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From the 5/7/2021 release of VAERS data:

Found 188,897 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 21 out of 1,889

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VAERS ID: 1258576 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-04-09
Onset:2021-04-21
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrial fibrillation, Cerebral infarction, Intensive care, Thrombosis
SMQs:, Supraventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: There are several for the long term conditions listed below. I can submit that information a little later today.
Current Illness: None
Preexisting Conditions: Diabetes High blood pressure High Cholesterol
Allergies: None
Diagnostic Lab Data: We will have to get the from the hospital.
CDC Split Type:

Write-up: Heart went into Atrial fibrillation causing blood clotting. He has no prior heart condition. A blood clot traveled to his brain causing a Posterior Cerebral Artery Stroke. He has been in ICU since 04/22/2021.


VAERS ID: 1258921 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-09
Onset:2021-04-21
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A2IA / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Blepharospasm, Tic
SMQs:, Dyskinesia (broad), Dystonia (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ziprasidone, sertraline, Lo loestrin, Klonopin, Lunesta, Zyrtec
Current Illness: Schizoaffective disorder, PTSD
Preexisting Conditions: schizoaffective disorder, PTSD
Allergies: Penicillan
Diagnostic Lab Data:
CDC Split Type:

Write-up: I''ve developed a tic on my left eye that makes my eye keep closing about twenty times in a minute. A few days later it spread to my righ eye and now sometimes I cannot see because my eyes want to close at almost all points in time. This started about a week to ten days after I received the vaccine. Currently did no treatment, and it is ongoing.


VAERS ID: 1258926 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-16
Onset:2021-04-21
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802070 / N/A - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: covid test positive SARS-CoV-2 (COVID-19), Micro Detected 4/24/2021
CDC Split Type:

Write-up: covid symptoms SOB $g 14 days after vaccine ( 4/21/21) covid test positive


VAERS ID: 1259570 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-04-06
Onset:2021-04-21
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Dyspnoea, Fatigue, Musculoskeletal chest pain
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins
Current Illness: None. Going to physician for sinus issues.
Preexisting Conditions: None.
Allergies: Penicillin
Diagnostic Lab Data: Did blood tests and CT on 4/23/2021.
CDC Split Type:

Write-up: On Wednesday the 21st he came home and was tired. It got gradually worse on the 22nd. Was also feeling rib pain on the right side. Was a little bit short of breath. Went to the ER on 4/23 and they gave him IV fluids and pain medications. Put him on Tylenol, Naproxen, and Eliquis. States today 4/26 he is feeling a little bit better.


VAERS ID: 1259597 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-03-27
Onset:2021-04-21
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / N/A LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Headache, Sleep disorder, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had a severe headache starting in the evening. The pain was constant, dull, and felt like it was coming from the center of the head. I don''t have a history of headaches, so this was unusual. After going to bed at 11PM, I woke up around 2AM from the intense pain. I could not sleep for a couple of hours in the night and I took Nyquil, which helped a little bit. I considered going to the emergency room, but decided to wait until morning to make the decision. I was able to go back to sleep and then slept until 11AM. I woke up feeling weak and groggy, although it may have been due to the Nyquil. The headache was improved and gradually diminished throughout the day. The next morning, it was completely gone and I felt back to normal.


VAERS ID: 1260339 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-07
Onset:2021-04-21
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Chlorthalidone 25 MG po qd, KCL 20meq po bid, bariatric multivitamin, synthroid 112 might po qd
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 2 weeks to the day after Janssen vaccine spontaneous outbreak of hives all over body. Required steroid shot and oral burst dose of steroids for 7 days. Hives present for 4 days with continued sporadic itching for several days after.


VAERS ID: 1261026 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-21
Onset:2021-04-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Lymphadenopathy, Myalgia, Neck pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever 24 hours Sore muscles 12 hours Headache 12 hours Neck pain small lump, above left clavicle, started 1-2 days after. Lump still there on April 26 5 days later


VAERS ID: 1261034 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-19
Onset:2021-04-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Back pain, Chills, Dyspnoea, Fatigue, Nausea, Thirst
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Arthritis (broad), Dehydration (broad)

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

Write-up: Fatigue, shortness of breath, thirsty, joint pain, lower left back pain, nausea and chills. All symptoms have been going on for 5 days now


VAERS ID: 1261362 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-04-21
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Rash vesicular
SMQs:, 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: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210444349

Write-up: RASH/2 BLISTERS ON CHIN UNDER LIP; This spontaneous report received from a patient concerned a 61 year old male. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 043A21A, and expiry: UNKNOWN) dose was not reported, administered on 11-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 21-APR-2021, the subject experienced rash/2 blisters on chin under lip. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from rash/2 blisters on chin under lip. This report was non-serious.


VAERS ID: 1261535 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-21
Onset:2021-04-21
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Passed out; Sweaty; Slightly feverish; This spontaneous case was reported by a consumer and describes the occurrence of LOSS OF CONSCIOUSNESS (Passed out) in a 41-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 045B21A and 045A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 21-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 21-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 21-Apr-2021, the patient experienced LOSS OF CONSCIOUSNESS (Passed out) (seriousness criterion medically significant), HYPERHIDROSIS (Sweaty) and PYREXIA (Slightly feverish). At the time of the report, LOSS OF CONSCIOUSNESS (Passed out), HYPERHIDROSIS (Sweaty) and PYREXIA (Slightly feverish) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medications were not reported. Description: The patient felt sweaty and slightly feverish all night on 21 April 2021. When he got up to urinate he actually passed out (medically significant) and was on the floor for a few seconds. Later last night, on the same day, he went to drink some water, and passed out again for a few seconds. The patient did not seek any medical attention, and stated that he felt fine now. No treatment information provided. The patient received both scheduled doses of mRNA-1273 prior to the event, therefore action taken with the drug in response to the event is not applicable. Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.


