753303 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Electrocardiogram, Exposure during pregnancy
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer COVID-19 Vaccine Dose #2 in January 2021; symptoms similar though less severe.
Other Medications: LEVOTHYROXINE 50 mcg daily; PRENATAL VITAMIN
Current Illness: None, 30 weeks pregnant with uncomplicated, low-risk pregnancy. Vaccine did not affect pregnancy
Preexisting Conditions:
Allergies: NSAIDs: anaphylaxis
Diagnostic Lab Data: None. On-call provider asked for EKG performed with Apple watch, which demonstrated mild ST elevated but monitoring from home recommended.
CDC Split Type:

Write-up: Approximately 15 hours after vaccine administration, patient experienced significant, severe, chest pain. Pain was a heavy, crushing pain without a reflux quality. Pain lasted for approximately 28 hours though decreased in severity after about 10 hours. Uncomplicated, low-risk pregnancy of 30 weeks, 3 days at time of vaccine dose. EDD 11/17/2021. No known complications to pregnancy.


VAERS ID: 1753314 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Asthenia, Fatigue, Haemorrhage, Menstruation irregular, Muscle spasms, Palpitations
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Fertility disorders (broad)

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

Write-up: Heart palpitations, weakness, extreme fatigue, cramping, period messed up, and bleeding.


VAERS ID: 1753655 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-31
Onset:2021-09-12
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allergy medicine; vitamin D supplements
Current Illness: Surgery for Hernia Repair (March 1)
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Covid Test.
CDC Split Type: vsafe

Write-up: September 12 in the afternoon, I started feeling kind of tired but that was really about it. I never had a cough and maybe a little congested. September 13th I tested positive for Covid on one of the at-home tests. I notified my Doctor and he referred me to do the infusion on September 18th. I felt better after the infusion. Other than that I had a slight headache, was a little stuffy, and it was incredibly mild. I was really myself again by September 20.


VAERS ID: 1753735 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram, Disorientation, Electrocardiogram, Fatigue, Head injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: sulfa drugs
Diagnostic Lab Data: Sep 12, CT scan in ER as well as ECG and standard blood tests
CDC Split Type:

Write-up: Subject had initial fatigue on the day after (Sep 11), but the major event was fainting on Sep 12 (2 days after), combined with disorientation upon hitting her head from fainting. Fainting was sudden, unexplained and unexpected.


VAERS ID: 1754074 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Levothyroxine, Lipitor, Benazepril/HCTZ, Multivitamin
Current Illness:
Preexisting Conditions: Diabetes, Hypertension
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Worsening of tinnitus, bilateral


VAERS ID: 1754148 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-09-09
Onset:2021-09-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chest X-ray, Condition aggravated, Dyspnoea, Migraine, Ocular discomfort, Pain, Urine analysis
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: wellbutrin inhalers albuterol trazadone
Current Illness: none
Preexisting Conditions: Anemia Border line diabetic Dyspnea Migraines adjustment disorder with anxiety and depression
Allergies: none
Diagnostic Lab Data: x ray of chest urine
CDC Split Type:

Write-up: Pain in lower left side, first week of vaccine, migraines worse, pressure behind eyes, difficulty breathing


VAERS ID: 1754152 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-09-09
Onset:2021-09-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Disturbance in attention, Dyspnoea exertional, Exophthalmos, Fatigue, Headache, Hypertension, Loss of consciousness, Mental impairment
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), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Hyperthyroidism (narrow), Depression (excl suicide and self injury) (broad), Ocular infections (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: React moderately to severely to every vaccine I?ve had from as early as I can remember
Other Medications: Metformin, trazadone, acyclovir, pregabalin, etodolac, tizanidine, Flonase, cetirizine, montelukast na, atorvastatin, symbicort 160/4.5
Current Illness: N/A
Preexisting Conditions: Fibromyalgia, diabetes, PTSD, Depression
Allergies: Pork, Bees
Diagnostic Lab Data:
CDC Split Type:

Write-up: Very bad headache for 3 weeks now with no relief. Extreme fatigue - so severe I pass out with no warning once, sometimes twice a day. Eyes feel as if they are going to pop out of my head, feel as if they are bulging out of my head and it never stops. Documented high blood pressure from both home monitoring and physician monitoring. Very difficult to think straight and lose track of actions and thoughts, lack of concentration and ability to focus. Shortness of breath when moving (walking, carrying, etc).


VAERS ID: 1754164 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Electrocardiogram, N-terminal prohormone brain natriuretic peptide increased, Pain, Pericarditis, Troponin T increased
SMQs:, Cardiac failure (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: fever reported on 9/12/21
Preexisting Conditions: scoliosis
Allergies: None
Diagnostic Lab Data: 9/13/21 EKG, troponin T=1,123 ng/L, NT-proBNP=272 pg/mL, CRP=63.6 mg/L
CDC Split Type:

Write-up: pericarditis diagnosed on 9/13/21 - treated with ibuprofen, famotidine, and colchicine with resolution of pain and normalization of labs, resolution of pain in 24 hours


VAERS ID: 1754195 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Diarrhoea, Fatigue, Feeding disorder, Hyperpyrexia, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dietary supplements L-lysine; glucosamine; collagen; vitamin c
Current Illness: osteo arthrosis. I had Covid in December 2020 and had tested positive for antibodies in March 2021
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: High fever, throwing up; severe body aches, diarrhea; not able to eat for 24 hours; extreme fatigue; very weak for 24 hours and fatigue for 48 to 72 hours afterwards


