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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 209 out of 8,010

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VAERS ID: 1700563 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-08
Onset:2021-09-11
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 25mg, Claritin 10mg, Vitamin D 2000 IU
Current Illness: None
Preexisting Conditions: None other than mild anxiety
Allergies: No
Diagnostic Lab Data: PCR nasal swab test 09/13/2021
CDC Split Type:

Write-up: Breakthrough infection confirmed by PCR test on 09/13/2021


VAERS ID: 1700578 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-21
Onset:2021-09-11
   Days after vaccination:82
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Hypovolaemia, Hypoxia, Inflammatory marker test, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Outpatient Medications amLODIPine (NORVASC) 5 MG tablet atorvastatin (LIPITOR) 10 MG tablet Calcium Carb-Cholecalciferol (CALCIUM/VITAMIN D) 600-400 MG-UNIT TABS dexamethasone (DECADRON) 6 MG tablet loratadine (CLARITIN) 10 MG tablet melato
Current Illness: NA
Preexisting Conditions: Hyperlipidemia Essential hypertension Cognitive impairment
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized; COVID-19 positive (9.11.21); fully vaccinated Admission Date: 9/11/2021 Discharge Date: 9/14/2021; DISCHARGE DISPOSITION: Home to assistant living facility DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Acute hypoxemic respiratory failure due to COVID-19 (HCC) [U07.1, J96.01] Pneumonia due to COVID-19 virus [U07.1, J12.82] HOSPITAL COURSE: Patient is a 92 yo female who lives in an assisted living facility home. She presented to the ER today with hypoxia secondary to COVID-19. She is requiring 2L''s of supplemental oxygen to maintain O2 sats over 90%. Hopsitalist service contacted for admission. We agreed to admit her for an inpatient stay, anticipating greater than a 2 midnight stay. She is vaccinated with the Johnson and Johnson vaccine. She is non-verbal, non-ambulatory at baseline. I spoke with her DPOA, who states patient is DNR. She consents to convalescent plasma should that treatment be indicated. She would like to be contacted prior to placing a central line or starting vasopressors should that become necessary. She did not know when symptoms started. Her chest x-ray shows possible pneumonia. Procalcitonin ordered at the time of admission. Antibiotics held pending results. Some concern for AKI versus CKD. Will bolus 500ml NSS but hold on additional IV fluids at this time as her blood pressure is good and she does not appear overly dry. We will titrate oxygen to keep O2 Sats over 92%, wean as tolerated. Convalescent plasma not ordered at the time of admission as I could not confirm onset of symptoms. Patient required 2 L of oxygen on admission. She received dexamethasone and Remdesivir. She tolerated medical management well and was able to be weaned off of oxygen. Her AKI most likely secondary to fluid volume depletion and resolved with IV fluids. Her vitals remained stable and her inflammatory markers were improving. She was discharge back to assisted living facility and provided a prescription for dexamethasone 6 mg for 7 days to finish the 10 day course treatment. Assisted living facility updated on discharge plan including scheduling follow-up with her PCP in 3-5 days, day were agreeable.


VAERS ID: 1700582 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Oropharyngeal pain, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: Neoral, urso, Carvadol, garlic
Current Illness: no
Preexisting Conditions: Liver transplant ,Right lung missing
Allergies: codeine, sulfa precordia narvase Iv Dyes
Diagnostic Lab Data: no
CDC Split Type:

Write-up: Swollen arm Extremely sore throat


VAERS ID: 1700591 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Pharmacy       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: Did not leave my house or see anybody 3 days before vaccine shot on Friday. Nor left my house the day of or the Saturday + Sunday after shot. COVID-19 symptoms started Sunday, 2 days after shot. COVID-19 tested positive on Monday.


VAERS ID: 1700625 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Rash macular, Skin warm, Swelling of eyelid
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: This employee received a Moderna covid-19 vaccine 9/10/21. Today presented with patchy red blotches and warm to the touch site on right deltoid. Injection site clear. Also complains of right shoulder pain. Also complained of fatigue. Said he woke up with what he thought might be conjunctivitis 2 days later and eyes swollen shut. He has been taking Ibuprofen for the symptoms. No complaints of nausea vomiting or diarrhea or respiratory difficulty. He had covid-19 11/2020. Assessment. Vital signs stable. We will continue to follow this employee until his condition is resolved. A Medical Exception Letter to be done Per MD and forwarded to Employee health Nurse.


VAERS ID: 1700666 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-26
Onset:2021-09-11
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH: Arthritis, CAD, DM II, Glaucoma, HTN, MI x 5, Afib, vertigo
Allergies: Uncertain
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized on 9/11/21 - due to SOB, loss of taste, and difficulties breathing


VAERS ID: 1700667 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: two days of chills and fever and three days of headaches, dizziness and fatigue. symptoms are improving except for lingering dizziness.


VAERS ID: 1700669 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-01
Onset:2021-09-11
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SC

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Decreased appetite, Diarrhoea, Disturbance in attention, Malaise, Pain, Pain in extremity, Tinnitus, Vision blurred
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Hearing impairment (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (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: Influenza, 32 years old, hives, redness to face
Other Medications: Flagyl
Current Illness: Bacterial vaginosis, yeast infection
Preexisting Conditions: Na
Allergies: Influenza vaccine, amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Malaise lasting over 6 days, decreased appetite, arm pain, body aches, abdominal pain, diarrhea, blurred vision, ringing in the ear, difficulty concentrating


VAERS ID: 1700675 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Headache, Muscle spasms, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu shot neck/throat swelling fall of 2014 Tdap abscess formed over vaccine site in 2016
Other Medications: None
Current Illness: None
Preexisting Conditions: Benign liver tumors
Allergies: Latex, sulfa, penicillin, cephalosporins, flu shot, Tdap
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever, ibuprofen to treat, onset 3 days post vaccine lasted for 24 hours Body aches, ibuprofen, onset less than 24 hours, not completely resolves Muscle cramps/Charlie horses, rest, onset 6 hours and resolves in 24 hours Left side pain under ribs (spleen area), ibuprofen to reduce pain, ongoing and worsened since 48 hours post vaccine Headache, ibuprofen, onset 48 hours and ongoing


VAERS ID: 1700728 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D31A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Headache, Migraine, Pyrexia, Tinnitus
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hearing impairment (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: Nothing
Current Illness: nothing
Preexisting Conditions: Nothing at the time
Allergies: Shellfish
Diagnostic Lab Data: Called my doctor and they said go to ER. Unable to go due to my young children
CDC Split Type:

Write-up: Intense Headache from shot #1 on August. Sight impairment and ringing in ears, headache/migraine for 3 days. Fever of 103 post shot.


VAERS ID: 1700769 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Breast pain, Injection site erythema, Lymphadenopathy, Pain in extremity, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Lipodystrophy (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: B complex, alprazolam, allergy medication, stress essentials balance, Vitamin D, Bi-est, famotidine, fiber, folic acid, levothyroxine, methotrexate, metoprolol tartrate, prazosin, probiotic, progesterone, Ventolin inhaler
Current Illness: None
Preexisting Conditions: Psoriatic arthritis, Hashimoto''s hypothyroidism, GERD, ADHD, PTSD, sleep apnea
Allergies: Latex, PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, swollen arm, swollen lymph nodes, arm pain, breast pain, redness to site. Start on Clindamycin 300 mg 4x daily.