VAERS ID: 1261938 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-20
Onset:2021-04-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling abnormal, Haematochezia, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (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: USMODERNATX, INC.MOD20210

Write-up: a lot of blood in his stool twice in the morning; Felt "really bad"; Fever; This spontaneous case was reported by a consumer and describes the occurrence of HAEMATOCHEZIA (a lot of blood in his stool twice in the morning) in a 48-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 046B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 20-Apr-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 21-Apr-2021, the patient experienced FEELING ABNORMAL (Felt "really bad") and PYREXIA (Fever). On 23-Apr-2021, the patient experienced HAEMATOCHEZIA (a lot of blood in his stool twice in the morning) (seriousness criterion medically significant). At the time of the report, HAEMATOCHEZIA (a lot of blood in his stool twice in the morning), FEELING ABNORMAL (Felt "really bad") and PYREXIA (Fever) outcome was unknown. Concomitant product use was not provided. Treatment included Ibuprofen and Tylenol. Action taken with mRNA-1273 in response to the events was not Applicable. Company comment:Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1262180 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-21
Onset:2021-04-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Axillary pain, Blood test, Contusion, Discomfort, Dizziness, Fatigue, Feeling hot, Hyperhidrosis, Increased tendency to bruise, Lymph node pain, Lymphadenopathy, Mobility decreased, Pain, Pain in extremity, Rash, Rash erythematous, Rash pruritic, Sleep disorder, Somnolence, Vertigo
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular disorders (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control, Zyrtec, montelukast, methocarbamol, allerflo, azelastine
Current Illness:
Preexisting Conditions: Migraines and allergies
Allergies: Only seasonal allergies
Diagnostic Lab Data: Waiting on blood tests.
CDC Split Type:

Write-up: Day 1: The evening of shot, my entire body began to feel achy, and my arm was so sore that I couldn?t sleep. Day 2: body very achy. Theraflu helped with aches. Lymph node under arm swelled up to the size of a 1/2 grapefruit and was so painful that I took hydrocodone for one day to deal with it. It was throbbing and occasionally shooting pain around armpit area. I couldn?t let my arm touch it. I was a bit sweaty and hot and slept most of the day. Day 3: I noticed small bruises under my armpit. The area was still very sore but bearable. I couldn?t use that arm at all. I also got a rash in my back on the right side that was extremely itchy for a minute and then was just red. It faded somewhat quickly. I called my dr because I was concerned about reactions. He told me to come in Monday for blood tests because my reactions were concerning. Later that night when I got undressed for bed, I saw that I now had 7 bruises all on my right side all around armpit area. Tired. Day 4: feeling pretty normal. Arm is still very sore, but I can use it. I can?t lift my arm without discomfort. Only new bruise is a BIG one on my arm. I finally figured out it was from taking off my shirt! Day 5 etc = feeling better and better except for occasional vertigo in morning and dizziness throughout the day.


VAERS ID: 1262334 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-20
Onset:2021-04-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tegretol, Risperdal
Current Illness: Unknown infection (took Keflex)
Preexisting Conditions: sickle cell, anemia, arrhythmia
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated red rash developed down entire left arm 1 day following vaccination and persisted for 3 days after. Patient reported to us 7 days following vaccination stating that rash has resolved now. She went to her doctor who told her to take diphenhydramine prior to next dose.


VAERS ID: 1262561 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-02
Onset:2021-04-21
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 LA / IM

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

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

Write-up: Worse headache of her life. No history of headaches. Started on 4/21/21


VAERS ID: 1262861 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-12
Onset:2021-04-21
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysmenorrhoea, Heavy menstrual bleeding, Menstrual disorder
SMQs:, Haemorrhage terms (excl laboratory terms) (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: Venlafaxine (75 mg) Vitamin D Iron Zyrtec
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Extremely heavy and painful menstruation one week after shot. It was abnormal for me to be that heavy with flow and to even have cramps, let alone that strong.


VAERS ID: 1262924 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-30
Onset:2021-04-21
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anticoagulant therapy, Deep vein thrombosis, Heparin-induced thrombocytopenia test, Infusion, Myocardial strain, Platelet count decreased, Pulmonary embolism, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Primidone 250 mg po two times daily Atorvastatin 20 mg po every day Lisinopril 20 mg po daily Metoprolol 25 mg po twice daily Calcium carbonate-vitamin D3 - 400 unit tablet 1 tablet daily furosemide 40 mg po daily aspirin 81 mg po daily bac
Current Illness:
Preexisting Conditions: HTN CAD
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received J&J vaccine 3/30/21 4/21/21 Presented to hospital with syncope and collapse, work-up for NSTEMI and placed on heparin infusion Patient found to have RLE DVT and bilateral PE with right heart strain. Platelet decreased and patient started on argatroban infusion. HIT negative, platelets remaind stable. Discharged 4/25/21 on apixaban


VAERS ID: 1263147 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-04-20
Onset:2021-04-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: My filler started swelling. I also had a terrible headache and was exhausted.


VAERS ID: 1264371 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-11
Onset:2021-04-21
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Headache, Pain, Pyrexia, Respiratory symptom, SARS-CoV-2 test positive, Sinus congestion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data: Covid test on April 22nd. Positive result received on April 24th, 8:15pm
CDC Split Type:

Write-up: The day after, started with mild headache and fatigue. On or about April 21st, she started having upper respiratory symptoms, cough, sinus congestion, fever and aches. She tested positive for COVID on April 22nd.


VAERS ID: 1264458 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-04-21
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Name: Body temperature; Result Unstructured Data: 103 F
CDC Split Type: USJNJFOC20210448316

Write-up: ARM PAIN; FEVER; MIGRAINE; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported for prophylactic vaccination. No concomitant medications were reported. As per protocol, no follow up performed for social media case hence batch number not requested. On 21-APR-2021, the subject experienced migraine. On an unspecified date, the subject experienced arm pain, and fever. Laboratory data (dates unspecified) included: Body temperature (NR: not provided) 103 F. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the fever, arm pain and migraine was not reported. This report was non-serious.


VAERS ID: 1264911 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-04-12
Onset:2021-04-21
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Prevnar August 2001
Other Medications: Escitalopram
Current Illness: None
Preexisting Conditions: Depression and Anxiety
Allergies: Penicillin, Prevnar vaccine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: She had a severe allergic reaction. Swollen lips, throat, hives.


