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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 207 out of 8,010

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VAERS ID: 1693271 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Abdominal pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin, metformin, topimax, ellavil, gabapentin, fish oil, magnesium, glucosamine, potassium
Current Illness: None
Preexisting Conditions: Exercise induced asthma
Allergies: Penicillin
Diagnostic Lab Data: Did not receive any
CDC Split Type:

Write-up: Almost 12 hours post vaccine experiencing severe abdominal cramping, similar to menstrual cramping.


VAERS ID: 1693273 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Back pain, Burning sensation, Hypoaesthesia, Pain, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Latex, erythromycin
Diagnostic Lab Data: There were none. The hospital, refused to do them.
CDC Split Type:

Write-up: After the vaccine I had burning in my arm off an on the day of injection. Today at around 9:30 am I developed numbness, tingling, and pain going down my right arm. The pain radiated into my back and shoulders. I called the vaccine manufacturer and was told to go to the hospital. My treatment consisted of Tylenol and a physical exam. I was told to watch out for nerve damage in a few days and look for severe swelling in my arm due to possible blood clot. I''m still having pain


VAERS ID: 1693276 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 3 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: No Adverse effect reported. Patient''s daughter, came in to report patient had received the wrong vaccine. On patient''s CDC card the first and second dose read as Moderna and the third dose which was administered on site read as Pfizer. Record on RA site and on patient log records indicated patient received Moderna vaccine.


VAERS ID: 1693293 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Dyspnoea, Erythema, Peripheral swelling, Pharyngeal swelling, Swelling face
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Morphine, wellbutrin, tompamax,ropinirole, zetia,, zyrtec, albuterol, advair, Singulair, atorvastatin,, trazadone, nurtec, equality, both every 3 months
Current Illness: No
Preexisting Conditions: Crohn''s disease, asthma
Allergies: Ceftin, shellfish, nsaids, Reglan, Coumadin, iv contrast , iodine, latex sensativoty
Diagnostic Lab Data: Went to the er the doctor listened to my airway and had nurses administer steroids, benadryl, and pepcid, and I was monitored for some time until they deemed I was ok to go home and rest.
CDC Split Type:

Write-up: Anaphylaxis. Face started turning red and swelling up, throat swelled up and couldn''t breath, hands were swollen and red too.


VAERS ID: 1693297 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-09
Onset:2021-09-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac flutter, Headache, Injection site pain, Pain, Pain in extremity
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Extravasation events (injections, infusions and implants) (broad), Tachyarrhythmia terms, nonspecific (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Injection pain :sharp stabbing pain , throbbing in arm, Headache ,, increased in weird heart flutter


VAERS ID: 1693305 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Feeling cold, Headache, Myalgia, Nausea, Oropharyngeal pain, Pain, Pyrexia, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Fever, fatigue, muscle & body aches, chills, headache, nausea, tremors in both arms, sore throat.


VAERS ID: 1693313 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Gastrointestinal pain, Injection site inflammation, Menstrual disorder, Pulmonary pain, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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: Norethindrone Acetate & Ethinyl Estradiol (generic Loestrin FE)
Current Illness: None
Preexisting Conditions: None
Allergies: Azythromycin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chest pain, throat tightening, bilateral, sharp pain lungs with wheezing breath sounds, severe inflammation at injection site, GI pain and pattern alteration, cessation of menstruation during menses following administration of vaccine.


VAERS ID: 1693319 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-01
Onset:2021-09-11
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site pain, Malaise, Myalgia, Nausea, Pyrexia, SARS-CoV-2 test negative, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: headache,malaise,weakness
Other Medications: none
Current Illness:
Preexisting Conditions: high cholesterol
Allergies: latex
Diagnostic Lab Data: covid-19 test at the job 09.10.2021 Negative
CDC Split Type:

Write-up: severe headache,muscle ache,fever,nausea,vomitting,local pain of injection,malaise


VAERS ID: 1693321 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-09
Onset:2021-09-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Ventricular extrasystoles
SMQs:, Anaphylactic reaction (broad), Ventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypokalaemia (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: Flu vaccine
Other Medications: B3 Claritin Zinc
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Flu vaccine
Diagnostic Lab Data:
CDC Split Type:

Write-up: PVCs Saturday all day off and on . They are bad enough to cause it to catch my breath


VAERS ID: 1693322 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dry throat, Flushing, Lip swelling, Pallor, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: PT. COMPLAINED OF TONGUE SWELLING AND DRY THROAT. THAT STARTED TO SUBSIDE IN 5 MINUTES. PT. WAS NOT HAVING ANY BREATHING DIFFCULTIES PT WAS FLUSHED. I TOOK PT. BLOOD PRESSURE AND CHECKED OXYGEN LEVELS. SWELLING STARTED IN PT. LIPS AT THIS TIME AND I ADMINISTERED EPINEPHRINE AT THIS TIME. PT STARTED TO GET COLOR BACK IN HER FACE AND SWELLING OF THE LIPS SUBSIDED. I HAD PT. TO CALL HER SISTER TO DRIVE HER HOME


VAERS ID: 1693343 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Headache
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: No
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache, pain in left axilla


VAERS ID: 1693346 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro 10 mg
Current Illness: URI week prior. Negative PCR COVID test 10 days prior
Preexisting Conditions: ASD unrepaired
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Significant swelling to R axillary lymph nodes. Size of entire palm, significantly tender. No redness or warmth


VAERS ID: 1693362 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-09
Onset:2021-09-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 2025 HTz Adderall 10 mg three times a day Paxel 30 mg once a day
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Not tested yet
CDC Split Type:

Write-up: Woke up Saturday sept the 11th 7 am with soreness in my chest while breathing in deep and the pain throbs with each heart beat I have not experienced this with dose 1 or dose 2


VAERS ID: 1693371 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-24
Onset:2021-09-11
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Haematochezia, Menstruation irregular, Thyroid disorder
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Fertility disorders (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Diltaziem, labatelol, ferrous sulphate, lezothroxyne, losartan/hcl
Current Illness: None at the time
Preexisting Conditions: Hi blood pressure, eczema, polysistic ovaries, thyroid, alpha thalassemia
Allergies: None known
Diagnostic Lab Data: Waiting for doctorl
CDC Split Type: Uknown

Write-up: I missed my period for the month of August. My last period date was July 24th as of date I have not received my period. Secondly on September 11, 2021. I start getting Bowl Movements with blood in it. The stools are soft and the urge to go is more frequent.