VAERS ID: 1700792 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Dizziness, Electric shock sensation, Fatigue, Lacrimation increased, Nausea, Pain, Sleep disorder
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Lacrimal disorders (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Got sick after flu shot many years ago.
Other Medications: aspirin (81mg), atorvastatin/Lipitor (20mg), bee pollen, Men 50+ multivitamin, vitamins c & d, zinc, Prilosec
Current Illness:
Preexisting Conditions: asthma (although not active), occasional heartburn, abdominal pain from scar tissue from kidney removed in 2016.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I woke up several times in the night of the vaccine and had pretty bad pain in my knees and other joints. This pain was twice as bad as normal joint pain an almost 63 year old has. Additionally and strangely, I had either shooting pains, continuous dull pains or burning pains everywhere I have scar tissue (kidney removal (2016), hernia (2012?) and laser/cryo surgery on my right eye (2012?) which was in pain and watering profusely around 4:30). I had a couple of bouts of nausea around 3:00 and 5:30. Finally, when I got up at 5:30 and 7:30, I had what I call "brain-zaps", which I remember from when I was withdrawing from Cymbalta at the time of my kidney surgery. These are called brain-zaps because they feel like an electric shock to your brain that zings you and makes you lightheaded. It''s like this thing recognized and went after every medical "vulnerability" I had, very strange. I then was light-headed all day on the day following the vaccine. Then three days later after swimming 20 laps in our pool, I again became light-headed and was fatigued the following day. I am writing this the day after my swim, so unsure on how long this will continue.


VAERS ID: 1700808 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301B08A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Headache, Hot flush
SMQs:, 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: Influenza, (estimated 4yrs ago) Flu +
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states that after receiving the 1st dose of Phizer 09/11/2021, started experiencing symptoms of weakness, headaches, and hot flashes. Still continuing to experience symptoms.


VAERS ID: 1700841 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Back pain, Cough, Diarrhoea, Fatigue, Feeling abnormal, Feeling hot, Headache, Musculoskeletal chest pain, Oral discomfort, Pain, Paraesthesia oral
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (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: 2005 Flu shot
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: The first day it was upset stomach and diarrhea, tired and hazy and awful headache. The next day it was tired and headache. Then second night and third day body aches, my body feels on fire but no fever and head hurts tired dazed. Fourth and fifth day rib and back pain, cough, tongue and lips feel weird.


VAERS ID: 1700851 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-09
Onset:2021-09-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Depressed level of consciousness, Fall, Mental status changes
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Altered mental status, difficult to arouse, fall.


VAERS ID: 1700889 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

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

Write-up: Fever Fatigue Body aches Swollen and red arm ( this has continued into. Day 5)


VAERS ID: 1700920 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-08
Onset:2021-09-11
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blister, Burning sensation, Dry skin, Paraesthesia, Peripheral swelling, Skin discolouration, Skin exfoliation, Tenderness
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 81mg asperin as per my PCP
Current Illness: none
Preexisting Conditions: none
Allergies: N/A
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Finger tips on both hands present as tingling an swollen. All ten finger and thumb tips are tender to touch. Skin appeared dry and flaking on the first morning. since that day they appear to look blistered and white. the tingling has continued to present time. Finger tips feel as though they were burnt and are now in a healing process. DR. advised the use of Ibuprofen or asperin when contacted.


VAERS ID: 1700928 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Back pain, Decreased appetite, Diarrhoea, Fatigue, Headache, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: sore arm, nauseous, diarrhea, fatigue, loss of appetite, lower back pain, upper thigh muscle ache, mild headache, joint pain


VAERS ID: 1701108 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event, Pain in extremity, Product preparation error
SMQs:, Tendinopathies and ligament disorders (broad), Medication errors (narrow)

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

Write-up: Patient was given the entire vial of the undiluted Pfizer Covid vaccine. I spoke with the patient and he stated that he only had a sore arm on 9/11/21. He has no other adverse effects.


VAERS ID: 1701113 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram, Headache, Metabolic function test, Vaccine positive rechallenge
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Chest pain following Pfizer dose #1
Other Medications: ibuprofen, albuterol inhaler
Current Illness: - Chest pain, unspecified type - Chronic bilateral low back pain without sciatica - Morbid obesity, concerned OSA Pickwickian syndrome - Lower back pain likely muscle strain vs spondylosis no red flags associated including motor or sensory loss - Costochondritis - SOB (shortness of breath)
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data: POCT ECG ordered for same day - Comprehensive metabolic panel; Future - Hemoglobin A1c; Future - Troponin I; Future - CBC (includes DIFF/PLT); Future - Lipid panel; Future - C-reactive protein; Future - Sedimentation rate, automated; Future
CDC Split Type:

Write-up: 21 year old male presented for second dose Pfizer developed chest pain within 15 mins of vaccination that escalated to headache in addition to chest pain within the following 5 mins.


VAERS ID: 1701295 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-10
Onset:2021-09-11
   Days after vaccination:124
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Condition aggravated, Left ventricular failure, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen PRN, aripiprazole, bisacodyl EC, Advair diskus inh, furosemide, hydrocortisone cream PRN, polyethylene glycol 17gm packet, propylthiouracil, simethicone PRN, Ventolin HFA inh, vitamin B complex
Current Illness:
Preexisting Conditions: obesity, obstructive sleep apnea, chronic hypoxic/hypercarbic respiratory failure, heart failure preserved ejection fraction, schizophrenia
Allergies: Chlorpromazine, guaifenesin, penicillin
Diagnostic Lab Data: COVID status positive 9/11/21.
CDC Split Type:

Write-up: Patient was vaccinated with Janssen COVID vaccine on 5/10/21. On 9/11/21, patient was admitted to our facility with COVID-19 pneumonia, acute on chronic hypercabic respiratory failure triggered by COVID-19 pneumonia, and acute on chronic exacerbation of diastolic heart failure. As of 9/15/21, patient is still admitted in the med/surg unit.


VAERS ID: 1701317 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 LA / IM

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

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

Write-up: Red rash/itching on arm of vaccine...patient doing ok, treating with antihistamines and topicals


VAERS ID: 1702855 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Dysarthria, Dysgeusia, Eye disorder, Facial paralysis, Musculoskeletal discomfort, Paraesthesia, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Taste and smell disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Corneal disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hearing impairment (broad), Hypoglycaemia (broad)

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

Write-up: Facial Paresthesia, metal taste in mouth, LUQ pain and neck swelling/discomfort, left side facial droop, eyes close bilaterally, slurred speech.


VAERS ID: 1703945 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-11
Onset:2021-09-11
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abnormal loss of weight, Asthenia, Fatigue, Nausea, Paraesthesia, Tachycardia
SMQs:, 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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Dehydration (broad)

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

Write-up: he patient presents with 58-YEAR-OLD FEMALE HISTORY OF CHRONIC ALCOHOLISM, MELANOMA PRESENTS TO EMERGENCY DEPARTMENT WITH MULTIPLE COMPLAINTS. STATES APPROXIMATELY 5 MONTHS AGO SHE RECEIVED HER JOHNSON & JOHNSON CORONAVIRUS VACCINE AND SINCE THAT TIME HAS FELT FATIGUED WITH LITTLE ENERGY. STATES SHE ALSO HAS UNEXPECTED WEIGHT LOSS OF ABOUT 20 LB SINCE THIS YEAR. SHE SAW A DOCTOR AT THE CLINIC THIS MORNING WHO REFERRED HER TO THE EMERGENCY DEPARTMENT. STATES SHE DRINKS VODKA DAILY AND HAS BEEN CUTTING BACK TO 2 SERVINGS PER DAY. STATES SHE HAS TINGLING IN HER BILATERAL HANDS AND FEET AND FEELS NAUSEATED. NOTED TO BE TACHYCARDIC UPON ARRIVAL. HER DOCTOR SENT HER WITH A LETTER RECOMMENDING INPATIENT ALCOHOL DETOX. SHE DENIES ANY CHEST PAIN OR SHORTNESS OF BREATH, NO NECK PAIN OR STIFFNESS. NO AUDITORY VISUAL HALLUCINATIONS. NO BLACK OR BLOODY STOOLS. NO HEMATEMESIS OR ABDOMINAL PAIN.. The onset was chronic. The course/duration of symptoms is fluctuating in intensity. Location: SEE HPI. The character of symptoms is SEE HPI. The degree at onset was moderate. The degree at present is moderate. Risk factors consist of SEE HPI. Therapy today: see nurses notes. Associated symptoms: denies chest pain, denies headache and denies back pain. .