VAERS ID: 1265436 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-09
Onset:2021-04-21
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Contusion, Eye haemorrhage, Ocular icterus
SMQs:, Cholestasis and jaundice of hepatic origin (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Retinal disorders (broad), Conjunctival disorders (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: Spirinolactone, progesterone, iron, vitamin c, vitamin d
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Burst blood vessels in eye and eye yellowing, mysterious bruising on limbs


VAERS ID: 1265614 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-04-20
Onset:2021-04-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe headache and vomiting


VAERS ID: 1266105 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-20
Onset:2021-04-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Chills, Headache, Hyperhidrosis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Fever around 40 degrees Celsius for 24 hours, chills, headache, strong sweating, general weakness of the body. After a day, lower-grade fever (38 degrees Celsius for the next day and 37 degrees later on) and general body weakness for the next 5 days.


VAERS ID: 1266153 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-04-19
Onset:2021-04-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Seasonique, metoprolol succinate ER 50 mg
Current Illness: None
Preexisting Conditions: Tachycardia
Allergies: Dust, fluoride
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shingles on left side of body


VAERS ID: 1266246 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-11
Onset:2021-04-21
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Dysuria, 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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: headaches starting after second vaccine persisting til current time, painful urination starting 4/21 cause not confirmed by doctor


VAERS ID: 1266266 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-04-21
Onset:2021-04-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Rabies Vaccine
Other Medications: Claritin, Magnesium Oxide, Vit D, Vitamin B12
Current Illness: None
Preexisting Conditions: Migraines
Allergies: Rabies Vaccine, Peanuts/nuts, Duck Eggs, Benadryl, Augmentin
Diagnostic Lab Data: Hospital ER visit
CDC Split Type:

Write-up: swelling of face, facial numbness


VAERS ID: 1266336 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-21
Onset:2021-04-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abortion, Back pain, Exposure during pregnancy, Haemorrhage, Headache, Multigravida, Pregnancy, Pubic pain, Pyrexia, Ultrasound scan, Uterine dilation and curettage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow), Normal pregnancy conditions and outcomes (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt. started having fever that evening, headache, and lower back pain (significant). Yesterday drove to ER due to continued severe lower back pain and pubic pain. On the way to the ER, she started bleeding a lot. At the hospital, she had a sono and was told she had an abortion. They performed a D&C. She was 10wks. This is 2nd pregnancy, which was uncomplicated pregnancy.


VAERS ID: 1266359 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-03-15
Onset:2021-04-21
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / N/A LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Eczema, Rash, Visual impairment
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: I now have mini little eczema patches on my face - two or three of them; I use Fluticasone (steroid) on them which I was using for the original adverse event with red patches on/below my neck. I had a health report today primarily related to a different health issue but I asked her if I should use the Fluticasone cream on them. She cautioned me to use the steroid cream minimally on my face. The eczema I have on my hand - that is what I always there in dry, bad weather - seems worse than it normally gets. The rash on my neck is gone. Also, two weeks after the Vaccine, I have noticed that my eye sight is different. I am going to the eye doctor tomorrow because of this.


VAERS ID: 1266718 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-28
Onset:2021-04-21
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

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

Write-up: Client had a breakthrough infection.


VAERS ID: 1267911 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-21
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Cough, Fatigue, Nasopharyngitis, Pain, Pain in extremity, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Tendinopathies and ligament disorders (broad), COVID-19 (broad)

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

Write-up: Pt called the call center. Reporting cold like symptoms"coughing, body aches, chills, both arms hurting, fatigue" after J&J covid vaccine 4/9/2021. Pt is taking ginger tea for symptoms but no medication. Pt denies emergency s/sx. Urgent Care appt made but pt no showed on4/21/21. New appt scheduled for 4/23/21. COVID test negative on 4/23/21.


VAERS ID: 1267998 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-09
Onset:2021-04-21
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

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

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

Write-up: Patient reports a debilitating headache which started roughly 2 weeks after vaccine administration. We advised the patient to let her primary care provider know as soon as possible.


VAERS ID: 1268297 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-04-10
Onset:2021-04-21
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Laboratory test, Palpitations, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (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: Zoloft Allegra Losartan Amitriptyline Omeprazole Metoprolol Hydroxyzine
Current Illness: Hypothyroidism Migraines Chronic low back pain Hypertension GERD Depression Allergic Rhinitis OSA
Preexisting Conditions: See above
Allergies: Topamax
Diagnostic Lab Data: Labs pending. Cardiology referral placed for holter monitor.
CDC Split Type:

Write-up: Intermittent tachycardia with palpitations, shortness of breath, lightheadedness at rest. Currently undergoing further workup. Onset 7 days ago.


VAERS ID: 1269147 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Minnesota  
Vaccinated:0000-00-00
Onset:2021-04-21
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210421; Test Name: COVID-19 antigen test; Result Unstructured Data: Positive; Test Date: 20210422; Test Name: COVID-19 antigen test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20210446463

Write-up: SUSPECTED COVID-19 INFECTION; This spontaneous report received from a health care professional concerned a patient of unspecified age and sex. The patient''s weight, height, and medical history were not reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 12-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 21-APR-2021, the subject experienced suspected covid-19 infection. Laboratory data included: COVID-19 antigen test (NR: not provided) Positive. On 22-APR-2021, Laboratory data included: COVID-19 antigen test (NR: not provided) Positive. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of suspected covid-19 infection was not reported. This report was non-serious.; Sender''s Comments: V0 Medical assessment comment not required as per standard procedure as the case was assessed as non-serious.


VAERS ID: 1269269 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Wisconsin  
Vaccinated:0000-00-00
Onset:2021-04-21
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210454441

Write-up: BROKE OUT WITH SHINGLES; This spontaneous report received from a patient via a company representative concerned a female of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 07-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 21-APR-2021, the subject experienced broke out with shingles. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of broke out with shingles was not reported. This report was non-serious. .