VAERS ID: 1755873 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-12
Onset:2021-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Body temperature, Burning sensation, Cardiac stress test, Chest discomfort, Chest pain, Cold sweat, Cough, Dyspnoea, Erythema, Fatigue, Feeling abnormal, Feeling cold, Headache, Illness, Oral pain, Pain in extremity, Palpitations, Pyrexia, Rhinorrhoea, Sinusitis, Spinal pain, Tongue discomfort, Ultrasound scan
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (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:
Preexisting Conditions: Medical History/Concurrent Conditions: Chest pain; Fatigue; Palpitations
Allergies:
Diagnostic Lab Data: Test Date: 202110; Test Name: Body Tempearture; Result Unstructured Data: Patient got 1 degree of fever; Test Date: 202110; Test Name: stress test; Result Unstructured Data: upcoming stress test in October 2021; Test Date: 202110; Test Name: ultrasound; Test Result: Negative ; Result Unstructured Data: found no structural abnormalities nor inflammation
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: face felt cold; face felt clammy; felt so poorly; felt very very sick; lower spine started to hurt; burning behind their nose fleur up after getting the vaccine.; Sinusitis fleur up after getting the vaccine.; Chest pain; Mouth ulcers fleur up after getting the vaccine; left arm is sore; left arm is red; achy shoulders; horrific headache; got 1 degree of fever; felt awful/ worst they have felt; had the sniffles/runny nose; tong was burning; chest felt heavy; got winded easily; cough; felt super exhausted/completely exhausted/ worst tired day; palpitations; This spontaneous case was reported by a consumer and describes the occurrence of ERYTHEMA (left arm is red), PALPITATIONS (palpitations), FEELING ABNORMAL (felt awful/ worst they have felt), RHINORRHOEA (had the sniffles/runny nose) and TONGUE DISCOMFORT (tong was burning) in a 72-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 054C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Palpitations, Chest pain and Fatigue. On 12-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 12-Sep-2021, the patient experienced PALPITATIONS (palpitations). On 14-Sep-2021, the patient experienced FEELING ABNORMAL (felt awful/ worst they have felt), RHINORRHOEA (had the sniffles/runny nose), TONGUE DISCOMFORT (tong was burning), CHEST DISCOMFORT (chest felt heavy), DYSPNOEA (got winded easily), COUGH (cough) and FATIGUE (felt super exhausted/completely exhausted/ worst tired day). On an unknown date, the patient experienced ERYTHEMA (left arm is red), FEELING COLD (face felt cold), COLD SWEAT (face felt clammy), FEELING ABNORMAL (felt so poorly), ILLNESS (felt very very sick), SPINAL PAIN (lower spine started to hurt), BURNING SENSATION (burning behind their nose fleur up after getting the vaccine.), SINUSITIS (Sinusitis fleur up after getting the vaccine.), CHEST PAIN (Chest pain), ORAL PAIN (Mouth ulcers fleur up after getting the vaccine), PAIN IN EXTREMITY (left arm is sore), ARTHRALGIA (achy shoulders), HEADACHE (horrific headache) and PYREXIA (got 1 degree of fever). The patient was treated with PARACETAMOL (TYLENOL) for Ache and Headache, at an unspecified dose and frequency; IBUPROFEN for Ache and Headache, at an unspecified dose and frequency and CETIRIZINE HYDROCHLORIDE (CETRIZINE) for Burning tongue, at an unspecified dose and frequency. On 20-Sep-2021, FEELING ABNORMAL (felt awful/ worst they have felt), RHINORRHOEA (had the sniffles/runny nose), TONGUE DISCOMFORT (tong was burning), CHEST DISCOMFORT (chest felt heavy), DYSPNOEA (got winded easily), COUGH (cough) and FATIGUE (felt super exhausted/completely exhausted/ worst tired day) had resolved. At the time of the report, ERYTHEMA (left arm is red), FEELING COLD (face felt cold), COLD SWEAT (face felt clammy), FEELING ABNORMAL (felt so poorly), ILLNESS (felt very very sick), SPINAL PAIN (lower spine started to hurt), BURNING SENSATION (burning behind their nose fleur up after getting the vaccine.), SINUSITIS (Sinusitis fleur up after getting the vaccine.), CHEST PAIN (Chest pain), ORAL PAIN (Mouth ulcers fleur up after getting the vaccine), ARTHRALGIA (achy shoulders), HEADACHE (horrific headache) and PYREXIA (got 1 degree of fever) outcome was unknown and PALPITATIONS (palpitations) and PAIN IN EXTREMITY (left arm is sore) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In October 2021, Body temperature: other (abnormal) Patient got 1 degree of fever. In October 2021, Cardiac stress test: other upcoming stress test in October 2021. In October 2021, Ultrasound scan: negative (Negative) found no structural abnormalities nor inflammation. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Concomitant drugs were reported. Patient states their blood pressure was normal and that they do not take any medication regularly


VAERS ID: 1756409 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Contusion, Fatigue, Headache
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow)

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

Write-up: Tiredness,chills,dark bruise on right forearm 4 inches in diameter,headache that lasted for about 5 days after first vaccine shot


VAERS ID: 1756503 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Hypoaesthesia, Rhabdomyolysis
SMQs:, Rhabdomyolysis/myopathy (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

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

Write-up: Patient had severe weakness, legs felt numb and paralyzed. This lasted for 3 weeks. Patient says her Dr told her it was rhabdomyolysis.