VAERS ID: 1703947 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Virgin Islands  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / SYR

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

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

Write-up: Continuous Headaches. Taken Tylenol


VAERS ID: 1703979 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-09
Onset:2021-09-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: bystolic, lisinopril, crestor mulitvivtamins, cranberry probiotic
Current Illness: surgical removal of ovarian tumor. Angiomyolipoma renal
Preexisting Conditions: hypertension
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: red warm swollen itching at injection site and surrounding arm area. Appeared 48 hours post injection. This was third dose. No such reaction with doses 1 or 2.


VAERS ID: 1704003 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-02
Onset:2021-09-11
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abortion spontaneous, Blood test, Maternal exposure before pregnancy, Ultrasound scan
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), 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:
Current Illness:
Preexisting Conditions:
Allergies: Sulfa allergy
Diagnostic Lab Data: Hcg blood test 9/13/21 Ultrasound 9/13/21
CDC Split Type:

Write-up: Miscarriage; tested positive for pregnancy on 9/4/21 and 9-9/21. Began cramping and bleeding 9/11/21, miscarriage confirmed 9/13/21.


VAERS ID: 1704009 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Fall, Hyperhidrosis, Incoherent
SMQs:, Neuroleptic malignant syndrome (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Low grade temperature the day after. 38 hours after pt. collapsed and was not coherent for a short period of time. After I was able to lay here down she was noticeably sweating on her face and body. We had her pulse taken by an EMS worker who was at the event the time of occurrence.


VAERS ID: 1704027 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Pain, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Within a minute after I had the vaccine, I had prickling feelings all over. I had big aches. Body aches and joint aches. I had pain that was in the arm and chest area. The more severe lasted a couple of hours while I was driving. What worries me is that they said side effects are more severe with the second dose than with the first dose. I really don?t want to experience something worse than what I had with the first one. I might have a better result with the Moderna. I was unvaccinated until the 9/11/2021 and I have not have Covid. I have followed all the guidelines and I have not gotten Covid. So getting the vaccine isn?t really much for me as it is for other people. I am worried to see that it works for me and if I cant get somebody to listen to me about this, I would not rather have another Pfizer vaccine, I would rather have the Moderna vaccine but if I can?t, then I will not get the second Pfizer vaccine. I will go to the doctor today because my PCP does not accept my insurance so I am going to another one. I have only called the pharmacies and doctor''s offices and nobody has helped me.


VAERS ID: 1704062 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site reaction, Pain, Pain in extremity, Rash, Rash macular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 9/10/2021- Headache, arm pain 9/11/2021- Headache, arm pain, body aches, fatigue, red splotches below injection site. 9/12/2021- Headache, red splotches below injection site 9/13/2021- Headache, red splotches increasing below injection site ( 3 large areas) 9/14/2021- Rash developed under arms and initial 3 large areas increased redness. 9/15/2021- rash spread all over body 9/16/2021- Rash still spreading over body and initial 3 large areas are still present.


VAERS ID: 1704171 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Injected limb mobility decreased, Injection site pain, Vaccine positive rechallenge
SMQs:, Extravasation events (injections, infusions and implants) (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: Synthroid 75 mg and Estrogen-Methyltestosterone Hs
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: Physical Therapy started 8/23/2021
CDC Split Type: vsafe

Write-up: It''s chronic pain in my left shoulder and it goes down into my elbow. The pain into my elbow started this morning 9/16/2021. The pain has gotten a lot more intense. I can''t do anything with it. I alter heat and ice on the area. I started physical therapy in August from the first shot. I didn''t connect the symptoms between the two doses until I got the second vaccine. I notice the exact same symptoms.


VAERS ID: 1704195 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-09
Onset:2021-09-11
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PCR Covid-19 positive on 9/11
CDC Split Type:

Write-up: Patient is fully vaccinated on 1/09/2021 with Pfizer and contracted COVID, tested positive on 9/11/2021.


VAERS ID: 1704268 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-06
Onset:2021-09-11
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Pain in extremity, Paraesthesia, Sensory disturbance
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Tendinopathies and ligament 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? No
Hospitalized? No
Previous Vaccinations: influenza vaccine
Other Medications:
Current Illness: none
Preexisting Conditions:
Allergies: influenza vaccine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain in both thighs, altered sensation both lower legs, and slight numbness/tingling both feet lasting 2 days


VAERS ID: 1704276 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-13
Onset:2021-09-11
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abscess limb, Cellulitis, Full blood count, Metabolic function test, SARS-CoV-2 test
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PTSD, chronic back pain, drug dependence
Allergies: NKDA
Diagnostic Lab Data: CBC, CMP, rapid COVID
CDC Split Type:

Write-up: abscess left thigh, cellulitis, given antibiotics


VAERS ID: 1704294 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-03
Onset:2021-09-11
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

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

Write-up: breakthrough case, hospitalization


VAERS ID: 1704299 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-01-23
Onset:2021-09-11
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Computerised tomogram abdomen, Dysuria, Full blood count, Metabolic function test, Pyrexia, SARS-CoV-2 test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amitiza, amlodipine, aripiprazole, benztropine,cerovite, chlorpromazine,eucerine,ferrous sulfate, fluticasone, furosemide,loratadine,potassium prednisone, singulair
Current Illness:
Preexisting Conditions: CKD, anemia, CHF, HTN,
Allergies: haldol, penicillin
Diagnostic Lab Data: CBC, CMP, CXR, rapid COVID, CT abdomen
CDC Split Type:

Write-up: fever, dysuria


VAERS ID: 1704315 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-09
Onset:2021-09-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema
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: losartan 50 mg , anastrozole 1mg
Current Illness: no
Preexisting Conditions: Breast Cancer cleared in July High Blood Pressure
Allergies: Vicodin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Red outline from vaccine site down arm about 10 inches


VAERS ID: 1704326 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Condition aggravated, Injection site erythema, Injection site pain, Injection site reaction, Injection site swelling, Nausea, Pain, Pyrexia, Rash, Rash pruritic, Skin warm, Vomiting
SMQs:, Anaphylactic reaction (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), 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: Same/Similar reaction to 1st injection on 8/13/2021
Other Medications: Wellbutrin Levothyroxine Doxycycline
Current Illness: Illness from 1st Moderna Covid vaccine which was 8/13/2021
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Approx 8 hours after injection I woke with fever, chills, body aches, nausea and vomiting. I ran a fever for approx 36 hours. Pain, redness and swelling around injection site (approx 3"x3" area) also warm to the touch. An itchy rash has developed around the injection site 6 days after injection. It is also sore and warm to the touch.


VAERS ID: 1704331 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-04
Onset:2021-09-11
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None Documented
Current Illness: None documented
Preexisting Conditions: Genital prolapse and carpal tunnel syndrome
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated 9/11/2021 - Cough congestion, and fatigue


VAERS ID: 1704407 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: New York  
Vaccinated:2021-01-06
Onset:2021-09-11
   Days after vaccination:248
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose12/19/20 2nd dose 01/06/21 Diagnosed covid positive:09/12/21 Symptom onset:09/11/21 Exposure: Symptoms:


VAERS ID: 1704422 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Chills, Dyspnoea, Fatigue, Feeling abnormal, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

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

Write-up: Patient came to pharmacy indicating after the first dose of MODERNA COVID vaccine was administered Friday 10/09/2021 the next day she started to feel bad with fatigue, chills, nausea, chest pain and needed air. She went to the hospital for care and was given oral pump.