VAERS ID: 1693379 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-09
Onset:2021-09-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Breast pain, Pain, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Lipodystrophy (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: MMR reaction Bee Venom
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen left arm with radiating pain into left arm pit and left breast.


VAERS ID: 1693383 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Hyperhidrosis, Pain, Pyrexia, SARS-CoV-2 antibody test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Pleurisy
Allergies: None
Diagnostic Lab Data: On September 7th I received an antibody test to see if I still had antibodies. I had a positive COVID case in October of 2020. It came back positive showing I had 52 or 58 antibodies. Not sure if that?s a lot or not I couldn?t find a range.
CDC Split Type:

Write-up: After 12 hours I developed full body chills and shivers. Uncontrollable. A fever. Body aches and joint pain. Extreme headache. Extreme sweating when my fever would break each time. This went on for another 24 hours. Fever was as high as 103.8. Shivers and chills were very extreme. Stayed in bed for 33 hours until it passed.


VAERS ID: 1693385 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0881721A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (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: Iron, lysine, garlic
Current Illness: None
Preexisting Conditions: Iron deficiency anemia
Allergies: Penicillin
Diagnostic Lab Data: I read in an article that this symptom should resolve itself and since I don''t have health insurance I don''t intend to seek treatment unless it''s an emergency
CDC Split Type:

Write-up: Yesterday about 5 hours after receiving the vaccine I started to feel a tingling numbness down my whole left arm down to my fingertips. I assumed it was related to the soreness of the injection site but then I started feeling it down my right arm as well. The sensation has persisted for over 18 hours straight.


VAERS ID: 1693392 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Fatigue, Headache, Injected limb mobility decreased, Nausea, Pain in extremity, Sleep disorder
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily; Norethindrone 5 mg 1/2 tab; Estradiol 1 mg; Silver multi vitamins; Biotin 10,000 mg Calcium 500 mg with D 400 IU; Fish oil 1000 mg + 300 mg Omega 3; Glucosamine HCI with MSM 1500 mg; Monthly; Risedronite sodium 150 mg
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Beginning at 3:30 am on Saturday, Right arm extremely sore, painful to sleep. Hard to lift and use. Headache and very tired all day. Felt nauseated all day. Symptoms continuing Sunday morning as I am filling this out.


VAERS ID: 1693395 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Blood glucose normal, Fall, Feeling abnormal, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE KNOWN
Current Illness: NONE KNOWN
Preexisting Conditions: NONE KNOWN
Allergies: NONE KNOWN
Diagnostic Lab Data: EMT''s took blood pressure and blood sugar tests.
CDC Split Type:

Write-up: Patient fainted approximately 2 minutes after receiving the vaccine. He sat down to wait for the 15 minutes but fell forward and off of his chair. He recovered quickly, but stated he felt nauseous as well as "weird". Ambulance was called for precaution and while waiting for arrival we got a cold compress, water, and some crackers for him to eat as his father stated he did not eat any breakfast before he came in. Anxiety seemed to be the most prevalent cause of the fainting, but father insisted he normally does well with shots. His breathing was normal, and color was retuning quickly after eating the crackers. EMT''s arrived, took blood pressure, blood sugar and stated eveyrthing was normal. However it was mentioned that the patient takes medication for anxiety and EMT''s stated it was most likely fainting from anxiety as all tests were normal. We kept him for observation for another 30 minutes, and will follow up to check in on patient.


VAERS ID: 1693402 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Headache, Injection site pain, Pain, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (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: Citalopram
Current Illness: None
Preexisting Conditions: None
Allergies: Augmenton, Amoxycillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, severe headache, body aches, injection site soreness, drowsiness . Started when woke up day after vaccine and continued into second day after.


VAERS ID: 1693403 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-09-03
Onset:2021-09-11
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: I broke out into rash and haven''t had time to see if allergy medicine will help.


VAERS ID: 1693416 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nothing
Current Illness: Nothing
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills, body aches


VAERS ID: 1693417 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac operation, Chills, Dizziness, Dyspnoea, Headache, Hyperhidrosis, Influenza like illness
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metroprolol, Lisinopril, Rosuvastatin, Chondroitin, Propecia, Vitamin B12, Zinc, Vitamin D, Magnesium
Current Illness: None
Preexisting Conditions: Open heart surgery 3/2019
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had very mild symptoms the morning following the second Covid - 19 vaccination. I was feeling fatigued and took 500 mg of Niacin for energy. Within 5 minutes I began to sweat profusely, had extreme difficulty breathing, my dull headache became pronounced, and mild body aches became very intense. It was like an intense flu and I considered calling the paramedics. The reaction began to pass after 30 minutes after which I experienced intense chills and dizziness. After another hour the chills passed but the dull headache, body aches, and dizziness remained until about midnight. I took all of my other supplements and prescription medication approximately 90 minutes before the Niacin and had no reaction. The Niacin was the trigger. I did not take Niacin after the first vaccination.


VAERS ID: 1693418 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

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

Write-up: 30 minutes post vaccine. IM injection in left deltoid. Left hand fingers tingling. Intermittent tingling in left forearm.


VAERS ID: 1693439 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / SYR

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

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

Write-up: Fever 102, body aches, fatigue, headache, enlarged lymph nodes in armpit.


VAERS ID: 1693444 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Hyperhidrosis, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Fever, chills, body aches, excessive sweating


VAERS ID: 1693463 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-12
Onset:2021-09-11
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Immediate post-injection reaction, Sensory disturbance, Throat irritation
SMQs:, Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Vestibular disorders (broad), Hypersensitivity (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: not known
Current Illness: not known
Preexisting Conditions: not known
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: immediately following injection pt states "i fell dizzy and funny in the head". she also reports "itchy throat".