VAERS ID: 1756644 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-04
Onset:2021-09-12
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Activated partial thromboplastin time normal, Animal scratch, Blood fibrinogen normal, Fibrin D dimer, Fibrin D dimer increased, Gingival bleeding, Haematocrit normal, Haemoglobin normal, Haemophagocytic lymphohistiocytosis, Haemorrhage, International normalised ratio increased, Platelet count decreased, Prothrombin time prolonged, Red blood cells urine, Thrombocytopenia
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Gingival disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 09/12/21 Platelets of <1 (normal levels 139-361x10(3)uL), Hbg 15.1, Hct 42.4, protime 14.9, APTT 30, INR 1.3, D-dimer 831, Fibrinogen 284, RBCs in Urine $g100
CDC Split Type:

Write-up: Patient presented to employer health clinic complaining of persistent bleeding from a cat scratch on his right upper arm, bleeding gums, was sent to the ER were was found to be severely thrombocytopenic, subsequently diagnosed with HLH as of 09/30/21


VAERS ID: 1756871 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: hemorroids


VAERS ID: 1756977 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-30
Onset:2021-09-12
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Computerised tomogram thorax normal, Hypoxia, Pneumonia, SARS-CoV-2 antibody test negative, White blood cell count increased
SMQs:, Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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? Yes
Hospitalized? Yes, 17 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient has history of lymphoma, previous history of Covid pneumonia 9 months ago, fully vaccinated for COVID-19 and was admitted to the hospital 17 days peior with shortness of breath. He was diagnosed with COVID-19 pneumonia. Was started on heated flow due to significant hypoxia. Patient was treated with with steroids, antibiotics, he was not given remdesivir due to the late presentation. Baricitinib given for few days, later on discontinued due to further elevation of his white count. Had a CT of the chest that did not show any pulmonary embolus but multifocal pneumonia. All respiratory measures have been tried and they have been not successful. Patient requires supplemental oxygen of 3 l/min. He is at his baseline functioning and ambulatory at home. Patient requires oxygen via nasal cannula due to prolonged hypoxia. He continued taking Bactrim and prednisone, and using his inhalers upon discharge. Of note antibody were checked and they have been negative for Covid.


VAERS ID: 1757173 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-12
Onset:2021-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
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: Client recieved Pfizer Dose 1 on 09/12/2021 returned to site to recieve Pfizer Dose 2 on 10/03/2021. Immunization Record shows Janssen given on 03/29/2021. Client reports no severe adverse reaction to Pfizer Dose 1.


VAERS ID: 1757527 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-12
Onset:2021-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disturbance in attention, Eye discharge, Headache, Vision blurred, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Serevent Diskus, Flovent, Montelukast, Ritual +55
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Penicillin, pineapple, vinegar, sulfa, msg, gluten
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Difficulty focusing eyes, vomiting, sticky eyes, inability to concentrate, head pain


VAERS ID: 1758708 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-12
Onset:2021-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Arthralgia, Chest pain, Diarrhoea, Fatigue, Headache, Irritability, Muscle twitching, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Dyskinesia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Buspirone 5mg Sumatriptan 50mg Phentermine 37.5mg Bupropm Hcl 150mg
Current Illness:
Preexisting Conditions: Chronic Migraines, anxiety
Allergies: Fruit (all) and latex
Diagnostic Lab Data: None- I was told the side effects are not "severe".
CDC Split Type:

Write-up: Left-arm twitching for 3 days. Full body rash, fever, lasted 12 hours. Diarrhea and stomach cramping for 4 hours. Joint pain in hands and fingers, chest pains, and headache lasted until now, date of 10/4/21. Fatigue and irritability lasting until now, date of 10/4/21.


VAERS ID: 1758980 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Irregular menstruation. Spotted for 3 weeks and got heavy period week early.


VAERS ID: 1759041 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-10
Onset:2021-09-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Grip strength decreased, Injected limb mobility decreased, Injection site erythema, Injection site mass, Injection site pain, Injection site pruritus, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamin D2, omeprazole, triamterine/hctz, topiramate, carbamazepine, prednisone
Current Illness: none
Preexisting Conditions: Arthritis, Meniere''s Disease, GERD, Trigeminal Autonomic Cephalgia''s
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient received Moderna Covid Vaccine # 1 from pharmacy on 9/12/2021. Reports that 2 days after the injections she started experiencing symptoms of pain at injection site, swelling, redness, itching, fever, developed a large knot at injection site. She notified Pharmacy of symptoms and was advised to continue to monitor, take ibuprofen and benadryl. Symptoms improved minimally. Since injection, symptoms have progressively gotten worse. She now c/o difficulty lifting left arm above her head or gripping, severe itching which is worse at night. Symptoms have now been present for almost four weeks.