VAERS ID: 1704538 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-03-15
Onset:2021-09-11
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Decreased appetite, Headache, Nasopharyngitis, Pyrexia, SARS-CoV-2 test positive, Throat irritation
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril - 40mg/1xday Atenolol - 50mg/1xday Multivitamin - 1xday
Current Illness:
Preexisting Conditions: High Blood Pressure Chronic Migraines
Allergies: Sulfa medications
Diagnostic Lab Data: covid test - positive
CDC Split Type: vsafe

Write-up: I got a scratchy throat and my head started to hurt. I spiked a fever. This was about 4 days after my son was diagnosed with Covid. He lost his taste and smell, but I did not. I pretty much have just been laying low and chilling out. I have been taking cough medicine and Tylenol for the headache and fever. The fever stopped about 3 days in. It just feels like a bad cold. I have been trying to stay hydrated and I have not really had an appetite. I have had sinus infections that are worse than this. I went to the urgent care center and my test came back negative. I went to pharmacy the next day to get my test redone and that one came back positive.


VAERS ID: 1704606 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Injection site pain, Lymph node pain, Pain, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (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: none
Current Illness: nothing
Preexisting Conditions: none
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: On the day of vaccination, groggy and very tired, pain at lymph nodes of arm and under armpit, pain at injection site, throbbing and radiating, to lymph nodes and elbow and wrist. Felt chills on the first day. Pain at lymph nodes continued 4 days post vaccination. Patient is starting to feel better on day 5


VAERS ID: 1704703 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Vulvovaginal mycotic infection
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: Atrovent nebulizer treatment and inhaler, singular, nexium, Trulance, Tylenol, promethazine, melatonin, benadryl.
Current Illness: Only chronic illnesses.
Preexisting Conditions: Cirrhosis, restrictive lung disease, rheumatoid arthritis, black bleeding ulcer.
Allergies: Morphine, Albuterol, NSAIDs, sulfa drugs,
Diagnostic Lab Data: I did not receive any testing at this time, but may need to if this doesn''t clear up after I finish my medication.
CDC Split Type:

Write-up: I developed a vaginal yeast infection that is difficult to treat. My boyfriend also developed a yeast infection, but we had not had sexual intercourse in months, so intercourse did not what cause our infections and we both had the same shot on the same day.


VAERS ID: 1704755 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Fungal infection, Penile erythema, Penile swelling, Pruritus genital
SMQs:, Angioedema (broad), Hypersensitivity (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lasix, carvadilol, avrostatin, Xarelto, clonopin, effexor, Albuterol inhaler.
Current Illness: None
Preexisting Conditions: Congestive heart failure, kidney disease, hypertension, diverticulitis, hiatal hernia.
Allergies: None
Diagnostic Lab Data: I didn''t have any testing yet, but I will need it if this doesn''t go away soon. I''ve never seen a yeast infection that took this much medicine and still haven''t got rid of it yet.
CDC Split Type:

Write-up: I started itching and having a little redness on my penis the following evening after receiving the vaccine, then by the next day It was itching and continued to get worse, and now it''s swollen too. My doctor called me in medication for a yeast infection, but it didn''t help it, I had taken 2 rounds of medicine for it, and today they had to call in more medicine for it because it doesn''t want to go away and I am sure it''s from the 2nd Covid vaccine I received, how I know is because my girlfriend got the yeast infection too, but we hadn''t had sex in months, so sex didn''t cause it. And my girlfriend got the shot the same day I got mine, so now we both have a infection from it


VAERS ID: 1704791 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-09
Onset:2021-09-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 2 LA / IM

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

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

Write-up: left arm turn red a streak down front of her arm


VAERS ID: 1704803 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-01
Onset:2021-09-11
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood ketone body, Chest X-ray, Electrocardiogram, Electrocardiogram ambulatory, Hyperhidrosis, Inflammatory marker test, Night sweats, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Armour Thyroid 60mg Lisinopril 25mg/12.5mg Venlafaxine 150mg
Current Illness: NONE
Preexisting Conditions: Hypertension
Allergies: NONE
Diagnostic Lab Data: EKG CHEST XRAY LABS (BH, RA MARKERS) HEART HOLTER MONITER
CDC Split Type:

Write-up: EXTREME NIGHT SWEATS (OCCURRED DURING DAY ALSO) HEART PALPITATIONS


VAERS ID: 1704832 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-08
Onset:2021-09-11
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pericarditis which resulted in urgent care, ER, and cardiologist visits. Treating with NSAIDs. No change in outcome yet.


VAERS ID: 1704972 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3014I8A / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Hypersomnia, Kidney infection, Laboratory test abnormal, Pain, Pain in extremity, Renal pain, Somnolence, Tenderness, Vaccination complication
SMQs:, Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Tendinopathies and ligament disorders (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: Gabapentin, Xarelto blood thinner, baclofen muscle relaxer, ibuprofen, furosemide for water retention, metformin for pre diabetes.
Current Illness: Normal leg pain from the nerve damage.
Preexisting Conditions: DVT right leg, Asthma, Lower back pain (had surgery a few years ago and I have nerve damage).
Allergies: Shellfish, clams, Cats, Wellbutrin.
Diagnostic Lab Data: Kidney Infection Test
CDC Split Type: vsafe

Write-up: When I got the vaccine I was fine until the next morning when I woke up and I didn?t feel too bad and was just sleepy and achy but mostly sleepy. I woke up at 10 AM and I went and had breakfast and then went back to bed and slept until 3:30PM. My arm was sore but just achy and if you touch it, it hurt but I went right back to bed and slept until 10 PM. I then got up and took a shower, went back to sleep. Next morning I got up and did the same thing but I was able to get up and do what I had to do and I drank a lot of water. Saturday and Sunday was the same thing. Monday I was supposed to work up at 7 but I didn?t get up until 10 AM. I ended up going to the Doctor with back ache and I figured it was from sleeping so much. I ended up having a kidney infection and she said it was probably from the shot and it would go away and as of today (09/16/21) it has went away. It was hurting last night but not excruciating. Each day got better and I''ve been drinking a lot of water and kept moving. Sleepiness went away Monday afternoon (09/13/21). My body ached a little bit but I wasn?t sure if it was because I was sleeping so much.


VAERS ID: 1704989 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Blood pressure increased, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: flu allergic to eggs
Other Medications: Synthroid asprin 81m triamterene hydrochlorothiazide gluclosimin holy basil vitamin D
Current Illness: no
Preexisting Conditions: hyperthyroidism
Allergies: Eggs sun flower seed penicillin ampicillin
Diagnostic Lab Data: no
CDC Split Type:

Write-up: Facial tingling that has continued .Left arm join pain and elevate blood pressure.


VAERS ID: 1704998 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Acoustic stimulation tests, Deafness unilateral, Sudden hearing loss
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lyconpril 10mg
Current Illness: none
Preexisting Conditions: High Blood pressure
Allergies: none
Diagnostic Lab Data: Hearing in right ear tested on 9/15/2021.
CDC Split Type:

Write-up: Sudden and almost complete hearing loss in the right ear. Currently being treated with direct injections of steroids to the ear.