VAERS ID: 1269636 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-21
Onset:2021-04-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Mydriasis, Vision blurred, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 50mg
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Taken by paramedics Blood pressure: 130/60 Blood sugar: 76
CDC Split Type:

Write-up: Within five minutes of my vaccination I started to feel very dizzy and my eyesight became blurry. I told my husband who had also been vaccinated that I thought something was wrong and within a seconds I then passed out and he caught me. I vomited twice in the span of the next ten minutes and I was not alert for any of that time-no recollection of being able to see or hear. My husband stated my eyes were open and pupils very dilated. He was able to get me to the ground with the help of the pharmacist who had administered the vaccine. 911 was called and by the time they arrived I became coherent enough to talk and interact. I declined a hospital visit because I had no interest in a ambulance ride but did follow up with my primary. No history of ever fainting or medical anxiety.


VAERS ID: 1269666 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-20
Onset:2021-04-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood albumin decreased, Blood test normal, Computerised tomogram head, Computerised tomogram normal, Disorientation, Feeling abnormal, Headache, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine
Current Illness: Pre-diabetes
Preexisting Conditions: Hypothyroidism, PCOS
Allergies: Sulfur
Diagnostic Lab Data: I went to the clinic with complains of headache and disorientation. Head CT and blood work done, but everything was okay.
CDC Split Type:

Write-up: A day after receiving my second moderna, I developed general body aches, headaches and three days later I became disoriented and I got lost when I was going to my brother''s house. I also got disoriented on the fourth day and I got lost in my own neighborhood, I could find a way to my home in the neighborhood that I have lived in it for 20 years. I still have headache upto this minute with foggy brain.


VAERS ID: 1269671 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-21
Onset:2021-04-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 1 LA / SYR

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

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

Write-up: I experience a severe headache that made me feel like laying down and I experienced it for about 4 days, going away for good on Sunday (4/25). But I started experiencing rashes on the back my legs around Friday 4/23, and I still have the rashes. Today is 4/28.


VAERS ID: 1269814 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Vermont  
Vaccinated:2021-04-21
Onset:2021-04-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 943B21A / 2 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Bursitis, Injected limb mobility decreased, Product administration error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acalabrutinib Allopurinol
Current Illness: CLL
Preexisting Conditions: CLL
Allergies: Doxycycline
Diagnostic Lab Data: Examined by primary care provider
CDC Split Type:

Write-up: Bursitis from vaccine. Poorly administered in wrong location with a needle that was possibly too long. Clinician did not roll up my sleeve and examine my arm before choosing needle size. Cannot lift or use left arm after 1 week.


VAERS ID: 1269945 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-04-21
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Immune thrombocytopenia, Platelet count decreased, Platelet factor 4
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Hyperlipidemia; Hypertension; Non-smoker; Obesity
Preexisting Conditions: Comments: no history of acute illness Family history is negative for any thrombocytopenia, bleeding disorders.
Allergies:
Diagnostic Lab Data: Test Date: 20210421; Test Name: Platelet count low; Result Unstructured Data: 9000; Test Date: 20210421; Test Name: Platelet count low; Result Unstructured Data: 30000; Test Name: Platelet factor 4; Result Unstructured Data: normal
CDC Split Type: USJNJFOC20210444881

Write-up: IDIOPATHIC THROMBOCYTOPENIC PURPURA; This spontaneous report received from a company representative concerned a 60 year old female. Initial information was processed with additional information received from the patient''s physician, in response to telephone follow-up, on 26-APR-2021. The patient''s weight and weight were not reported. The patient''s concurrent conditions included hypertension, hyperlipidemia, and obesity. She was a non-smoker and had no history of acute illness. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration not reported, batch number: Unknown) frequency one total, dose was not reported, administered on 27-MAR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. Concomitant medications included blood pressure medication, vitamins, and a statin (all unspecified). On 21-APR-2021, the patient experienced Idiopathic thrombocytopenic purpura and was in critical condition. The patient presented with petechiae on her legs. Her platelet count was low, less than 9000 and all other labs were normal. The patient was hospitalized on 21-APR-2021 and the duration of hospitalization was not reported. The patient did not have any clots and she was treated with decadron and Intravenous immunoglobulin. On 22-APR-2021, the patient''s and improved the next day with platelet of 30,000 and she was discharged same day. on an unspecified date anti-PF 4 antibodies were performed and were normal. Fibrin D-dimer tests were not performed. The reporter stated the discharge diagnosis was Idiopathic thrombocytopenic purpura which could have been related to recent vaccination. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from Idiopathic thrombocytopenic purpura. This report was serious (Hospitalization Caused / Prolonged, Other Medically Important Condition, and Life Threatening).; Sender''s Comments: V0: This 60-year-old female was hospitalized for immune thrombocytopenia 25 days after receiving the Janssen Covid-19 vaccine for the prevention of symptomatic SARS-CoV-2 virus infection. Concurrent conditions included hypertension, hyperlipidemia, and obesity. She was a non-smoker and had no history of acute illness. Concomitant medications included unspecified blood pressure medication, a statin, and vitamins. Twenty-five days post-vaccination, she developed petechiae on her legs and was found to have a platelet count of 9000; all other labs were normal including anti-platelet factor 4. She did not have clots. She was admitted to the hospital the same day and was treated with dexamethasone and iv immunoglobulin. The next day, her platelet count improved to 30,000 and was discharged. Based on the available information, the relationship with Janssen Covid-19 vaccine is considered indeterminate. Additional information has been requested.


VAERS ID: 1270007 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-20
Onset:2021-04-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Bell's palsy, Lip swelling, Oral discomfort
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hearing impairment (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: METFORMIN
Current Illness: Diabetes mellitus
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Bell''s Palsy, face twisted; Burning in the mouth; Lips swelling; This spontaneous case was reported by a consumer and describes the occurrence of FACIAL PARALYSIS (Bell''s Palsy, face twisted) in a 60-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 031B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Diabetes mellitus. Concomitant products included METFORMIN for Diabetes mellitus. On 20-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 21-Apr-2021, the patient experienced FACIAL PARALYSIS (Bell''s Palsy, face twisted) (seriousness criterion medically significant), ORAL DISCOMFORT (Burning in the mouth) and LIP SWELLING (Lips swelling). At the time of the report, FACIAL PARALYSIS (Bell''s Palsy, face twisted), ORAL DISCOMFORT (Burning in the mouth) and LIP SWELLING (Lips swelling) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Treatment information was not provided. Company comment: Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.; Sender''s Comments: Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.