VAERS ID: 1693470 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dyspnoea, Lower respiratory tract congestion, Pallor, Pyrexia, Respiration abnormal, Vomiting
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Norethindrone Acetate Ethinyl Estradiol & Ferrous Fumarate tablets, 1 mg/0.02 mg Spironolactone 100mg Vitamin D Garden of life Dr. Formulated probiotics once daily womens
Current Illness: None
Preexisting Conditions: MRKH NCCAH
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Feverish 1pm following day Took 3,000 mg vitamin C and 2 Acetaminophen tablets Color turned pale/gray, lips lost all color, threw up 3 times between 5pm-9pm. Had severe chills after vomiting. Had congestion in chest and was taking deep breaths to breathe. Took pepto bismol at 9pm, ate some saltine crackers, and drank some Gatorade. Took 1 ibuprofen at 10pm, then slept for 11 hours. Woke up at 9am on 9/12/21. Got out of bed at 10am. Feeling better but still feeling out of breath and not breathing normally..


VAERS ID: 1693472 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, Throat irritation, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (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: Propranolol 10mg 2x daily, was not taken the morning prior to the vaccination. Last dose was 9/9/21.
Current Illness: None
Preexisting Conditions: High blood presssure
Allergies: Seasonal allergies
Diagnostic Lab Data: None, reported to my family physician the next day,
CDC Split Type:

Write-up: Within a few minutes of injection, my left arm began itching, followed by neck and my face. I reported to the pharmacist and he instructed me to take Benadryl. I had no other symptoms at the time. After leaving I began to have a scratchy throat and some wheezing, I continued with the Benadryl and self monitored until symptoms began to subside within two hours.


VAERS ID: 1693494 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 LA / IM

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

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

Write-up: 28 year old patient after receiving the second dose of Pfizer after 20 minutes started to feel a rash on the neck and then the skin turned red on the chest just like the left wrist. At 4:42pm, the patient took half of a Benadryl 25mg and her vitasls were verified which were: 107 pulse, 98 saturation, 120/70 B/P and clear lungs. Patient was kept in observation and later at 4:56pm took the other half of the Benadryl. At 5:10pm, the patient was re-evaluated and the vital signs were: 108 Pulse, 110/80 B/P, 99 saturation and 16 Respiration.


VAERS ID: 1693496 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 RA / SYR

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

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

Write-up: Severe migrane Extreme dizziness Extreme nausea


VAERS ID: 1693509 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Fall, Head injury, Hyperhidrosis, Loss of consciousness, Nausea
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (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: N/a
Current Illness: No Known
Preexisting Conditions: No Known
Allergies: No Known Allergies
Diagnostic Lab Data: Paramedics took vital signs including blood pressure and blood sugar, and a patient medical history. It seems the patient refused to be transported to the hospital and left the pharmacy on their own accord.
CDC Split Type:

Write-up: Following vaccination, the patient was seated. After a few minutes they approached the pharmacy counter asking to use the bathroom as they felt nauseous, and was visibly sweating, red in color. They seemingly lost consciousness, fell forward into the plastic divider, and then backwards onto the store floor, possibly hitting their head. Pharmacist alerted the pharmacy intern to call 911, and entered the store floor to assist the patient, who had quickly regained consciousness and sat themselves up. They were offered water, after which point they reported starting to feel better, and was able to make it back into a chair on their own power until paramedics arrived, and the pharmacist relayed the details of the adverse event.


VAERS ID: 1693511 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall 20mg Lisinopril Fish oil Multivitamin
Current Illness: Unsure
Preexisting Conditions: HPB ADHD Adjustment Disorder
Allergies: Dairy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Numbness from September 11th early in the morning to September 12 a full 24 hours later.


VAERS ID: 1693523 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

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

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

Write-up: Patient passed out on the ground as she was walking to us to inform the staff that she isn''t feeling well. EMS was contacted but she refused to be taken to the hospital with them. Her parents were present and followed her home. She claimed that she suffers from chronic anxiety


VAERS ID: 1693526 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Chills, Fatigue, Headache, Hyperhidrosis, Injection site pain, Nausea, Pain, Pyrexia, Vaccine positive rechallenge
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Womens MV, Calcium, vitamin D, Cymbalta 40mg/qd, baclofen 10mg tid.
Current Illness: None
Preexisting Conditions: Cervical stenosis with myelopathy
Allergies: Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had the same reactions to both the first injection on 8/10/21 and 9/10/21. I had chest pain, high fever, sweats, chills, fatigue, joint pain, body aches, nausea, arm pain at injection site and could not get up from the floor for a day and a half following the injection. These symptoms lasted 2 days with only the headache lasting until the 3rd day. What concerns me is that I am breastfeeding and my baby after nursing post my injection fell asleep within an hour and did not wake up until the next day. After the first injection on 7/10/21 , he fell asleep at 4pm and did not awake until 6am the next day. After my second injection on 8/10/2021 he fell asleep at 3pm and slept until 6am the next day. He did not awake for dinner on both occurrences. He has never done this before other than after nursing several hours after each of the moderna shots that I received. I pumped breast milk on 8/11/21 in the morning if you would like to study.


VAERS ID: 1693534 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 08802IA / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: fish oil, vit D, flax seed, lisinopril, digoxin, Claritin.
Current Illness: n/a
Preexisting Conditions: none
Allergies: Aloe, petroleum, latex, silicone, hay fever, dust, mold.
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Generalized body rash with hives, approx. 2 hours after injection.


VAERS ID: 1693544 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

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

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

Write-up: patient reported headache then passed out; 1 dose of epipen given; patient left store with paramedics


VAERS ID: 1693560 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bone pain, Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Osteonecrosis (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: Deep bone pain and aches in lower half of body around 12hr after injection; arm injection site pain started around 2 hours after injection


VAERS ID: 1693566 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-09
Onset:2021-09-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test, Computerised tomogram thorax, Electrocardiogram, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood work, CT chest, EKGs on 9/11/21 and 9/12/21. Hospital admission on 9/12/21.
CDC Split Type:

Write-up: Pericarditis


VAERS ID: 1693592 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Feeling cold, Malaise, Nausea, Pallor, Palpitations, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (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: no
Current Illness: no
Preexisting Conditions: no
Allergies: peaches, cherries
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient received the vaccine with no history of allergic reaction or fainting . Approximately 7 minutes after receiving the vaccine and moving to a chair the patient stood up to tell pharmacist he wasn''t feeling well. He began to faint and fell to the floor in a seated position. Patient looked very white and he said his heart was racing and his body felt cold all over and he felt nauseous . After observing him for about another 20 minutes he began to feel better and was able to then leave the pharmacy on his own. He had his vitals checked by EMT and all was fine.