VAERS ID: 1705010 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-14
Onset:2021-09-11
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Tested positive after vaccination


VAERS ID: 1705021 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-02
Onset:2021-09-11
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

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

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

Write-up: Tested positive for COVID only 10 days after 1st dose


VAERS ID: 1705262 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 RA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Blood test, Burning sensation, Chest discomfort, Chest pain, Dyspnoea, Electrocardiogram, Fatigue, Gait disturbance, Hypoaesthesia, Laboratory test, Limb discomfort, Lymphadenopathy, Pharyngeal swelling, Uterine pain
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None.
Preexisting Conditions: None.
Allergies: None known. I''ve never had an allergic reaction to any medicine or vaccine.
Diagnostic Lab Data: Vitals taken - 9/11 Vitals, EKG, Oxygen level, BP, HR, lots of lab tests-blood drawn - 9/11
CDC Split Type:

Write-up: Initially, my only symptom was a burning sensation up and down my right arm. After the 15 minute observation period, I left the clinic and drove to my office. As I drove to my office I started experiencing minor "numbness" in my left arm, left shoulder, and left side of my chest. Within a few minutes of arriving in my office, I had to leave and walk to a meeting. As I was outside walking to the meeting I started feeling chest pain, fatigue, a pounding in my chest, and breathing felt "heavy." I arrived a little out of sort to my meeting and was advised to go back to the clinic. While sitting at the meeting my symptoms lessened. When walking back to my office the symptoms became stronger. I was asked if I was okay to drive and I was; I quite literally felt 100% conscious and able. Upon returning to the clinic, I asked to speak with a doctor about my side effects. The doctor checked my vitals and asked how I was feeling. By this point I had commenced feeling a numbness in my extremities, walking felt heavy--like I had to consciously think about picking up my feet--walking felt laborious. Thus, even though all I wanted to do at the moment was lie down?as my fatigue had significantly increased?I answered the doctor?s questions and fully planned on returning to work after she checked me. My vitals were within normal range and so after the doctor told me severe allergic reactions to lookout for and reasons I?d need to go to an ER, she advised me to go home and rest. She worried that I didn?t have anyone that could drive me home, or another adult in the home to observe me for the next few days. I assured her I would figure out a plan. Leaving the clinic and walking to my car I was short of breath, and still experiencing the other symptoms. As I drove back to my office from the clinic, I started feeling a swelling on the left side of my throat. As I touched my throat I could tell it was swollen and felt the glands swollen. I touched the right side of my throat and it felt normal. I communicated these symptoms to my leadership at work and was dismissed for the day. My boss offered to drive me home but I felt bad asking this of her since I live an hour away. Even though I was experiencing all these symptoms I felt completely conscious and able. Of course, I wasn?t at my prime but I felt strong/aware enough to sit in a car and steer/push the pedals/react. It?s important to note I?m a single mother. My son only has me. My getting sick/being hospitalized/etc., are not options. I willed myself to get it together and overcome these symptoms.? Of course, at the time I wasn?t aware I was having an allergic reaction to the vaccine. I simply thought this was my immune system?s response to some component of the vaccine and that it would be over soon. Another symptom that I experienced intermittently throughout the day was pain on the left side of my uterus. I do not experience cramping/menstrual pains, and thus this was out of the norm for me. Regardless, I made it home to my son that night and rested. Resting decreased the symptoms. The only new symptom I experienced that night was a burning sensation at the heel of my hand when I leaned on my desk, and rested weight on my hand. The swelling of the left side of my throat and glands went away within 2 hours of onset. This was quite abnormal for me. Sunday morning I woke up with the same feeling of a weight on my chest, chest pain, shortness of breath when doing any activity?even blow-drying my hair. I contacted a cardiologist and he suggested I go to an ER and get a full evaluation and documentation. Which I did. When I initially arrived at the ER I was out of breath from simply walking from my car to the ER. I had to catch my breath continuously to answer all the questions asked during the registration process. I was out of breath and feeling chest pains as I sat on the bed at the ER. I opened up a breathing exercise video and focused on my breathing, and regaining control of my body. My breathing returned to normal within 2 hours of sitting on the bed at the ER. The ?final? EKG at the ER looked great according to the doctor and I was discharged after 4 hours. I was given specific instructions of signs to look for/reasons to return to the ER. To this day I continue to experience minor chest pain and shortness of breath/feeling of fatigue, which increases when walking around and doing normal activities. My plan is to work with a doctor to figure out which component of the vaccine I?m allergic to. I will also continue to get evaluated if these symptoms don?t go away. I?m really hoping they do though.


VAERS ID: 1705282 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-09
Onset:2021-09-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 9XX32 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Diarrhoea, Feeding disorder, Malaise, Musculoskeletal discomfort, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (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: quetiapine, buspirone, sertraline, gabapentin
Current Illness: none known
Preexisting Conditions: bipolar, active drinker and smoker
Allergies: no known allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pt received Moderna dose one as well as Fluarix (flu shot) on Thursday, Sept 9 at around 6 pm. On or around Saturday, patient experienced diarrhea and chest tightness, overall ill feeling. He reports feeling hungry or "empty" inside, but can not seem to eat and must take tylenol or motrin to function. Pt also reports poor sleep, as chest/back pain keeps him up. He continued to have this chest/lung/back tightness on and off for about a week, then returned to pharmacy today (9/16/21) to report symptoms. Symptoms continue. Pharmacist recommended seeing family doctor or going to ER if family doctor can not be reached.


VAERS ID: 1705285 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oropharyngeal blistering, Oropharyngeal pain, SARS-CoV-2 test negative
SMQs:, Severe cutaneous adverse reactions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: Erythromycin
Diagnostic Lab Data: Retail clinic visit and COVID test on 9/16/21 - negative.
CDC Split Type:

Write-up: sore throat started a few hours after injection. worsening sore throat with blistering in posterior pharynx on night 5 after vaccine. Resolved by day 6.


VAERS ID: 1705486 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Peripheral swelling, Pruritus, Swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), 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: non stated
Current Illness:
Preexisting Conditions: dm,htn
Allergies: penicillin, rosuvastatin, vicodin, sulfametoxazole
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: arm swollen from elbow down to wrist(started 09/11/2021 and still present til present 09/16/2021). itching was present for couple of days (from 09/11/2021) but subsided. the swelling has gone down a bit; but from wrist to elbow on left arm swelling still present. pt advised to speak to pcp about any potential necessary treatment.


VAERS ID: 1705494 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Condition aggravated, Decreased appetite, Diarrhoea, Discomfort, Fatigue, Feeling of body temperature change, Headache, Impaired work ability, Injection site pain, Injection site swelling, Injection site warmth, Migraine, Nausea, Pain, Sleep disorder
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Noninfectious diarrhoea (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: levothyroxine; Wellbutrin; Prozac; Xanax; vitamin d; loratadine; women''s multivitamin; biotin; melatonin; Singulair; Fish Oil; magnesium; Riboflavin; Maxalt PRN for migraines
Current Illness: none
Preexisting Conditions: hypothyroidism; depression; anxiety; vitamin d deficiency; allergies; migraines
Allergies: dust, pollen, mold, grass
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I am not sure what is important, so I am going to try to describe everything I can remember from the last few days. I received my second vaccine last Saturday. After receiving the second vaccine I initially only had some soreness at the injection site. As the day progressed I began feeling increasingly fatigued, the injection site was more painful, and I began to get a headache. I went to bed around 10pm. I woke up several times throughout the night with either cold chills, or hot sweats, and body aches (my head continued to hurt). The next day (Sunday) I continued to have body aches, fatigue, nausea, headache, pain around the injection site, feeling weak, and discomfort under my left armpit. The area around the injection site felt swollen and hot to the touch. By the next day (Monday) I continued to feel nauseated, I had diarrhea, my head continued to hurt, and my arm continued to hurt and feel hot around the injection site. The following day, which was a Tuesday, I had a severe headache that developed into a migraine; I believed the side effects of the vaccine triggered a migraine. I felt nauseated, but this was likely due to the migraine itself. I continued to feel really tired, and did not have an appetite. The injection site still felt warm to the touch. I was out of work on Monday and Tuesday. I did return to work Wednesday, but I continued to feel fatigued, weak, and nauseated, as well as had a moderately bad headache (not migraine level). Today is Thursday and I finally feel back to normal.