VAERS ID: 1271589 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-08
Onset:2021-04-21
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Disseminated varicella zoster virus infection, Herpes virus infection
SMQs:, Sepsis (broad), Opportunistic infections (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Valtrex, gabapentin, levothyroid
Current Illness: HYPOTHYROIDISM HYPERLIPIDEMIA HX OF TOTAL HYSTERECTOMY SCREENING FOR COLORECTAL CANCER, AVERAGE RISK DECLINES VACCINATION DECLINES MAMMOGRAM SCREENING DISSEMINATED HERPES ZOSTER
Preexisting Conditions:
Allergies: Sulfur
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt developed a disseminated Zoster-kin lesions on 4/21


VAERS ID: 1271931 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-02
Onset:2021-04-21
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Vertigo
SMQs:, Vestibular disorders (narrow)

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

Write-up: Severe virtigo


VAERS ID: 1272492 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-19
Onset:2021-04-21
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Coronary arterial stent insertion, Electrocardiogram abnormal, Myocardial infarction, Thrombosis
SMQs:, Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none reported
Preexisting Conditions: Unknown
Allergies: unknown
Diagnostic Lab Data: EKG, 4 Stints, Blood clot 4/25/21
CDC Split Type:

Write-up: Patient experienced a severe heart attack and was diagnosed with a blood clot


VAERS ID: 1272628 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-21
Onset:2021-04-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Blood test, Dizziness, Electrocardiogram, Loss of consciousness, Syncope, Urine analysis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), 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: Women?s multi vitamin, fish oil
Current Illness: None
Preexisting Conditions: None. Minor slightly high blood pressure.
Allergies: None known
Diagnostic Lab Data: Blood pressure and pulse monitored. Received EKG, blood, and urine tests. 4/21/21
CDC Split Type:

Write-up: Became slightly dizzy within ten minutes of vaccination. Increasing dizziness became severe. Passed out completely while sitting down. Woke up with an IV in my arm. Medic said my blood pressure had dropped dangerously low. Was loaded onto stretcher and transported by ambulance to the hospital ER. Blood pressure and pulse monitored. Received EKG, blood, and urine tests. No reported abnormalities. Discharged after three hours. Formal diagnosis was Syncope, a fainting episode.


VAERS ID: 1273787 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-14
Onset:2021-04-21
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 01805029 / UNK - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood immunoglobulin G normal, Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine
Current Illness: None
Preexisting Conditions: Thyroid
Allergies: None
Diagnostic Lab Data: Spike Protein (IGG) semi-quant 4/21/2021 Spike Protein (IGG) semi-quant 4/28/2021
CDC Split Type:

Write-up: No antibodies detected in Spike Protein (IGG) semi-quant tests performed 5 weeks (4/21) and 6 weeks (4/28) after the shot.


VAERS ID: 1273816 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-04-07
Onset:2021-04-21
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Anticoagulant therapy, Mesenteric vein thrombosis, Portal vein thrombosis, Splenic vein thrombosis, Thrombocytopenia
SMQs:, Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 24-year-old male patient with no past medical history received Johnson & Johnson Covid vaccine on April 7 presented to ED with abdominal pain and was found to have portal vein, splenic vein, superior mesenteric vein thrombosis. Patient was also found to be thrombocytopenic he was admitted to the stepdown unit placed on bivalirudin. Patient remains hospitalized at the time of this report.


VAERS ID: 1275930 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-17
Onset:2021-04-21
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest pain, Headache, Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: My arm went totally numb five days after the shot and stayed numb for a week, chest pain, tingling headaches.


VAERS ID: 1276406 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-04-21
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Ventricular extrasystoles
SMQs:, Ventricular tachyarrhythmias (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210442462

Write-up: PREMATURE VENTRICULAR CONTRACTION; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 041A21A expiry: UNKNOWN) dose was not reported, administered on 05-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 21-APR-2021, the patient experienced premature ventricular contraction. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of premature ventricular contraction was not reported. This report was non-serious.; Sender''s Comments: V0: Medical assessment comment not required as per standard procedure since case assessed as non serious.


VAERS ID: 1276423 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: South Carolina  
Vaccinated:0000-00-00
Onset:2021-04-21
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Suspected COVID-19, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210445626

Write-up: SUSPECTED COVID-19 INFECTION; SUSPECTED CLINICAL VACCINATION FAILURE; This spontaneous report received from a consumer concerned a male of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808609, expiry: UNKNOWN) dose was not reported, administered on 23-MAR-2021 for prophylactic vaccination. No concomitant medications were reported. On 21-APR-2021, the subject experienced suspected covid-19 infection. On 21-APR-2021, the subject experienced suspected clinical vaccination failure. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the suspected covid-19 infection and suspected clinical vaccination failure was not reported. This report was non-serious.; Sender''s Comments: v0-Medical assessment comment not required as per standard operating procedures, as case was assessed as non-serious.


VAERS ID: 1276426 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Indiana  
Vaccinated:0000-00-00
Onset:2021-04-21
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 test, Suspected COVID-19, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Blood pressure high (BP was stable at the time of report.)
Preexisting Conditions: Comments: The patient had no known allergies.
Allergies:
Diagnostic Lab Data: Test Date: 20210421; Test Name: SARS-CoV-2 test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20210446272

Write-up: SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION; This spontaneous report received from a healthcare professional (patient''s wife) concerned a 40-year-old, male patient. The patient''s height, and weight were not reported. The patient''s concurrent conditions included high blood pressure (stable at the time of report). The patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration was not reported, batch number: 1805031, and expiry: 26-MAY-2021) dose was not reported, 1 total, administered on right deltoid on 23-MAR-2021 for prophylactic vaccination. No concomitant medications were reported. On an unspecified date (couple of weeks before this report), the patient and his wife had been to a restaurant. On 14-APR-2021, the patient experienced nasal congestion which resolved on 17-APR-2021. On 21-APR-2021, the patient experienced cough and his wife recognized it as ‘COVID cough''. On the same day, the patient was tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was described by his wife as a breakthrough infection (suspected COVID-19 infection and suspected clinical vaccination failure). The patient''s wife mentioned that she thinks her husband probably caught the infection at the restaurant they had been to earlier. The reporter (wife) stated that the patient''s symptoms were very mild, he had no fever and did not need an HCP consultation or any medication to treat the symptoms. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the suspected covid-19 infection and suspected clinical vaccination failure was unknown. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0-COVID-19 VACCINE AD26.COV2.S-Suspected clinical vaccination failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS.