VAERS ID: 1693599 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache, Pain, Respiratory tract congestion
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: Dose 1- body aches
Other Medications: Humira
Current Illness: N/A
Preexisting Conditions: Crohns disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue, body aches, headache, congestion.


VAERS ID: 1693613 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-09
Onset:2021-09-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear pain, Lymph node pain, Lymphadenopathy
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: nitrofurantoin, duloxetine. lamotrigine, methotrexate, clonidine, nabumetone
Current Illness: UTI
Preexisting Conditions: carpal tunnel, rheumatoid arthritis, polyneuropathy, low back pain
Allergies: latex, cat, naproxen, oxcarbazepine
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Left submandibular lymph node is swollen, tender to touch, left ear hurts


VAERS ID: 1693614 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 LA / -

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

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

Write-up: The patient was given the vaccine at 4:01. She was asked to wait for 30 minutes after her vaccine due to her pcn allergy. The patient went to the restroom at 4:19 and her boyfriend came to the pharmacy and said she was light headed. The patient laid in the floor bc she didn''t feel well, 4:20 I took her blood pressure 104/68 pulse 85. we elevated her head and gave the patient an ice pack. Patient said she was queasy when she was filling out her paperwork. 4:24 patient was able to sit up and drink water. 4:28 BP TAKEN AGAIN 132/55 PULSE 97. patient was feeling better at 4:33 I checked on the patient at 6pm and was feeling better


VAERS ID: 1693655 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Palpitations, Paraesthesia, Respiratory rate increased
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (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: not a vaccine, similar reaction to the iv drug administered before a CT scan
Other Medications:
Current Illness: none
Preexisting Conditions: high cholesterol
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heart started racing within a couple of minutes of the vaccine. Felt flushed and tingly/prickly all over. Breathing was kind of quick, almost like a panic attack. Symptoms went away after a few minutes. *Have had something similar happen when administered the drug they give to do a CT scan. NOT a comfortable sensation!


VAERS ID: 1693659 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ689AB / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: CHILLS AND LOW GRADE FEVER OF 99.4, TOOK IBUPROFEN AS DIRECTED


VAERS ID: 1693665 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Conjunctivitis, Conjunctivitis viral, Erythema, Lacrimation increased, SARS-CoV-2 test
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Ocular infections (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

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

Write-up: This is very mild. She came to ED for acute conjunctivitis left eye only with tearing. It began 2 hours after the vaccine. There is minimal erythema and tearing of the left eye. Will treat with topical antibiotic. I think its likely she has a coincidental concurrent viral conjunctivitis and this is not related to the vaccine, but timing is compelling for VAE. She has no other viral symptoms and she was perfectly well at time of vaccine administration.


VAERS ID: 1693672 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Brain natriuretic peptide, Chest pain, Electrocardiogram abnormal, Full blood count, Pericarditis, Troponin I
SMQs:, Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Tourette''s'' disorder, peanut allergy, microscopic hematuria
Allergies: Peanut
Diagnostic Lab Data: Completed: EKG Pending: CBC, troponin I, BNP
CDC Split Type:

Write-up: Chest pain beginning 24hours after vaccination. EKG suggestive of pericarditis


VAERS ID: 1693682 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 LA / IM

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

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

Write-up: pt got an itchy rash all over body around 5 hours after getting her shot. red welts all over body and very itchy. pt has no such rxn the forst dose. pt did not have trouble breathing.


VAERS ID: 1693686 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pain, Nausea, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Nextstellis, biotin, Vit D, Vit C, magnesium, Vit B complex
Current Illness: No other than same reaction to first vaccine as this one.
Preexisting Conditions: High cholesterol
Allergies: Penicillin and sulfa.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, headache, nausea, vomiting, body aches, fatigue, soreness at injection site for 24 hours


VAERS ID: 1693689 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Haematuria, IgA nephropathy
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Tubulointerstitial diseases (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: gross hematuria, 56, 04/12/21, SARS COVID-19 Moderna
Other Medications: Vitamin D 2,000 Mg, Vitamin C 1,000 mg
Current Illness: None
Preexisting Conditions: Being monitored for bladder cancer. Microscopic hematuria of unknown cause, with four prior episodes of gross hematuria -- including an episode after 2nd dose of Moderna vaccine (previously reported).
Allergies: None
Diagnostic Lab Data: None yet. Will be following up with Dr. and urologist and oncologist and schedule appointment with nephrologist. Suspect undiagnosed Nephropathy. Suggest caution for people with kidney disease.
CDC Split Type:

Write-up: Gross hematuria, unresolved as of 9/12/2021.


VAERS ID: 1693696 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Glossodynia, Oral mucosal eruption, Oral pain, Tongue eruption
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: VIT D, Vit A, Zinc, Quercetin, Vit K2
Current Illness: None
Preexisting Conditions: HBP, High Cholesterol
Allergies: PCN, tomatoes, bananas, mango, papaya, shrimp, Propylene Glycol sensitivity
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Painful tongue sores Painful sore on inner mucosa of bottom lip


VAERS ID: 1693702 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Chills, Feeling abnormal, Myalgia, Neck pain, Pain, Pyrexia, Sleep disorder, Tinnitus
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Eosinophilic pneumonia (broad), Hearing impairment (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 08/19/2021 - Pfizer Covid 19
Other Medications: Cholecalciferol 2000 intl units, Xarelto 20 mg, Hydrochlorothiazide-lisinopril 12.5 mg-20 mg, Atorvastatin 20MG
Current Illness: COVID 19 Infection late February, 2021. COVID Pneumonia and Covid related DVT March, 2021. Prior negative reaction to first Pfizer COVID-19 Vaccine dose - see report 642525
Preexisting Conditions: Joint and muscle Fatigue, ringing of the ears and Muscle failure under stress since initial COVID-19 infection Late February 2021
Allergies: Milk, Strawberries
Diagnostic Lab Data:
CDC Split Type:

Write-up: Neck/shoulder muscle and joint pain and loud ringing of the ears within first 8 hours. Fever, chills, foggy brain, and whole body pain within the first 12 hours. Highest recored fever 101.6. Fever, chills and whole body pain continued until approximately 23:30 on 09/11. The pain then centered in the shoulder joints and was significant preventing sleep. Ice and heat) did not resolve the pain. I took over the counter Tylenol with helped slightly. Ringing of the ears continued and got louder. by 16:30 on 09/12 the pain in my shoulder joints decreased. Whole body fatigue is still present as is the ringing of the ears.