VAERS ID: 1705678 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chest pain, Diarrhoea, Dyspnoea, Fatigue, Glossodynia, Headache, Heart rate increased, Immediate post-injection reaction, Lip pain, Muscle spasms, Nasal congestion, Nausea, Pain, Palpitations, Paraesthesia, Paranasal sinus discomfort, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediately after injection, I had tingling in my left arm and hand. That night, I had tingling and pins and needles throughout my entire body. The next day on 9/11 and getting progressively worse on 9/12, I had rapid heart beat and chest pains, shortness of breath , a severe headache, fatigue, nausea, diarrhea, cramping, extreme runny nose, congestion, sinus pressure, body aches, weakness, and shooting pains throughout my body. I had strange pains in my tounge and lips. I went to urgent care on 9/12 and they said my heart rate was high. They said they have seen many terrible side effects similar to mine and to take Tylenol and drink water and follow up with primary care doctor. My symptoms continued through 9/13 and 9/14 and some began subsiding. However, I still have chest pressure and pain, rapid heart beat and palpitations, and shortness of breath. I also still have fatigue and headaches. I am terrified about my heart because heart disease runs in my family. I am following up with my primary care doctor tomorrow, 9/17. I was mandated to get the vaccine by my work.


VAERS ID: 1705914 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymphadenopathy, Vaccine positive rechallenge
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: Pfizer vaccine, 08/20/21, swollen left lymph node near collarbone
Other Medications: Fenofibrate
Current Illness:
Preexisting Conditions: IBS
Allergies: Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extremely enlarged/swollen left lymph node near collarbone. Did not want injection in right arm because I had a nerve conduction test of my right arm/hand scheduled for 09/16/21.


VAERS ID: 1705921 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Feeling hot, Respiratory rate increased
SMQs:, Hypoglycaemia (broad)

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

Write-up: Systemic: anxiety pt stated they were very hot and had rapid breathing-Mild, Additional Details: patient was given an ice pack and water and calmed down and had few issues


VAERS ID: 1705923 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Hyperhidrosis, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Flushed / Sweating-Severe, Systemic: Nausea-Medium, Additional Details: Patient got nauseous and sweaty while in post vaccination area. I had him lay down and put his feet up for about 15 minutes. After a few minutes of laying down he drank some orange juice he had with him. Felt better/back to normal after.


VAERS ID: 1705924 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD4884 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Fatigue, Flushing, Hyperhidrosis, Hyperventilation, Lethargy, Loss of consciousness, Malaise, Seizure, Syncope, Throat tightness, Tremor, Unresponsive to stimuli, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Mild, Systemic: Confusion-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Mild, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Hyperventilation-Severe, Systemic: Seizure-Mild, Systemic: Shakiness-Medium, Systemic: Visual Changes/Disturbances-Medium, Additional Details: Pt didn''t feel good, 5 mins post vaccine. She was talking on the phone when we overheard her not feeling well. She passed out and woke up after 10 seconds. Juice and water was provided. She felt visual distrubances that recovered after 5 mins. Pt reported tightness of her throat with NO difficulty breathing, 2 tabs of benadryl was given. Pt was okay after 20 mins. Pt smelled strongly of marijuana.


VAERS ID: 1705925 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Hyperhidrosis, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Systemic: had slight panic attack-Mild, Systemic: Flushed / Sweating-Mild


VAERS ID: 1705927 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dyspnoea, Neck pain, Pruritus, Rash, Rash macular
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Systemic: Allergic: Difficulty Breathing-Severe, Systemic: Allergic: Itch (specify: facial area, extremeties)-Medium, Systemic: Allergic: Itch Generalized-Medium, Systemic: Allergic: Rash Generalized-Medium, Systemic: Chest Tightness / Heaviness / Pain-Severe, Additional Details: Pt states that she has blotches all over her body, experiencing neck pain and chest felt heavy.


VAERS ID: 1705930 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Hypotension, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Hypotension-Severe, Systemic: Nausea-Severe, Systemic: Weakness-Severe


VAERS ID: 1705933 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Flushing, Hyperhidrosis
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Allergic: Difficulty Breathing-Severe, Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Mild, Additional Details: Lasted a few minutes and then patient felt normal


VAERS ID: 1705934 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

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

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

Write-up: Systemic: Vomiting-Mild


VAERS ID: 1705935 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Dizziness, Headache, Nausea, Seizure, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Systemic: Chills-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Headache-Mild, Systemic: Nausea-Mild, Systemic: Seizure-Mild, Systemic: Weakness-Mild, Additional Details: patient had a seizure about 10 minutes after receiving the moderna vaccine. the seizure episode lasted 30-60 seconds. the patient regained consciousness, but experienced lightheadedness, weakness, nausea, headache, and chills. patient was provided with a benadryl 25 mg, orange juice, and a cookie. patient felt better afterward. patient will follow up with a physician at an urgent care.


VAERS ID: 1705941 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC1384 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Dizziness, Flushing, Hyperhidrosis, Hypotension, Loss of consciousness, Syncope, Unresponsive to stimuli
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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Mild, Systemic: Hypotension-Medium, Additional Details: Patient lost consciousness after vaccine administered. Temp was measured at 95.9 F before injection and 97.5 F after reaction. Patient lost conciousness for a couple of minutes and was very sweaty. Blood pressure was measured 90/71 mmHg at time of event. Blood pressure 30 minutes later was 120/79 mmHg.


VAERS ID: 1705946 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

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

Write-up: Systemic: Fainting / Unresponsive-Severe


VAERS ID: 1705975 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pain, Lethargy, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Medium, Systemic: Body Aches Generalized-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fever-Medium, Systemic: Headache-Medium


VAERS ID: 1706456 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Injection site pain, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Site: Pain at Injection Site-Mild, Systemic: Chills-Mild, Additional Details: patient felt chills, pharmacist follow up on sunday patient feeling better a little sore on the arm but nothing else


VAERS ID: 1706466 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Medium


VAERS ID: 1706482 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Arkansas  
Vaccinated:0000-00-00
Onset:2021-09-11
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Non-smoker; Social alcohol drinker (Social not very often)
Preexisting Conditions: Comments: The patient did not have any history of drug abuse or illicit drug use.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210921399

Write-up: JOINT PAIN ALL OVER; PINS AND NEEDLES SENSATION; This spontaneous report received from a patient concerned a 20 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: social alcohol user, and non smoker, and other pre-existing medical conditions included: The patient did not have any history of drug abuse or illicit drug use. The patient experienced anaphylaxis to flu vaccine at 6 months of age when treated with influenza vaccine for prophylactic vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A expiry: UNKNOWN) dose was not reported, administered on 10-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 11-SEP-2021, the patient experienced pins and needles sensation. On 12-SEP-2021, the patient experienced joint pain all over. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from pins and needles sensation on 11-SEP-2021, and had not recovered from joint pain all over. This report was non-serious.


VAERS ID: 1706494 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-09-11
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Headache, Insomnia, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (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: Comments: The patient had no known drug allergies, no known medical conditions and no known medication usage.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210921647

Write-up: HEADACHE; NO SLEEP; BLURRY VISION; CHILLS; This spontaneous report received from a consumer concerned a 21 year old male. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: The patient had no known drug allergies, no known medical conditions and no known medication usage. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 11-SEP-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 11-SEP-2021, the patient experienced no sleep. On 11-SEP-2021, the patient experienced blurry vision. On 11-SEP-2021, the patient experienced chills. On 12-SEP-2021, the patient experienced headache. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from chills, no sleep, blurry vision, and headache. This report was non-serious.


VAERS ID: 1706500 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Georgia  
Vaccinated:0000-00-00
Onset:2021-09-11
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Chills, Extra dose administered, Injection site pain, Malaise, Off label use, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Body temperature; Result Unstructured Data: low grade
CDC Split Type: USJNJFOC20210921907

Write-up: MALAISE; CHILLS; INJECTION SITE SORENESS; LOW GRADE FEVER; RECEIVED TWO DOSES OF JANSSEN COVID-19 VACCINE; OFF LABEL USE; This spontaneous report received from a pharmacist concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: Unknown) dose was not reported, administered on 30-MAR-2021, and dose was not reported, administered on 11-SEP-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 11-SEP-2021, the patient experienced received two doses of janssen covid-19 vaccine. On 11-SEP-2021, the patient experienced off label use. On an unspecified date, the patient experienced malaise, chills, injection site soreness, and low grade fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from low grade fever, malaise, chills, and injection site soreness, and the outcome of received two doses of janssen covid-19 vaccine and off label use was not reported. This report was non-serious.