VAERS ID: 1759052 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-02
Onset:2021-09-12
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Cough, Diarrhoea, Fatigue, Fluid retention, Gastric dilatation, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific dysfunction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Noninfectious diarrhoea (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Testosterone
Current Illness: none
Preexisting Conditions: Low Testosterone
Allergies: none
Diagnostic Lab Data: COVID-19 PCR, Urgent Care Facility, Exam, Antibiotic Treatment
CDC Split Type:

Write-up: Stomach distension, vomiting'', retention of water, diarrhea , fatigue, cough, sore throat, runny nose, back pain


VAERS ID: 1759338 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Mastication disorder, Pain, Pain in jaw, Polymenorrhoea, Swelling face, Temporomandibular joint syndrome
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Osteonecrosis (broad), Hypersensitivity (narrow), Arthritis (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: Birth Control, daily vitamin, B-12, and Iron
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: heavy period, with massive clots. period lasted for 8 days had 4 days off and started again. had second shot 10/1 and still on. Had worst TMJ pain of my life. it felt like it was on fire. hard to chew or eat anything. face and jaw swelling. experienced pain when resting jaw.


VAERS ID: 1759723 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-12
Onset:2021-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH SS2587 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea, Migraine, Nausea, Urticaria
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu- 2011
Other Medications: Amitriptyline, Minipress, Lexapro
Current Illness: None.
Preexisting Conditions: PTSD, Migraines, Asthma, Fibromyalgia
Allergies: Sulfa Drugs, Lamb, Beef, Walnuts, Grass, Trees, Cats
Diagnostic Lab Data: None.
CDC Split Type: vsafe

Write-up: They asked if I had allergies before vaccine and what I was allergic to and then I got the injection and since I have allergies and have had reactions in past I had to stay for 30 mins and within 10 minutes I started getting big whelps from head to toe and started having trouble breathing. After I left I went home and had to take an EpiPen and for several days I still had whelps and hives. This lasted 4-5 days.. When I followed up with my Doctor they said to not take another shot and that I shouldn''t have taken it in the first place since I''ve had a reaction to a vaccine before. I had a migraine and nausea for several days as well for 4-5 days after the vaccine.


VAERS ID: 1760031 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blepharospasm, Chest discomfort, Muscle tightness
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow)

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

Write-up: left eye twitching for a month, tightness in chest and back


VAERS ID: 1760678 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-12
Onset:2021-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 59267-1000-01 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Chest discomfort, Dysphagia, Loss of consciousness, Lower respiratory tract infection, Paraesthesia, Pharyngeal swelling, Pregnancy test, Speech disorder
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vienva, Sertraline 50MG, Albuterol, QVar, Zyrtec, XyZal
Current Illness: none
Preexisting Conditions: Asthma, Severe Seasonal Allergies, allergic to cats
Allergies: None
Diagnostic Lab Data: I was told, in the ER, that they were going to do blood work. Nothing was done, except a pregnancy test???
CDC Split Type:

Write-up: immediately started feeling tingling sensations and burning in both arms, Chest felt cold and tight making it difficult to talk, throat felt like it was swelling and I couldn''t swallow, Lost consciousness within minutes of getting the shot.


VAERS ID: 1761840 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dry mouth, Gingival disorder, Lip swelling, Vaccine positive rechallenge
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Gingival disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: severe dry mouth and lip swelling, inner lip gum issues. it was starting to clear up then i went for the second shot and it started all over again. i mentioned the reaction to the tech at when i went for my second dose. I went thru my food history, healthcare supplies, nothing changed but the shot. Ive never had a flu shot and never had the flu. I literally slept next to mr covid and nothing. the shot tech said Wow, then checked his phone. so no, i didnt follow up, just sucking it up.


VAERS ID: 1762497 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-12
Onset:2021-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: NO ADVERSE OUTCOME


VAERS ID: 1764099 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Myalgia, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: tingling in my hands, my face and my feet/ started like in chin area and spread; Chills; Body aches; This spontaneous case was reported by a consumer and describes the occurrence of PARAESTHESIA (tingling in my hands, my face and my feet/ started like in chin area and spread), CHILLS (Chills) and MYALGIA (Body aches) in a 58-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 004F21A) for COVID-19 vaccination. No Medical History information was reported. On 11-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 12-Sep-2021, the patient experienced CHILLS (Chills) and MYALGIA (Body aches). On 16-Sep-2021, the patient experienced PARAESTHESIA (tingling in my hands, my face and my feet/ started like in chin area and spread). The patient was treated with PARACETAMOL (TYLENOL) for Adverse event, at an unspecified dose and frequency. On 12-Sep-2021, CHILLS (Chills) and MYALGIA (Body aches) had resolved. At the time of the report, PARAESTHESIA (tingling in my hands, my face and my feet/ started like in chin area and spread) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications were reported


VAERS ID: 1764588 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-04-01
Onset:2021-09-12
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SC

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Blindness unilateral, Computerised tomogram, Echocardiogram, Gene mutation identification test, Hyperhidrosis, Vertebral artery dissection, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hypoglycaemia (broad)

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

Write-up: Left vetribral artery dissection (Spontaneous) higher than where they normally occur. This occured in the area protected by the skull. No known trauma to the area. Sweating, vomiting, temporary loss of vision in one eye.