VAERS ID: 1693722 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Swelling at injection site


VAERS ID: 1693724 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Feeling of body temperature change, Headache, Lethargy, Malaise, Muscular weakness, Rash, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: Birth control pills
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe rash/hives on lower legs and upper chest that started about 6 hours after injection (resolved about 24 hrs after presentaion); general malaise (headache, lethargy, lower leg weakness and hot/cold flashes) lasting for 24-48 hrs (all of these starting about 12 hours after injection).


VAERS ID: 1693734 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Diarrhoea, Nausea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: Nausea, severe diarrhea, chills, for minimum of 2 days


VAERS ID: 1693743 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Malaise, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Immediately within a second of giving the patient Dose 2 of the Pfizer vaccine, patient stated she did not feel good. She proceeded to grab her stomach and while sitting in the chair, she bent down with her head between her legs. Patient was alert and responsive and was experiencing syncope. Patient''s symptoms self-resolved in less than 2 minutes as the patient sat upright thereafter and was using her cell phone. Patient was assessed afterwards and noted she was doing fine. No other symptoms were noted.


VAERS ID: 1693758 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incoherent, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: sixteen hours after following the vaccination I became incoherent and unresponsive. An ambulance was called and was taken to the local Hospital and treated for numerous isses.


VAERS ID: 1693762 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Gingival discomfort, Gingival erythema, Gingival pain, Pain, Rash, Rash pruritic, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Gingival disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cymbalta 60mg bid Omeprazole 40mg daily
Current Illness: None
Preexisting Conditions: Rheumatoid arthritis, polyarthritis, fibromyalgia, neurothapy, mitral valve prolapse, asthma, anemia, vit d def, deaf in right ear, tremors, chronic fatigue syndrome
Allergies: Amoxicillin penicillin azithromycin Zyrtec cclore ketek zpak coreg gentamicin vancomycin omnicef, rocephin, imitrex, amitriptyline, cymbalta,
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Left arm welts red all the way down to elbow, bumps on left and right arm, pain and rash that itches on left hand, left side of gums are really red and raw like a later peeled off very painful and burning. Fatigue, body aches.


VAERS ID: 1693777 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-18
Onset:2021-09-11
   Days after vaccination:236
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: 9/12/21: Called to report covid positive result from 9/11/21. Still symptomatic- runny nose, HA, body aches, fever. Advised to quarantine x10 days since s/s first appeared and at least 24hrs passed since fever without use of fever-reducing meds and s/s have improved/resolved. Pt to also f/u with PCP. Pt will need to clear for RTW when done with quarantine and s/s improved/resolved. Pt fully vaccinated. Antibodies testing ordered. Instructed pt. to complete covid antibodies testing when done with quarantine. HISTORY 9/11/21: Pt returned on 9/10. She started to experience s/s today, 9/11. Pt did not get preflight travel testing. States her family members had preflight testing done and were all negative. Pt instructed to quarantine while results are pending; however, if negative then no longer needs to quarantine. Pt will get results from healthcare portal within 24-72 hours. Pt informed to call the hotline as soon as results are available and at that time will get a date of when to get clearance for RTW. Pt to call hotline with date of symptom resolution. Pt instructed to update manager.


VAERS ID: 1693786 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Breast pain, Contusion, Pain in extremity
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Lipodystrophy (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shot in left arm on Friday afternoon. Pain in arm Saturday afternoon. Extreme pain in arm, underarm/arm pit, and left breast Saturday night. Pain significantly worsened by Sunday morning in underarm that resting arm on side resulted in pain. By Sunday night noticed large bruise on armpit.


VAERS ID: 1693790 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Fatigue, Feeling abnormal, Nausea, Pain, Pneumonitis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuteral, duoneb, symbicort, delta 8, kratom, percocet
Current Illness: Had teeth removed Wednesday September 8th, no other illnesses was in perfect health other then having to have two painful teeth extracted
Preexisting Conditions: Asthma
Allergies: Sulfa, cephelexon, ibuprofen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, fatigue, mental fogginess, difficulty breathing due to inflammation in my lungs, random sharp pain all over body, nausea. Treated by steroids and multiple duonebs at the er. At home I had to take 3 albuteral and 3 duonebs as well as 4 extra doses of my symbicort to try to control my breathing and get out under control


VAERS ID: 1693802 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-07
Onset:2021-09-11
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None.
Preexisting Conditions: Asthmatic as child
Allergies: Shellfish/ shrimp
Diagnostic Lab Data: ER took blood while in ER room.
CDC Split Type:

Write-up: Hives all over entire body.


VAERS ID: 1693803 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-25
Onset:2021-09-11
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / SYR
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LA / -
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain, Swelling, Vaccination site mass
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No Prescriptions. Patient did receive 2 other vaccines (HPV & Hep A) the same day about 1 hour before Covid 19 Vaccine. One of the vaccines (HPV or Hep A) was in the same arm as the Covid 19 vaccine. Patient takes OTC Vitamins and Antih
Current Illness: None.
Preexisting Conditions: Had childhood Asthma, has outgrown it. Has bad allergies to outdoor things and cats and takes OTC antihistamines for it. No other long-standing health conditions.
Allergies: Patient has allergies to outdoor things (grasses and stuff) and cats, but has never shown allergic reactions to any foods or medications.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Large Marble-Sized lump at Vaccine site on upper Left Arm. Swelling and painful. No discoloration. Only hurts if pressed on, but even lightly touching site causes mild pain. Gave patient 400 mg OTC ibuprofen for pain and swelling, I will apply ice to her arm as well. I was just informed of the condition and have treated, but have not had time to see results of treatment.