VAERS ID: 1276735 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-04-21
Onset:2021-04-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Diplopia, Headache, Lymphadenopathy, Pyrexia, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Ocular motility disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: GABAPENTIN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210421; Test Name: Body temperature; Result Unstructured Data: High
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Double vision; blurry vision (unable to see clearly with prescribed glasses); swollen lymph nodes under left arm; fever 101; headache; This spontaneous case was reported by a consumer and describes the occurrence of DIPLOPIA (Double vision) in a 48-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 036B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concomitant products included GABAPENTIN. On 21-Apr-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 21-Apr-2021, the patient experienced PYREXIA (fever 101) and HEADACHE (headache). On 22-Apr-2021, the patient experienced LYMPHADENOPATHY (swollen lymph nodes under left arm). On 23-Apr-2021, the patient experienced DIPLOPIA (Double vision) (seriousness criterion medically significant) and VISION BLURRED (blurry vision (unable to see clearly with prescribed glasses)). On 23-Apr-2021, PYREXIA (fever 101) had resolved. At the time of the report, DIPLOPIA (Double vision) outcome was unknown, VISION BLURRED (blurry vision (unable to see clearly with prescribed glasses)) was resolving and HEADACHE (headache) and LYMPHADENOPATHY (swollen lymph nodes under left arm) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 21-Apr-2021, Body temperature: 101 (High) High. Patient received treatment with ibuprofen (Motrin) and acetaminophen (Tylenol). Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded


VAERS ID: 1276736 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-21
Onset:2021-04-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 1 LA / OT

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Amnesia, Dysstasia, Fatigue, Headache, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: USMODERNATX, INC.MOD20210

Write-up: blacked out; can''t remember much about it and don''t know how she got on the floor; hard to get up; headache; still tired; stomach is real messed up; This spontaneous case was reported by a consumer and describes the occurrence of LOSS OF CONSCIOUSNESS (blacked out) in a 62-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 013M20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 21-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 21-Apr-2021, the patient experienced ABDOMINAL DISCOMFORT (stomach is real messed up), HEADACHE (headache) and FATIGUE (still tired). On 22-Apr-2021, the patient experienced LOSS OF CONSCIOUSNESS (blacked out) (seriousness criterion medically significant), AMNESIA (can''t remember much about it and don''t know how she got on the floor) and DYSSTASIA (hard to get up). On 22-Apr-2021, LOSS OF CONSCIOUSNESS (blacked out) and DYSSTASIA (hard to get up) had resolved. At the time of the report, AMNESIA (can''t remember much about it and don''t know how she got on the floor) outcome was unknown, ABDOMINAL DISCOMFORT (stomach is real messed up) and FATIGUE (still tired) had not resolved and HEADACHE (headache) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant product use was not reported. Treatment information was not provided. Based on the information provided which includes a temporal association between the use of mRNA-1273 vaccine and onset of the reported events, a causal relationship cannot be excluded. Headache and fatigue are consistent with the product safety profile; Sender''s Comments: Based on the information provided which includes a temporal association between the use of mRNA-1273 vaccine and onset of the reported events, a causal relationship cannot be excluded. Headache and fatigue are consistent with the product safety profile


VAERS ID: 1276741 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-14
Onset:2021-04-21
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Feeling abnormal, Imaging procedure, Loss of consciousness, Nausea, Shock haemorrhagic, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Hypovolaemic shock conditions (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Splenectomy (did get embolization but progressed to further bleeding)
Allergies:
Diagnostic Lab Data: Test Name: Adbominal Imaging; Result Unstructured Data: abd imaging showed a large splenic subcapsular hematoma of unclear etiology (no hx of trauma) with hemoperitoneum
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: became unresponsive; hemorrhagic shock; syncope; abdominal pain; wasn''t feeling good; nausea; vomiting; This spontaneous case was reported by an other health care professional (subsequently medically confirmed) and describes the occurrence of LOSS OF CONSCIOUSNESS (became unresponsive), SHOCK HAEMORRHAGIC (hemorrhagic shock), SYNCOPE (syncope), ABDOMINAL PAIN (abdominal pain), FEELING ABNORMAL (wasn''t feeling good), NAUSEA (nausea) and VOMITING (vomiting) in a 63-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Splenectomy (did get embolization but progressed to further bleeding) on 24-Apr-2021. On 14-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 21-Apr-2021, the patient experienced LOSS OF CONSCIOUSNESS (became unresponsive) (seriousness criterion hospitalization), SHOCK HAEMORRHAGIC (hemorrhagic shock) (seriousness criterion hospitalization), SYNCOPE (syncope) (seriousness criterion hospitalization), ABDOMINAL PAIN (abdominal pain) (seriousness criterion hospitalization), FEELING ABNORMAL (wasn''t feeling good) (seriousness criterion hospitalization), NAUSEA (nausea) (seriousness criterion hospitalization) and VOMITING (vomiting) (seriousness criterion hospitalization). The patient was hospitalized on 21-Apr-2021 due to ABDOMINAL PAIN, FEELING ABNORMAL, LOSS OF CONSCIOUSNESS, NAUSEA, SHOCK HAEMORRHAGIC, SYNCOPE and VOMITING. At the time of the report, LOSS OF CONSCIOUSNESS (became unresponsive), SHOCK HAEMORRHAGIC (hemorrhagic shock), SYNCOPE (syncope), ABDOMINAL PAIN (abdominal pain), FEELING ABNORMAL (wasn''t feeling good), NAUSEA (nausea) and VOMITING (vomiting) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Imaging procedure: (abnormal) abd imaging showed a large splenic subcapsular hematoma of unclear etiology (no hx of trauma) with hemoperitoneum. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter considered ABDOMINAL PAIN (abdominal pain), NAUSEA (nausea) and VOMITING (vomiting) to have an unknown relationship. No further causality assessments were provided for LOSS OF CONSCIOUSNESS (became unresponsive), SHOCK HAEMORRHAGIC (hemorrhagic shock), SYNCOPE (syncope) and FEELING ABNORMAL (wasn''t feeling good). Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. However, Very limited information regarding these events has been provide at this time. Further information has been requested.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. However, Very limited information regarding these events has been provide at this time. Further information has been requested.