VAERS ID: 1764662 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-27
Onset:2021-09-12
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Coxsackie virus test, Herpes simplex test, Nasal ulcer, Oral herpes, Oropharyngeal blistering, Oropharyngeal pain, Pharyngeal swelling, Poor peripheral circulation, Pruritus, SARS-CoV-2 test negative, Skin discolouration, Skin ulcer, Stomatitis, Streptococcus test negative, Swelling
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: allegra OTC fluticisone nasal spray singulair
Current Illness: cold sores in mouth
Preexisting Conditions: none
Allergies: seasonal pet dander mold/mildew mites
Diagnostic Lab Data: 3 days after vaccine sore throat with swelling and blisters, low grade fever of 99.9 on 9/30/2021. Tested negative for covid and strep. Treated with augmentin and medrol. Mouth and nose sores/cold sores continued for 5 weeks despite being treated with Valtrex. Primary care changed dosage of Valtrex and did antibody testing for Coxsackie virus and herpes simplex virus type 1 (HSV-1), and type 2 (HSV-2) on 9/27/2021. Primary care could not determine cause of feet/toe sores and discoloration.
CDC Split Type:

Write-up: Approx. 2 weeks after vaccine, sore spots on toes appeared. Sores became itchy, swelled, and then turned purple. Purple discoloration never cleared, and new spots with itch and swelling continued to appear for 3 more weeks. Now in 6th week from first dose and toes still purple and splotchy as though they have poor circulation. New spots appearing on heel. Mouth sores/cold sores continued for 5 weeks despite being treated with Valtrex.


VAERS ID: 1764886 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-06
Onset:2021-09-12
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Feeling abnormal, Laboratory test, Myocardial infarction, Stent placement
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow)

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

Write-up: I had a heart attack on 09/12/2021. I was feeling pressure in my chest and I just did not feel right. I went to the emergency room and they said I was having a heart attack. I had four stents placed and I was in the hospital for three days. I have never had any heart problems before this.


VAERS ID: 1764954 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-10
Onset:2021-09-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Computerised tomogram thorax, Electrocardiogram, Fibrin D dimer, Metabolic function test, Troponin
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Chest xray 9/12/21 Chest angiograph 9/12/21 BMP D dimer Troponin EKG
CDC Split Type:

Write-up: New onset chest pain.


VAERS ID: 1765223 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-09
Onset:2021-09-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

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

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

Write-up: Intense itching of torso for 2 weeks


VAERS ID: 1765494 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Discomfort, Hypoaesthesia, Insomnia, Muscular weakness, Neck pain, Paraesthesia, Peripheral swelling, Vaccination site erythema, Vaccination site rash
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen for pain r/t sore arm
Current Illness: None.
Preexisting Conditions: None.
Allergies: NKA
Diagnostic Lab Data: None as of this report.
CDC Split Type:

Write-up: Pt called today, 10/06/2021, to report her symptoms that are ongoing. States that the day after receiving her second dose of the Moderna series (09/12/2021) that her whole arm became very swollen, there was a red rash about 2 inches underneath the vaccination site, and she developed a "kink" in her neck. She reports there have been painful tingling sensations down her whole should, arm, and near her breast. Her thumb, index, and middle finger have all become numb, and the tips of her ring finger and pinky are beginning to go numb. She states her left arm is very weak and she cannot use it well. She has only been getting 3 hours of sleep each night since 09/12/2021 due to being so uncomfortable. Pt states all of her symptoms are progressively getting worse. I advised her to go to an urgent care to have a medical evaluation as she has not been evaluated yet.


VAERS ID: 1765629 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-31
Onset:2021-09-12
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autonomic nervous system imbalance, Back pain, Blood test, Chest X-ray, Chest pain, Computerised tomogram thorax, Dizziness, Electrocardiogram, Fatigue, Headache, Insomnia, Magnetic resonance imaging heart, Nausea, Pain in extremity, Palpitations, Stress echocardiogram, Tachycardia, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin Vitamin D
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa
Diagnostic Lab Data: 9/20/2021, 9/24/2021 & 9/28/2021 EKG 9/24/2021 CXR, CT Chest and blood work 9/25/2021 Stress Echocardiogram 9/29/2021 Cardiac MRI
CDC Split Type:

Write-up: I received the Janssen COVID-19 vaccine on 8/31/2021. During the week of 9/12/2021 I began having intermittent chest pain. The chest pains were not going away, so I went to my doctor''s office on 9/20/2021. The chest pain continued to worsen and become more constant, so I went to a local urgent care center on 9/24/2021. From there I was sent to the emergency room, where they admitted me for continued workup. I was discharged home on 9/25/2021. I was diagnosed with Autonomic Nervous System Dysfunction. I continue to have chest pain, tachycardia, palpitations, tremors, difficulty sleeping, fatigue, headaches, leg pain, back pain, dizziness, lightheadedness and nausea.


VAERS ID: 1765693 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 UN / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Computerised tomogram, Dyspnoea, Electrocardiogram, Heart rate irregular, Induration, Malaise, Oxygen saturation decreased, Pain in extremity, Superficial vein thrombosis, Ultrasound Doppler, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (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: Celexa; Xiidra eye drops; Multiple supplement
Current Illness: N/A
Preexisting Conditions: Genetic Thrombocytic- history of DVTs
Allergies: Tetracycline
Diagnostic Lab Data: CT Scan EKG
CDC Split Type: vsafe

Write-up: The day after the third dose I felt unwell but on the second day I started to have trouble breathing and my heart rate got erratic. It would go up for no reason and then it went back down. I couldn''t seem to get enough air. I checked my Oxygen and it was a little lower than normal between 92-94% when I usually run close to 100. I waited until the next day and my doctor told me to go to the ER. I was tested and the tests area negative. A couple of days after when The next day I knew my left arm was in trouble because my vein was enlarged and rock hard. It was very sore and a visible enlargement of the vein in my arm. I have had had infusions and problems in that arm before so I knew there was something wrong. I called my doctor and I was given a Doppler scan on my left arm. I was diagnosed with a superficial clot in my arm. I was prescribed Eliquis at a higher dose and then tapered off. The Eliquis was discontinued on 10/01/2021 to prepare for surgery. I am a current Cancer patient. The clot seems to have resolved and my breathing problems are better. I was not given any lot numbers or information about my shots.