VAERS ID: 1693811 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: B complex vitamin, vitamin D3, sumatriptan
Current Illness: none
Preexisting Conditions: migraines
Allergies: penciillins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lymph node swelling in right armpit


VAERS ID: 1693824 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-08-24
Onset:2021-09-11
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Heavy menstrual bleeding, Menstrual disorder, Muscle spasms
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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: Alprazolam Adderall Vit D
Current Illness: None
Preexisting Conditions: Compound heterozygous MTHFR RA Endometriosis
Allergies: Morophine Eggs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Menstrual cycle 5 days early and three to four times as heavy as normal. Almost no coagulation, extremely high flow. Terrible cramping above my endometriosis normal cramping. Very weak after 12 hours of heavy flow.


VAERS ID: 1693827 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2020-12-24
Onset:2021-09-11
   Days after vaccination:261
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abortion spontaneous
SMQs:, Termination of pregnancy and risk of abortion (narrow)

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

Write-up: 2 miscarriages this year following vaccination


VAERS ID: 1693843 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Confusional state, Muscle spasms, Nausea, Pain, Paralysis, Vision blurred
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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: Zoloft, tri-sprintec birth control, adderall as needed- not taken day of vaccination
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I woke up to agony as if my body was being repeatedly beaten with a baseball bat yet I was paralyzed and could do nothing but take it. I had nonstop muscle spasms and period of confusion because my head felt like it was being hit with a bat and my eyes wouldn?t focus. I couldn''t stand up or even roll over. I had to have my daughters help me because I thought I was going to be stuck on my back and choke on my own vomit because I was so nauseous and paralyzed. This lasted from 3 AM on Saturday, September 11 till Sunday at 3 PM on September 12.


VAERS ID: 1693858 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN JANSSEN043A21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Headache, Lethargy, Movement disorder, Pain, Paraesthesia, Pollakiuria, Pyrexia, Sensory loss
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prilosec as needed
Current Illness: None
Preexisting Conditions: GERD. Cellulitis 10-15 years ago requiring 2 week hospital stay
Allergies: Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme lethargic and soreness starting out first couple of hours. Then began tingling and prickling sensations both arms below elbow to hands upper side and both legs below knee to top of feet. A few hours later, I had no sensation in fingers on right hand and fingers were ?locking?. Fever of 103 late Saturday into midday Sunday but this am down to 101. Low grade headache but not extreme. Urinated 7 times in middle of night and had nothing to eat minimal to drink and I never have to get up at night, I had to fall out of bed and crawl to toilet as EXTREMELY NO ENERGY. I live alone and no family close so I couldn?t even get to ER.


VAERS ID: 1694055 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bowel movement irregularity, Dizziness, Feeling cold, Loss of consciousness, Nausea, Paraesthesia, Tinnitus, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: not known
Current Illness: None
Preexisting Conditions: Not known
Allergies: none
Diagnostic Lab Data: Not known
CDC Split Type:

Write-up: Patient experienced dizziness, nausea, Feeling faint, Problems with her vision, ringing in the ear and she felt she had to defecate. She described it as passing out 3 times. Tingling in hands, being cold. She was not feeling better after 20 minutes so 911 was called and she was taken to the ER by paramedics. I spoke to her mom the following day she was released and feeling better.


VAERS ID: 1694067 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-08
Onset:2021-09-11
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VALSARTAN, SYMBICORT, ASPIRIN, MONTELUKAST, PHENTERMINE
Current Illness: PNEUMONIA, PINK EYE
Preexisting Conditions: ASTHMA, THALLASEMIA
Allergies: PROPOFOL
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 3 DAYS AFTE RECEIVING 2ND DOSE, A VERY LARGE CIRCLE (SODA CAN SIZE OR BETTER) APPEARED DIRECTLY BELOW THE INJECTION SITE. IT IS PERFECTLY ROUND, RED, AND ITCHY. THE ENTIRE CIRLE IS ALSO RAISED AND SWOLLEN. TOOK BENADRYL FOR THE LAST 2 DAYS. THE AREA DOES SEEM TO FLATTEN AND BECOME LESS ITCHY, BUT RETURN WHEN MEDICATION WEARS OFF.


VAERS ID: 1694095 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily Vitamin B12 supplement, Daily Multivitamin Supplement.
Current Illness: 1 month prior, recovered from COVID-19. PCR Positive 8/6, PCR Negative 8/26
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 1) Moderate (6/10) Headache starting 18 hours post injection, did not persist beyond 12 hours, treated with 400mg motrin (treated concurrently with #2) 2) Upper body Muscle Aches, starting 18 hours post injection; did not persist beyond 12 hours, treated with 400mg motrin (treated concurrently with #1) 3) Pain at injection site within an hour, persisted for 2 days, did not treat. *total medication taken: 400mg Motrin


VAERS ID: 1694120 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Condition aggravated, Cough, Dyspnoea, Heart rate irregular, Hepatic enzyme increased, Malaise, Muscle discomfort, Muscle disorder, Muscle spasms, Pain, Pyrexia, Tachycardia
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Diazepam, tizanadine, gabapentin, onfi, seroquil, carafate, protonics, corlanor, pristiq, IVIG
Current Illness: Vascular Ehlers Danlos Syndrome, Stiff Person Syndrome, lupus, pernicious anemia
Preexisting Conditions: Vascular Ehlers Danlos Syndrome, Stiff Person Syndrome, lupus, pernicious anemia
Allergies: Morphine, codeine
Diagnostic Lab Data: 9/12- had to go to ER due to uncontrollable symptoms. Lidocaine administered to control heart rhythm, pain medication, muscle relaxers oral and IV, cough meds, and iv fluids. Liver enzymes were elevated.
CDC Split Type:

Write-up: Dose 1- exasperation of muscle disease with spasms- slight discomfort for about 12 hrs. Dose 2- extreme chest pain with tachycardia/irregular heartbeat, high fever from 101-103 degrees, cough, difficulty breathing, pain, and spasms Began 9/11 Still very ill (9/13)


VAERS ID: 1694131 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Uterine 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: Estradiol
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Uterine Bleeding


VAERS ID: 1694133 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-03-04
Onset:2021-09-11
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. developed COVID-19 requiring hospitalization post-vaccination.