VAERS ID: 1706504 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-09-11
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cold sweat, Heart rate increased, Hot flush, Medication error, Panic disorder, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Medication errors (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Alcohol use (Very low moderate , just did last night.); Non-smoker
Preexisting Conditions: Comments: The Patient had no known allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210922096

Write-up: FEEL LIKE FLUSH LIKE HOT; PANIC; SHAKING; CLAMMY; ACCELERATED HEART RATE; MISTAKENLY RECEIVED SECOND JANSSEN SHOT INSTEAD OF FLU VACCINE; This spontaneous report received from a patient concerned a 49 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: alcohol user, and non-smoker, and other pre-existing medical conditions included: The Patient had no known allergies. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 1805029 expiry: UNKNOWN, and batch number: 043A21A expiry: UNKNOWN) dose was not reported, administered on 31-MAR-2021, and dose was not reported, administered on 11-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 11-SEP-2021, the patient experienced feel like flush like hot. On 11-SEP-2021, the patient experienced panic. On 11-SEP-2021, the patient experienced shaking. On 11-SEP-2021, the patient experienced clammy. On 11-SEP-2021, the patient experienced accelerated heart rate. On 11-SEP-2021, the patient experienced mistakenly received second janssen shot instead of flu vaccine. The action taken with covid-19 vaccine was not applicable. The outcome of the mistakenly received second janssen shot instead of flu vaccine, feel like flush like hot, panic, shaking, clammy and accelerated heart rate was not reported. This report was non-serious.


VAERS ID: 1706525 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-09-11
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Non-smoker; Overweight
Preexisting Conditions: Comments: The patient had no known drug allergies, did not have any history of drug abuse or illicit drug use, no known past reactions from vaccines or medication and did not have any breathing issues. The patient was doing well overall with no significant past medical history. The patient not pregnant at the time of vaccination.
Allergies:
Diagnostic Lab Data: Test Date: 20210911; Test Name: Body temperature; Result Unstructured Data: 102 F; Test Date: 20210913; Test Name: Body temperature; Result Unstructured Data: 100.8 F
CDC Split Type: USJNJFOC20210923902

Write-up: GENERALIZED MALAISE; ONE BIG RASH (TURNED RED ALL OVER); FELT FEVERISH/ FEVER; This spontaneous report received from a patient via a company representative concerned a 47 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: non smoker, non alcohol user, and mildly overweight, and other pre-existing medical conditions included: The patient had no known drug allergies, did not have any history of drug abuse or illicit drug use, no known past reactions from vaccines or medication and did not have any breathing issues. The patient was doing well overall with no significant past medical history. The patient not pregnant at the time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported) dose was not reported, administered on 10-SEP-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 11-SEP-2021, the patient experienced generalized malaise. On 11-SEP-2021, the patient experienced one big rash (turned red all over). On 11-SEP-2021, the patient experienced felt feverish/ fever. Laboratory data included: Body temperature (NR: not provided) 102 F. Treatment medications included: diphenhydramine hydrochloride. On 12-SEP-2021, treatment medications included: ibuprofen, and paracetamol. On 13-SEP-2021, Laboratory data included: Body temperature (NR: not provided) 100.8 F. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from one big rash (turned red all over) on 13-SEP-2021, and had not recovered from felt feverish/ fever, and generalized malaise. This report was non-serious.


VAERS ID: 1706536 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-09-11
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210924202

Write-up: ADMINISTERED THE COVID-19 VACCINE TO A 17 YEAR OLD PATIENT; This spontaneous report received from a pharmacist concerned a 17 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 207A21A, expiry: 21-SEP-2021) dose was not reported, administered on 11-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 11-SEP-2021, the patient experienced administered the covid-19 vaccine to a 17 year old subject. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administered the covid-19 vaccine to a 17 year old patient was not reported. This report was non-serious.


VAERS ID: 1706906 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Fatigue, Headache, Impaired work ability, Lethargy, Pain
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Systemic: Body Aches Generalized-Medium, Systemic: Exhaustion / Lethargy-Severe, Systemic: Headache-Medium, Systemic: Weakness-Medium, Additional Details: Patient came to pharmacy saying she requested days off from work. she never misses work. She feels showering and eating are are making her so tired.


VAERS ID: 1707974 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / IM

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

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

Write-up: Error: Incorrect Reconstitution-


VAERS ID: 1707975 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: recovered quickly from fainting. ems was called and checked her out. she was able to go home with no continued problems


VAERS ID: 1707977 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Injection site bruising, Injection site erythema
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Medication errors (narrow)

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

Write-up: Site: Bruising at Injection Site-Medium, Site: Redness at Injection Site-Mild, Additional Details: Pt reported red/black marks extending past her elbow starting saturday and that the continued to extent into sunday. Pt advised to go to the ER, but she opt''ed to call her MD monday morning. Pt states having an appt ths coming wednesday with her MD after a phone call monday afternoon. Pt states MD stated this is likely a struck vein or blood vessel from the administration.


VAERS ID: 1708029 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site nodule, Injection site pain, Injection site swelling, Injection site warmth
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Additional Details: Patient has a large knot that developed and has swollen and is red/warm to the touch. Concerned because she is 48 hours post shot and still having symptoms.


VAERS ID: 1708035 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 UN / IM

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

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1708229 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / IM

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

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

Write-up: Axillary pain with both shots and throat irritation causing and annoying cough after the second injection


VAERS ID: 1708237 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Asthenia, Blood pressure decreased, Dizziness, Pallor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Dehydration (broad)

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

Write-up: Seconds after shot was administered there was a stabbing sensation, not from the needle prick, at the injection site. A couple of minutes later, blood pressure drastically dropped, lost color in the face, weakness, dizziness. Felt much better lying down with legs elevated, but couldn''t sit up even in a chair. Ambulance was called and took me to the hospital emergency room for further precaution. After lying down for a couple of hours I was able to walk out of the clinic on my own. I did feel weak and a little dizzy for the following 36 hours or so.


VAERS ID: 1708254 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-06-11
Onset:2021-09-11
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 2 LA / IM