VAERS ID: 1765898 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-02-26
Onset:2021-09-12
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Muscle twitching, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Simvastatin 20mg, Aspirin 350mg, Omega 3, Womens One a day vitamin, CoQ10, Hydrocodone 325/7.5
Current Illness: No
Preexisting Conditions: I had Mitral Valve replacement on 2/20/2019.
Allergies: Sulpha
Diagnostic Lab Data: No
CDC Split Type:

Write-up: Muscle twitching, tingleing in lower left calf & left heel.


VAERS ID: 1766456 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-10
Onset:2021-09-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Lump in arm for 3.5 weeks for me unexplainable rash for 4 weeks + for my 13 month old daughter


VAERS ID: 1767609 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-09
Onset:2021-09-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210912; Test Name: tested positive; Test Result: Positive
CDC Split Type: USPFIZER INC202101288637

Write-up: This is a spontaneous report from a contactable consumer or other non hcp. A 12-years-old female patient received first dose bnt162b2 (BNT162B2, Solution for injection, Batch/Lot number was not reported) via an unspecified route of administration on 09Sep2021 as DOSE 1, SINGLE for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient experienced got their first dose of the Pfizer covid vaccine on 09sep2021 and tested positive on 12sep2021. The patient underwent lab tests and procedures which included sars-cov-2 test: positive on 12Sep2021. The outcome of the event covid-19 was unknown. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.


VAERS ID: 1768030 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-09-01
Onset:2021-09-12
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 1 LA / IM

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

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

Write-up: I received my first dose on 9/10 at 4pm and on 9/12 around 10am I noticed I felt tightness in my chest and shortness of breath. My heart felt sore and was beating slightly harder than normal. It remained this way for 2 weeks. Things started feeling better after week 3.


VAERS ID: 1768405 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-12
Onset:2021-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG2588 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal X-ray, Abdominal pain lower, Asthma, Blood test normal, Blood urine present, Chest discomfort, Computerised tomogram, Cough, Diarrhoea, Diverticulitis, Faeces discoloured, Headache, Oropharyngeal pain, Parasite blood test, Sinus congestion, Sinusitis, Urine analysis, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific inflammation (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Tetanus shot
Other Medications: Zyrtec, Singulair, multi vitamin, vit c, turmeric, fish oil, glucosamine chondroitin, zinc, super Quercetin, Elderberry
Current Illness: None
Preexisting Conditions: Heart murmur and asthma
Allergies: Penicillin, amoxicillin and all derivatives of
Diagnostic Lab Data: Sept 22 - blood work, urinalysis- white blood count slightly high, everything else normal Sept 27 - ct scan - no results yet Oct 3- blood work, urinalysis, parasite test, xray of abdomin- blood in urine (sent off for culture) test normal
CDC Split Type:

Write-up: Sept 12 12:00 shot, 2:00 sore throat, headache, 7:00 cough, (took inhaler) Sept 13 - urgent care for asthma attack - got steroid shot and prednisone Sept 14- 18 tightness in chest (needed inhaler daily) Sept 19- diarrhea started (took pepto) Sept 22- went to Dr for pain in left lower abdomin, diarrhea lasting longer than 3 days, Green and black stool - diagnosed with diverticulitis, blood work, urinalysis done, put on 2 antibiotics and Imodium (had to stop because it created abdominal swelling) follow up scheduled for Oct 9 Sept 27 - ct scan - still issues with diarrhea through Sept 29 Sept 25 - shot for diarrhea with asthma check up Sept 29 - cough, runny nose, sinus congestion starts (took sudafed) Oct 3 - went to Dr for sinus infection and new abdominal pain, new diarrhea- prescribed 1 antibiotic, cough pearls, anti-diarrhea meds, blood work, urinalysis and xray of abdomin, parasite breath test done


VAERS ID: 1768416 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-12
Onset:2021-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020FZIA / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Fatigue, Injection site mass, Injection site pain, Pain, Rash, Rash erythematous, Rash macular, Somnolence
SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: zinc, glutathione, vitamin c and d
Current Illness:
Preexisting Conditions:
Allergies: allergic to tree nuts
Diagnostic Lab Data: none
CDC Split Type:

Write-up: I received the moderna vaccine around 3pm and at 5pm I started getting a red splotchy rash on my stomach, then on my left arm the same arm as injection, then my shoulder. It went away after a couple hours. 24 hours after the shot I noticed a golf ball size lump at the injection site that was painful to touch and it lasted three days. Also 24 hours after the shot I felt very achey and so tired I had to lay down and fell asleep for 5 hours. I also experienced shortness of breath days after the shot.