VAERS ID: 1694135 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 1604397-04813 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 1606751-04813 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Diarrhoea, Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Losartan, Eliquis
Current Illness: None
Preexisting Conditions: Obesity
Allergies: Codeine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Within about 24-hours from receiving Dose 2 of Pfizer COVID-19 vaccine, started having headaches, diarrhea, muscle aches, chills, and fever that went up to around 100.4 degrees. The symptoms reduced after two days, taking Tylenol to help with fever reduction and headaches during that time. As of 8AM on 8/13/2021, only a mild headache remains with no other symptoms.


VAERS ID: 1694136 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Dyspnoea, Injection site erythema, Injection site swelling
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), 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: Women?s Multi vitamin
Current Illness: None
Preexisting Conditions: Pcos
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe joint pain started 9/11/21 in the morning but was gone by afternoon 9/12/21. Shortness of breath started in the evening of 9/11/21 and still continues on 9/13/21 spo2 levels have remained at 98%. Severe swelling and redness in my arm at injection site are still present on 9/13/21


VAERS ID: 1694149 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-27
Onset:2021-09-11
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

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

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

Write-up: dull pain at injection site 2 weeks later


VAERS ID: 1694151 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NOT KNOWN
Current Illness: NONE REPORTED
Preexisting Conditions: DIABETES
Allergies: NONE LISTED
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT WAS WAITING THE 20 MINUTES POST VACCINATION . WITHIN 10 MINUTES OF SHOT, PATIENT FELT LIGHT HEADED, HAD HER EYES CLOSED. PARTIALLY RESPONSIVE. AFTER LYING ON FLOOR WITH LEG ELEVATED, PT FELT A LITTLE BETTER BUT ALSO COMPLAINED OF LEFT LEG NUMBNESS. ON STROKING HER FOOT, PT HAD SENSATION. EMS WAS CALLED. PATIENTS VITALS WERE BP 80/60 AND BS 127 . PT WAS TAKEN TO HOSPITAL AS SHE STILL FELT LIGHTHEADED STANDING UP.


VAERS ID: 1694155 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-09
Onset:2021-09-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN Z03A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal distension, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness:
Preexisting Conditions: Psoriatic Arthritis, Lichen Sclerosis
Allergies: Gluten allergy, cipro, amoxicillin
Diagnostic Lab Data: na
CDC Split Type:

Write-up: I broke out in a cyst like rash all over my left side shoulder, neck and back on Saturday morning following the shot. I have also had severe bloating and stomach issues since Saturday.


VAERS ID: 1694166 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

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

Write-up: Tachycardia


VAERS ID: 1694171 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-17
Onset:2021-09-11
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient was fully vaccinated with J&J on 5/17/21 and tested positive for COVID on 9/8/21. Patient was admitted 9/11/21 with SOB and oxygen requirements needed. Patient remains admitted at this time


VAERS ID: 1694174 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-05
Onset:2021-09-11
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient tested positive for covid 19 s/p vaccination


VAERS ID: 1694175 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Diarrhoea, Dizziness, Headache, Hyperhidrosis, Hypoaesthesia, Nausea, Pruritus
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Diabetes
Preexisting Conditions: Obesity
Allergies: Citrus
Diagnostic Lab Data: I have not been to a doctor since I just lost my insurance. I have only taken Benadryl and Tylenol.
CDC Split Type:

Write-up: I took the shot and about 5 mins after, I became dizzy, nauseous, really weak and sweaty. I then felt a strong urge to diarrhea. I started drinking a lot of water because I couldn?t get cool inside my body. I sat at the pharmacy about 30 mins and eventually I gathered strength to go home. About 30 mins after being gone, I got a massive headache, itching all over my body, and my left arm became numb. It?s been 3 days so far and the itching has not stopped.


VAERS ID: 1694203 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure decreased, Cardiac disorder, Cough, Dizziness, Electrocardiogram, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Thyroid 112 mg daily Potassium daily Vitamin D daily
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: On Sept. 11, 2021 In the ER I was given fluids, an EKG, and Zofran. My blood pressure was low, once it improved to about 110-70, I was released.
CDC Split Type:

Write-up: I received my 2nd dose of Pfizer on 9-10-21 around 10:15am. The next morning 9-11-21 at around 9:30 am I was sitting in a chair and passed out. An ambulance was called, my blood pressure was taken twice and it was about 79-43. I was transported to the hospital and given fluids ,Zofran and an ekg. I began coughing while there. Once I was released the coughing persisted and now my heart is doing all kinds of funny things. The heart trouble began Sat. 9-11-21. I am still light headed (things try to go dark) as of Mon. 9-13-21. I have no underlying conditions and have been very healthy with no problems until this second dose.


VAERS ID: 1694207 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: Hives/rash


VAERS ID: 1694214 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-26
Onset:2021-09-11
   Days after vaccination:228
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 9/12 SARS/COV-2, NAAT Positive
CDC Split Type:

Write-up: BREAKTHROUGH COVID


VAERS ID: 1694245 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-12
Onset:2021-09-11
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 9/11/21 SARS/COV-2, Naat, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1694246 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-08
Onset:2021-09-11
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Rash at injection site at left arm; raised, erythema, papules; apparently occured with 1st injection as well; rash after 2nd injection more pronounced.