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

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

Write-up: Tested positive for COVID 19 9/11/2021


VAERS ID: 1708389 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-28
Onset:2021-09-11
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Condition aggravated, Dizziness, Hypotension, Magnetic resonance imaging head normal, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler apixaban (ELIQUIS) 5 MG tablet aspirin 81 MG tablet bisacodyl (DULCOLAX) 10 MG suppository budesonide/formoterol (SY
Current Illness: 9.2.21 - admitted to hospital for hypokalemia management COVID-19 positive - 9.11.21
Preexisting Conditions: Essential hypertension Thalassemia Abnormal nuclear stress test Chest pain OSA (obstructive sleep apnea) GERD (gastroesophageal reflux disease) Fatigue Depression Failure to thrive in adult Unspecified severe protein-calorie malnutrition Hypokalemia COVID-19 Dizziness Generalized weakness
Allergies: Keflex - Hive
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized; COVID-19 positive (9.11.21); fully vaccinated Admission Date: 9/11/2021 Discharge Date: 9/15/21 Discharge Disposition: home health care DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Dizziness Weakness COVID-19 HOSPITAL COURSE: Patient is a 52-year-old female with a history of PE on Eliquis, prior TIA, chronic obstructive pulmonary disease, SVT on beta-blocker and antiarrhythmic who presented with dizziness. She had a recent admission from 09/02-9/5 due to poor oral intake along with multiple electrolyte abnormalities, hypotension and hypoalbuminemia. Her electrolytes were replaced and she also received thiamine, folate and multivitamin due to history of chronic alcohol use and was discharged home with home care. She presented due to dizziness and was found to be positive for COVID-19. She was not hypoxic. She was not a candidate for remdesivir or Decadron. She did receive monoclonal antibodies on 09/12. Due to her ongoing dizziness, MRI of the brain was obtained which did not reveal any acute pathology. Patient continued to remain hypotensive and was on flecainide 100 mg twice a day as well as Toprol XL 150 mg daily in addition to methadone, Norco, tizanidine and gabapentin. She was seen by Neurology who felt that patient''s dizziness could be due to hypotension, COVID infection as well as the multiple medications that she was on that could cause dizziness. She was unable to be evaluated by PT and OT due to ongoing hypotension but this resolved and PT recommended home with home health care. . Amlodipine was held, Toprol XL was reduced to 25 mg daily, gabapentin was decreased to 300 mg 3 times a day and flecainide was dec. To 50 mg po bid. This was at the recommendation of cardiology. Patient had persistent SVT during an admission in July and was seen by Cardiology and EP and placed on flecainide as well as Toprol during that time. Cardiology has been consulted. She has f.u. with cardiology and EP as an out patient. She was also instructed to quarantine / isolate until 9/22 and was given warning signs and symptoms that would


VAERS ID: 1708435 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-01
Onset:2021-09-11
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Angiogram normal, Blood creatine phosphokinase normal, Blood folate normal, Blood thyroid stimulating hormone normal, C-reactive protein normal, Computerised tomogram head normal, Full blood count normal, Magnetic resonance imaging head normal, Metabolic function test, Paraesthesia, Red blood cell sedimentation rate normal, Trigeminal neuralgia, Venogram normal, Vitamin B12 normal
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Demyelination (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: norvasc, prozac, synthroid
Current Illness: none
Preexisting Conditions: hypothyroid, hypertension, anxiety
Allergies: sulfa, tramadol
Diagnostic Lab Data: had normal ct head, ct face, mri head, mra head, mrv head, cmp, cpk, crp, B12, folate, tsh, cbc, esr
CDC Split Type:

Write-up: trigeminal neuralgia and lower extremity paresthesias


VAERS ID: 1708445 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO185 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Illness, Menstruation delayed, Myalgia, Nausea, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Fertility disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None. Covid positive 2 months prior.
Preexisting Conditions: None.
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 9/10 I was administered my 2nd Pfizer vaccine the flu shot. I was severely sick with the symptoms of chills, muscle aches, and fatigue. The most ill I''ve ever been in my life. My most severe symptoms was painful nausea. I had painful nausea for 2 days in which I luckily had promethazine from a previous wisdom tooth surgery. All other symptoms subsided within 2 days except my GI symptoms. I continue to have nausea and have had 3-6 episodes of diarrhea daily and it has been 7 days since inoculation. I have been woken up several nights this week with diarrhea. This has never happened to me before in my life. There has been no change in my diet. I am a very healthy individual. I also started my cycle 10 days late with severe cramping. Bleeding has been normal. There is nothing else than can account for this change but 2 doses of the Pfizer vaccine.


VAERS ID: 1708469 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Neck pain, Pain in jaw, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Osteonecrosis (broad), Arthritis (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: Percocet, Lovaza, Singular, Astelin
Current Illness: N/A
Preexisting Conditions: N/a
Allergies: Ibuprofen; Levaquin
Diagnostic Lab Data: N/a.
CDC Split Type:

Write-up: Bubble like swelling right axilla and right side of neck, continue jaw and neck pain.


VAERS ID: 1708543 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram normal, Laboratory test normal, Pain in extremity, Paraesthesia, Paraesthesia oral
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: On 9/10/2021 received my first shot of Pfizer at work 1:30pm, 5 mins later felt a shooting sensation left arm all the way to my finger tips. On 9/11/2021 tinggling sensation left arm. On 9/12/2021 tinggling sensation on left arm, left side of face, lip, and left side of head went to ER. Ct and labs came back normal. On dates 9/13 thru 9/17, still having tingling sensations on and off on both arms, head, and legs. On 9/17 saw pcp and MRI was ordered.


VAERS ID: 1708553 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Public       Purchased by: ?
Symptoms: Blepharospasm, Chills, Feeling abnormal, Headache, Hyperhidrosis, Palpitations, Pyrexia, Restlessness, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Akathisia (broad), Dystonia (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data: Contacted and Notified brand new doctor on 9/13, but they simply said to keep an eye on it to make sure it doesn''t get worse.
CDC Split Type:

Write-up: After 1st shot Just a sore arm. The 2nd shot, 12 hours later, woke up with severe fever, chills, tachycardia, and heart beating uncomfortably hard. Severe headache, eyes twitching, and restless, I felt like my system was being fried. Lasted 16 hours and treated with 400mg ibuprofen every 4 hours which helped a little. However, 2 nights later, woke up sweating, with tachycardia, and chills. As well as last night for a pattern of every other night. Also, irregular feelings in my chest occur randomly now. Extremely scary and upsetting that I was healthy and now feel like something isn''t right. One day I''m fine, the next I''m not.


VAERS ID: 1708646 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-02-04
Onset:2021-09-11
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 2 RA / IM

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

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

Write-up: Shingles; Anti-viral medication, prednisone, and pain meds; currently on day 7.


VAERS ID: 1708702 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-08
Onset:2021-09-11
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH H9899 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Blood test, Chills, Diarrhoea, Faeces discoloured, Pain, Pyrexia, Sensitive skin
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fosomax Evista VitD Magnesium
Current Illness:
Preexisting Conditions: Rheumatoid arthritis
Allergies:
Diagnostic Lab Data: I haven''t received any results yet
CDC Split Type:

Write-up: After 24 hours I experience chills without a fever my skin was sensitive to touch and I was achy that lasted about 24 hours three days later I was experiencing stomach pain with diarrhea which has lasted for six days.. On day four I had a white/clay colored stool which caused me to call the doctor and I went in for an exam and he drew blood which I haven''t gotten the results back from and now I have an appointment for an ultrasound of my abdomen he doesn''t think that it''s my gallbladder or liver he believes it''s probably from the vaccine but we''re going to try to rule out Any other cause.


VAERS ID: 1708759 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-08
Onset:2021-09-11
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dovato,dolutegravir 50mg,lamivudine 300mg
Current Illness: none
Preexisting Conditions: HIV
Allergies: pennacillan
Diagnostic Lab Data: MY DOCTOR IS ORDERING AN EKG
CDC Split Type:

Write-up: EXPERIENCED A SENSE OF NUMBNESS IN LEFT ARM AND HAND,ALSO A VISABLE PULSATING PULSE NOTICABLE IN LEFT WRIST.THE NUMBNESS AS GONE AWAY,BUT I CAN STILL SEE MY PULSE BEATING IN MY WRIST.


VAERS ID: 1708765 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Pallor, Presyncope
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient a few moments after the administration of shot was pale and lightheaded and father was calling for help. the intern ran to help the patient and patient was laid on the ground. intern checked for a pulse and tended to the patient and i immediately ran to call 911. EMS services were here within a few minutes and assessed patient. they determined it was most likely a vaso vagal response to the shot and no other systems. patient was not transported to hospital and no further medical treatment needed. followed up with dad the next day and patient was still fine and nothing out of the ordinary.


VAERS ID: 1708849 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 09/11/2021 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysarthria, Feeling abnormal, Headache, Lymphadenitis, Malaise, Pain in extremity
SMQs:, Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: URI 3 weeks before vaccine
Preexisting Conditions: Asthma
Allergies: Morphine, succinylcholine
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Severe arm pain, lymphadenitis x 5 days, severe headache, slurred speech, malaise, and foggiest.


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