VAERS ID: 1768511 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-31
Onset:2021-09-12
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Chest pain, Cough, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None Reported
Allergies:
Diagnostic Lab Data: COVID 19 Antigen Positive on 9/16/2021
CDC Split Type:

Write-up: Breakthrough case after Covid vaccination, Dose #1 2/24/2021 Dose #2 3/31/2021 C/O cough and chest pain/onset 9/12/2021


VAERS ID: 1768654 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-10
Onset:2021-09-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Lactose intolerance, Milk allergy
SMQs:

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

Write-up: 2 days later developed severe milk allergy/lactose intolerance. Never had issue before


VAERS ID: 1771423 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-12
Onset:2021-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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? 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 error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1771849 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-01-08
Onset:2021-09-12
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, COVID-19, Cough, Malaise, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Positive Covid-19 test of unknown type.
CDC Split Type:

Write-up: C/O cough, elevated temperature, runny nose and congestion, malaise.


VAERS ID: 1772069 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-12
Onset:2021-09-12
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 2 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Atrial fibrillation
SMQs:, Supraventricular tachyarrhythmias (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Accupril, Amolodipine, Pravastatin, Tamsolusin, M2-K7, Cod Liver Oil, Ezetimibe, Lutein, D3?
Current Illness: None.
Preexisting Conditions: High BP, high cholesterol as gluten sensitivity.
Allergies: Dust & Pollen, gluten sensitivity..
Diagnostic Lab Data: DC cardio conversion.
CDC Split Type:

Write-up: Afib.


VAERS ID: 1772153 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-12
Onset:2021-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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: Extreme fatigue since vaccination.


VAERS ID: 1772592 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone, Electrocardiogram, Electrocardiogram ambulatory, Full blood count, Headache, Hyperhidrosis, Metabolic function test, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (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: multi vitamin, topamax 50mg daily, phenteramine 37.5mg 1 & 1/2 tabs/day, diethylproprion 25mg
Current Illness: migraines
Preexisting Conditions: migraines
Allergies: claritin, apple, rubber
Diagnostic Lab Data: holter monitor, ekg, cbc cmp, tsh
CDC Split Type:

Write-up: persistent daily headaches, diaphoresis, palpitations,


VAERS ID: 1775023 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site reaction, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Aspirin, ibuprofen
Diagnostic Lab Data: Patient says she has a CT scan scheduled soon (date not provided)
CDC Split Type:

Write-up: Patient received 1st dose of the Covid vaccine (Moderna) on 9/11/21. When she returned for her second dose on 10/09/2021, she informed me that since her first dose she has had radiating pain from the injection site up to her neck. She also described having swollen lymph nodes on her neck on the same side (left) she received the vaccine. No fever, headache, or other symptoms reported.


VAERS ID: 1775076 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dysstasia, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: severe myalgias of hamstrings bilateral . Initially unable to stand but subsided over a couple of days but persists.


VAERS ID: 1775260 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 LA / IM

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

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

Write-up: Patient reports soreness in his vaccinated arm, which started the next day and lingered for two weeks.


VAERS ID: 1775388 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-10
Onset:2021-09-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D3, magnesium, vitamin C
Current Illness: None
Preexisting Conditions: None
Allergies: Influenza vaccine, 2013, severe myalgias
Diagnostic Lab Data:
CDC Split Type:

Write-up: Post-menopausal bleeding


VAERS ID: 1776059 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-12
Onset:2021-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939901 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect route of product administration, Injection site swelling
SMQs:, Drug abuse and dependence (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow)

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

Write-up: Site: Swelling at Injection Site-Mild, Additional Details: Patient complains of knot/lump of skin at injection site that has lasted for 28 days. The knot/lump of skin locates below the deltoid muscle, about 3-4 inches above the elbow. Patient doesn''t complain of any itching or tenderness. Inappropriate administration technique is suspected. The vaccine may be given too low on arm.


VAERS ID: 1776350 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-12
Onset:2021-09-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Cluster headache, Joint stiffness, Musculoskeletal stiffness, Restlessness, Sleep disorder
SMQs:, Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Akathisia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Low dose antibiotic for acne, methyl folate, multivitamin for kids
Current Illness: Upper respiratory infection
Preexisting Conditions: Cluster headaches that are increasing in pain and frequency. Muscle stiffness and joint pain, lower back pain, sleep disruption, restlessness.
Allergies: Some seasonal allergies to pollen, dust, grass
Diagnostic Lab Data: Doctor appointment on 10/8. CT scan scheduled for 10/14/21. pending results, may have to get on medication for the headaches.
CDC Split Type:

Write-up: Cluster headaches that are increasing in frequency and intensity. Muscle and joint stiffness in limbs. Lower back pain with disruption in sleep and restlessness.


VAERS ID: 1776862 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-10
Onset:2021-09-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abscess, Blood test, Culture positive, Ingrown hair, Staphylococcal infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Xanax. Lexapro.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood work and cultures. 9/15/2021. MRSA.
CDC Split Type:

Write-up: I woke up to what seemed to be an ingrown hair. In the next 3 days grew to size of a mango. Ended up being an abscess that needed to be surgically removed. Once cultures returned it turned out to be MRSA.