VAERS ID: 1694250 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Confusional state, Facial paralysis, Feeling hot, Loss of consciousness, Transient ischaemic attack, Unresponsive to stimuli
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), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol, fosamax, atorvastatin, aspirin
Current Illness: none
Preexisting Conditions: hypertension, osteoporosis, hypothyroidism, mitral valve prolapse
Allergies: none
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: 21 hours after receiving vaccine patient described being extremely hot, then she became unresponsive and per spouse "passed out"; she was taken via EMS to nearest ER; due to nature of syncopal episode and left sided facial drooping patient was sent via air flight to nearest ER for neuro patients-- it was determined that patient had a TIA ; she remains confused post episode and is being monitored for additional symptoms


VAERS ID: 1694283 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site oedema, Injection site pain, Injection site warmth, Rash
SMQs:, Anaphylactic reaction (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: None
CDC Split Type:

Write-up: Redness, edema, warmth, pain around injection site roughly the size of a large pear. Rash on bilateral arms and scattered on rest of body. Only treated with Tylenol.


VAERS ID: 1694300 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-03
Onset:2021-09-11
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Intensive care, Lung opacity, Pleural effusion, Pneumonia, SARS-CoV-2 test positive, Sepsis, Vaccine breakthrough infection
SMQs:, Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol
Current Illness: PCP visit for ongoing eval of chronic CP, wheezing, cough, undergoing workup for COPD in setting of chronic tobacco use
Preexisting Conditions: possible COPD, ETOH abuse
Allergies: nka
Diagnostic Lab Data: Covid + 9.11, CXR: bilateral opacities and effusions
CDC Split Type:

Write-up: breakthrough Covid + w/ PNA and Sepsis requiring critical care admission


VAERS ID: 1694338 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Arthralgia, Arthritis, Asthenia, Axillary pain, Breast pain, Chest pain, Fatigue, Hyperhidrosis, Hypoaesthesia, Injected limb mobility decreased, Mobility decreased, Nausea, Palpitations, Paraesthesia, Tremor
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Lipodystrophy (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft 50 mg; Seasonique; Xyzal; Nortriptyline 50 mg; Magnesium Oxide; Vitamin D
Current Illness:
Preexisting Conditions: Seasonal allergies; Atypical facial nerve pain (left side); Anxiety disorder
Allergies: Latex; Tree nuts; Tree fruit; Grass and tree pollen; Neomycin; Garamycin; Reglan ; Lorabid ; Ceclor; Bactrim
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 2:00 am following injection, could not move injected arm without intense pain. Hand was tingling and would go numb. Shoulder and armpit hurt. 10:00 am I started icing arm. Began feeling nauseas, weak and tired. My chest would hurt and my heart would pound on occasion. Joint pain started a few hours later, mostly in knees, hips, and lower back. By 4:00 pm, mild fever started (100.4?). I could barely get out of bed all day. My legs would shake when walking to the bathroom. The area above my left breast under my collarbone became puffy and extremely sore. Left armpit also hurt. Fever broke late at night on 9/11. On 9/12, most symptoms improved except left breast/armpit pain, fatigue/weakness, and heart pounding. I got a stomach ache later on 9/12. I?d feel very weak if I tried to move around too much, so I stayed in bed. Through the night of 9/12, I woke up either freezing or sweating several times. The morning of 9/13 (today) I still felt weak. Left breast/armpit still hurt, and I could feel an almond sized swollen, tender lymph node above my left collar bone. I still feel weak and fatigued as I write this, and my heart continues to pound on and off.


VAERS ID: 1694375 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Headache, Oropharyngeal pain, Rhinorrhoea, Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

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

Write-up: Sore throat, runny nose, itchy throat, and headache


VAERS ID: 1694386 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-17
Onset:2021-09-11
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, SARS-CoV-2 test, Sick relative, 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), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Digoxin, eliquis, furosemide albuterol sulfate, breo ellipta, metoprolol, prednisone, spiriva mirtazapine,
Current Illness: Afib, heart failure PE obesity HTN
Preexisting Conditions: Afib, CHF, COPD, ex-smoker, HOH obesity, OSA, PE
Allergies: codeine
Diagnostic Lab Data: rapid test
CDC Split Type:

Write-up: SOB, Wheezing pt on home O2, Pt family member positive with covid


VAERS ID: 1694394 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Burning sensation, Chest pain, Chills, Dyspnoea, Headache, Pain in extremity, Pyrexia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: ACUTE GASTRONENTERITIS
Allergies: FLU VACCINE
Diagnostic Lab Data: Awaiting medical documentation from Hospital. Pt is now at home but states he still does not feel well.
CDC Split Type:

Write-up: Pt stated that once he received the vaccine on Saturday, 11 Sep 2021 at 11:00, he felt left arm pain and burning sensations throughout his arm. Later on in the evening, he experienced chills, fever and a severe headache. Pt came to work on Sunday and complained of chest pain and difficulty breathing. Pt was transported to ER.


VAERS ID: 1694408 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-01
Onset:2021-09-11
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Headache, Pain
SMQs:, Anaphylactic reaction (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
Current Illness:
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Long periods of headaches. Soreness. Some chest discomfort


VAERS ID: 1694421 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK LA / SYR

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

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

Write-up: Left hand in pain. Took ibuprofen as recommended by the Pharmacist. Pain has not gone away as of 9/13/2021.


VAERS ID: 1694462 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 3 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Chills, Decreased appetite, Headache, Lethargy, Nausea, Neck pain, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Clopidogrel Rosuvastatin Fenofibrate Losartin Ecotrin Levocitrizine Montelukast Pantoprazole Famotidine
Current Illness: none
Preexisting Conditions: Heart medications
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Sore arm, shoulder & neck Headache Chills difficulty breathing deeply lethargic hurt all over nauseous didn''t feel like eating conditions started to subside about 9:00 pm 9-11-2021. Almost gone 11:30 am on 9-13-2021


VAERS ID: 1694513 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-05-19
Onset:2021-09-11
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Fatigue, Nasal congestion, Oropharyngeal pain, Sneezing
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline Methylphenidate, Fiber powder, Guanfacine
Current Illness: none
Preexisting Conditions: attention deficit; Ehlers-Danlos disease; irritable bowel, pectus excavatum; development disorder, sleep disorder, tricholitomania
Allergies: Penicillin, Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: fatigue, nasal congestion, sore throat, cough, sneezing. starting on 9/11/21


VAERS ID: 1694522 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-25
Onset:2021-09-11
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

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

Write-up: No concerns noted per chart review at time of vaccine - admitted to hospital at this time with new dx of Guillian Barre Syndrome


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