VAERS ID: 1776879 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-19
Onset:2021-09-12
   Days after vaccination:116
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: C-reactive protein increased, COVID-19, Cough, Dyspnoea, Exposure to SARS-CoV-2, Fibrin D dimer, SARS-CoV-2 test positive, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, ILD, DM, HTN
Allergies:
Diagnostic Lab Data: Rapid COVID (9/12/2021) = positive D dimer = 759 CRP = 2.3
CDC Split Type:

Write-up: Patient with chronic SOB and wheezing was admitted with more severe SOB and coughing after being exposed to a COVID positive individual. She has been vaccinated. She is not requiring o2 above baseline, baseline o2 requirements of 3 L. Patient treated with Solumedrol (patient on chronic 10 mg prednisone), Vitamin C, Vitamin D, Vitamin Zinc, duonebs, doxycycline. Home o2 eval completed and patient not requiring o2 rest, activity (baseline 3L). Discharge to home with the following Rx''s -Rx doxycycline 100 mg PO BID x 7 days -Rx Prednisone 40 mg PO daily x 5 days -Rx duo nebs Q 6 hours x 5 days then Q 6 hours as needed -Rx mucinex 600 mg bid -resume home prednisone 10 mg after 40 mg prednisone finished


VAERS ID: 1776987 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-27
Onset:2021-09-12
   Days after vaccination:228
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 12M20A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Cough, Headache, Hyperhidrosis, Myalgia, Oropharyngeal pain, Rhinorrhoea
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: chills, muscle aches, runny nose, sore throat, headache,, cough, sweats


VAERS ID: 1777616 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Back pain, Chest pain, Dyspnoea, Electrocardiogram normal, Muscle twitching
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Dyskinesia (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: not known
Preexisting Conditions: ovarian insuficiency, deafness, PVC TR anxiety
Allergies: simethicone, augmentin, flu shot (palpitations), diazepam
Diagnostic Lab Data: EKG unremarkable
CDC Split Type:

Write-up: patient was seen in clinic after covid vaccination pfizer, extremely anxious. she reported the following: -left eye twitching -slight struggling with breathing -severe back pain - pleuritic chest pain despite symptomatic treatment patient remains with symtpoms and requested this provider fill out a adverse reaction form.


VAERS ID: 1777808 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-10
Onset:2021-09-12
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram normal, Brain natriuretic peptide increased, Chest pain, Computerised tomogram thorax abnormal, Fibrin D dimer, Pericardial effusion, Pericarditis, Pleural effusion, Troponin normal
SMQs:, Cardiac failure (broad), Systemic lupus erythematosus (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen, Alprazolam, Aspirin, Atorvastatin, Carvedilol, furosemide, lisinopril, metformin, metoprolol, ondansetron, pantoprazole, potassium, proair, spironolactone, Brilanta
Current Illness: Pt had hx of idiopathic CHF (peripartum for one episode). Pt had had an MI with resultant severe CHF. She had been exposed to COVID-19, but had antibodies negative. She got vaccinated with 2 doses of Pfizer vaccine. She developed pericarditis and pericardial effusion and was hospitalized for a short stay. Her biological sister got COVID-19 and had heart failure. Question if this family has genetic susceptibility to heart inflammation and spike protein. She has since recovered.
Preexisting Conditions: Anxiety, Abdominal pain, GERD
Allergies: Ketoralac, Vancomycin, Enestro,
Diagnostic Lab Data: BNP 2300 (baseline 403). D-dimer 1.26 (CT angiogram negative) Troponin normal CT with small pericardial effusion and small pleural effusion (L)
CDC Split Type:

Write-up: Pt had chest pain 2 days after vaccination. She did have pericarditis and a pericardial effusion develop. She was hospitalized for a few nights and treated with prednisone, ibuprofen and colchicine.


VAERS ID: 1779006 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-11
Onset:2021-09-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Cellulitis, Oedema, Pain in extremity, Peripheral swelling, Skin discolouration, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol PRN amlodipine 10mg qd ASA 81mg qd Carvedilol 6.25mg qd clobetasol 0.05% topical cream BID Wixela Inhub 250mcg-50 mcg inhalation powder BID Furosemide 40mg qd Lisinopril 40mg qd Oxycodone-acetaminophen 5mg-325mg q6h
Current Illness: Morphea - diffuse
Preexisting Conditions: acquired absence of left foot s/p DVT, COPD, HFrEF, Essential HTN, H/o MI, Morphea, Chronic pain, Opioid dependence, phantom limb syndrome with pain, tobacco use, chronic venous insufficiency
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: LLE discoloration and pain developing approximately 12 hours after administration of vaccine at local neighborhood church in the afternoon around 4pm by individuals who did not identify as medical professionals giving the J&J COVID vaccine, cellulitis developed in left with discoloration initially started in lower section of leg and ascending with engorgement of blood vessels and surrounding tissue becoming edematous and darkly discolored up to the knee ending at the area of the tibial tuberosity. Patient then had extension of discoloration without palpable vessels in the right lower extremity the following day and had swelling worsening in the left leg and required medical attention of amoxicillin and bactrim to treat the cellulitis. Patient refused to have blood draw nor be sent to the ED. Patient followed up in the clinic a week later and had some resolution of affected limbs with persistent discoloration that was not present prior to the vaccine administration.


VAERS ID: 1779356 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Wyoming  
Vaccinated:2021-09-09
Onset:2021-09-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Chest X-ray, Laboratory test, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pending CXR, labs, cardiology evaluation.
CDC Split Type:

Write-up: Palpitations 3-4 times daily, lasting few seconds before improving on own


VAERS ID: 1779507 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2020-12-23
Onset:2021-09-12
   Days after vaccination:263
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / UNK RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / UNK RA / IM

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

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

Write-up: COVID 19.


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