VAERS ID: 1276766 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-19
Onset:2021-04-21
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Oropharyngeal blistering
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)

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: USMODERNATX, INC.MOD20210

Write-up: blisters in the back of throat; This spontaneous case was reported by a consumer and describes the occurrence of OROPHARYNGEAL BLISTERING (blisters in the back of throat) in a 59-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 036A21A) for COVID-19 vaccination. No Medical History information was reported. On 19-Apr-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 21-Apr-2021, the patient experienced OROPHARYNGEAL BLISTERING (blisters in the back of throat) (seriousness criterion medically significant). At the time of the report, OROPHARYNGEAL BLISTERING (blisters in the back of throat) outcome was unknown. Not Provided Action taken with mRNA-1273 in response to the events was not Applicable. Concomitant and treatment information not provided. Treatment information was not provided. Company Comment: This case concerns a 59-year-old female with a serious unexpected event of oropharyngeal blistering. Event onset 3 days after second dose mRNA-1273. Event outcome unknown. Based on current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.; Sender''s Comments: This case concerns a 59-year-old female with a serious unexpected event of oropharyngeal blistering. Event onset 3 days after second dose mRNA-1273. Event outcome unknown. Based on current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.


VAERS ID: 1277479 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-30
Onset:2021-04-21
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, General symptom, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: 2 years post kidney transplant
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client had a breakthrough covid-19 infection. Symptom onset 4/21/21. Client was fully vaccinated with J&J on 3/30/21.


VAERS ID: 1280542 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-07
Onset:2021-04-21
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-05-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Headache, Neck pain, Pain of skin
SMQs:, Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Isosorbide, Felodipine, Metroprolol, Simvastatin, Vitamin D, C, Fish Oil. Stinging Nettle, Asprin, Multi Vitamin
Current Illness: None
Preexisting Conditions: Variant angina, Hypo Glycemia
Allergies: None aware of.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe headaches and pain, right foehead, right side of head and neck and right side back of neck. Skin in hair on right side hurts to touch.


VAERS ID: 1284724 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-04-21
Onset:2021-04-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure decreased, Dizziness, Feeling hot, Hyperhidrosis, Lethargy, Loss of consciousness, Myalgia, Pain in extremity
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: passing out; blood pressure of 70/40; Feeling hot; Sweaty; Dizziness; Lethargy; Sore arm; Achy all over; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of LOSS OF CONSCIOUSNESS (passing out) in a 56-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 027B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 21-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 21-Apr-2021, the patient experienced LOSS OF CONSCIOUSNESS (passing out) (seriousness criterion medically significant), BLOOD PRESSURE DECREASED (blood pressure of 70/40), FEELING HOT (Feeling hot), HYPERHIDROSIS (Sweaty), DIZZINESS (Dizziness), LETHARGY (Lethargy), PAIN IN EXTREMITY (Sore arm) and MYALGIA (Achy all over). On 21-Apr-2021, LOSS OF CONSCIOUSNESS (passing out) had resolved. At the time of the report, BLOOD PRESSURE DECREASED (blood pressure of 70/40), FEELING HOT (Feeling hot), HYPERHIDROSIS (Sweaty), DIZZINESS (Dizziness), LETHARGY (Lethargy), PAIN IN EXTREMITY (Sore arm) and MYALGIA (Achy all over) outcome was unknown. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications reported. Patient reports that paramedics had to come after he passed out. Treatment of the events included acetaminophen. Company comment: This case concerns a 56-year-old male with a serious unexpected event of loss of consciousness, and nonserious unexpected blood pressure decreased, feeling hot, hyperhidrosis, dizziness, lethargy and expected pain in extremity. Event onset the same day as first dose mRNA-1273. Events resolved. Based on current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.


VAERS ID: 1286651 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-10
Onset:2021-04-21
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiotensin converting enzyme, Anti-ganglioside antibody, Anti-muscle specific kinase antibody, Aspiration, Bladder catheterisation, Borrelia test negative, Borrelia test positive, CSF glucose increased, CSF lymphocyte count increased, CSF protein increased, CSF white blood cell count increased, Condition aggravated, Facial paralysis, Facial paresis, Lumbar puncture abnormal, Lyme disease, Magnetic resonance imaging head abnormal, Magnetic resonance imaging thoracic abnormal, Multiple sclerosis, Muscular weakness, Urinary retention, Viral test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Demyelination (narrow), Hearing impairment (broad), Malignant lymphomas (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen CR 650 mg by mouth every 8 hours as needed atorvastatin 40 mg daily Lithium CR 900 mg nightly. Lamotrigine XL 400 mg nightly with a blood level of 3.2 on 200 mg nightly. Olanzapine 30 mg nightly. Doxepin 10 mg nightly Clon
Current Illness: Recent mild worsening of his chronic multiple sclerosis symptoms of reduced right hand dexterity and gait imbalance.
Preexisting Conditions: Insomnia Hyperlipidemia Anxiety: Obsessive Excessive daytime sleepiness Restless leg syndrome Obesity OSA on CPAP Relapsing-remitting multiple sclerosis Myopia with astigmatism and presbyopia, bilateral Bipolar 1 disorder: Currently stable and most recent episode manic psychosis Lipoma of torso Weakness Tobacco use disorder
Allergies: NKDA
Diagnostic Lab Data: see above
CDC Split Type:

Write-up: The patient is a 49 year old male who has a past medical history significant for bipolar disorder with manic episodes, OSA on CPAP, morbid obesity, HLD, and relapsing remitting MS. Per chart review, patient''s MS was initially diagnosed in 2012 on MRI and LP and was on Copaxone for several years but stopped taking in 2017. Symptoms and imaging remained stable through 2019 then patient was lost to follow up until he was seen by Dr. on 4/12/21 who ordered an outpt MRI. Patient had COVID vaccine with Jansen vaccine on 4/10/21. He developed bilateral upper and lower exremity weakness and urinary retention on 4/21/21 which prompted presentation. He came into ED 4/21/21 and had foley placed but removed foley and decided to leave AMA. Returned on 4/22/21 with worsening symptoms and was subsequently admitted. Patient was seen by neurology and started on high dose steroid x5d for MS exacerbation. Initial MRI of the brain obtained on 4/22/21 was notably stable without change in previously described white matter disease. No new lesions to suggest active demyelination. New plaques were noted on MRI C and T spine (4/22/21). It is noted that patient received COVID19 vaccination with J&J vaccine on 4/10/21 and temporal relationship between his acute presentation and recent vaccination was questioned. On 4/30/21, patient developed severe bilateral facial weakness and he additionally was reported to have had an episode of aspiration. Repeat MRI brain on 4/30/21 showed new bilateral facial nerve enhancement. Etiologies could include: GBS, Lyme disease, botulism, neurosarcoidosis, less likely myasthenia gravis. LP was pursued on 5/1/21 which was significant for tube 4 with 136 WBC, 88% lymphocytes, glucose 89, protein 632. Meningitis/encephalitis panel was negative. Lyme CSF was negative, Lyme antibody panel was positive. MuSK antibody negative. ACE blood level normal. Ganglioside antibody panel and myasthenia graivs adult panel pending. He is being treated for Lyme disease with Ceftriaxone 2g IV daily since 5/1/21 with plan for 2-4 week course to cover for Lyme disease. He is still admitted and is still having symptoms of facial palsy as of today (5/4/21)


VAERS ID: 1288105 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-21
Onset:2021-04-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoaesthesia, Neuropathy peripheral, Pain, Paraesthesia, Vaccination complication
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Myelitis transverse (Patient had scar on spinal cord and caused by transverse myelitis.); Neuropathy (Neuropathy 7 years ago)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: neuropathy; having unusual reaction; shooting pain in an abdomen towards ovaries; extreme pain in spinal cord , it hurts badly;hand hurts like hell; numbness in both feet; tingling in both feet; This spontaneous case was reported by a consumer and describes the occurrence of NEUROPATHY PERIPHERAL (neuropathy) in a 41-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 028A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Neuropathy (Neuropathy 7 years ago) and Myelitis transverse (Patient had scar on spinal cord and caused by transverse myelitis.). On 21-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 21-Apr-2021, the patient experienced VACCINATION COMPLICATION (having unusual reaction), PAIN (shooting pain in an abdomen towards ovaries; extreme pain in spinal cord , it hurts badly;hand hurts like hell), HYPOAESTHESIA (numbness in both feet) and PARAESTHESIA (tingling in both feet). On an unknown date, the patient experienced NEUROPATHY PERIPHERAL (neuropathy) (seriousness criterion medically significant). At the time of the report, NEUROPATHY PERIPHERAL (neuropathy), VACCINATION COMPLICATION (having unusual reaction), PAIN (shooting pain in an abdomen towards ovaries; extreme pain in spinal cord , it hurts badly;hand hurts like hell), HYPOAESTHESIA (numbness in both feet) and PARAESTHESIA (tingling in both feet) outcome was unknown. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant medication information not provided. Treatment information not provided. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1288108 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-20
Onset:2021-04-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C1A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Sciatica, Systemic lupus erythematosus
SMQs:, Systemic lupus erythematosus (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Lupus erythematosus systemic; Sjogren''s syndrome
Preexisting Conditions: Medical History/Concurrent Conditions: Arthritis; Sciatica
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: Lupus flare up; Sciatica Pain in the Hip; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of SYSTEMIC LUPUS ERYTHEMATOSUS (Lupus flare up) in a 58-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 002C1A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Sciatica and Arthritis. Concurrent medical conditions included Sjogren''s syndrome and Lupus erythematosus systemic. On 20-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 21-Apr-2021, the patient experienced SYSTEMIC LUPUS ERYTHEMATOSUS (Lupus flare up) (seriousness criterion medically significant) and SCIATICA (Sciatica Pain in the Hip). On 27-Apr-2021, SYSTEMIC LUPUS ERYTHEMATOSUS (Lupus flare up) and SCIATICA (Sciatica Pain in the Hip) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications were provided. The patient visited the Emergency Room (Does not remember exact date but it happened after vaccination). Treatment medication reported includes Prednisone, Morphine and Phenergan. Company comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1289049 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-05
Onset:2021-04-21
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 0424214 / UNK - / -

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

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

Write-up: Had the single dose Jansen in the left arm in muscle. A couple of weeks later hair top of head fell out. Now balding


VAERS ID: 1289578 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-04-12
Onset:2021-04-21
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Asthenia, Dyspnoea, Fatigue, Fibrin D dimer increased, Headache, Neck pain, Pulmonary embolism
SMQs:, Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Arthritis (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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol-ipratropium amLODIPine atenolol cephalexin cilostazol clopidogrel
Current Illness: None
Preexisting Conditions: Benign hypertension COPD GERD Hypercholesterolemia Hypothyroidism Non-insulin dependent type 2 diabetes mellitus Right carotis bruit Thrombocytopenia TIA
Allergies: codeine, Dilaudid
Diagnostic Lab Data: 04.21.2021 D-dime 3.46 CT angiogram of the chest - small PE in right middle lobar pulmonary artery
CDC Split Type:

Write-up: Presented to ER with weakness and tired last couple of days. Left side of neck pain and headache, shortness of breath.


VAERS ID: 1294691 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-20
Onset:2021-04-21
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / -

Administered by: School       Purchased by: ?
Symptoms: Headache, Heart rate, Heart rate increased, Hyperhidrosis, Nausea, Pain, Pyrexia, SARS-CoV-2 test, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: MELATONIN; FISH OIL; CALCIUM
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210421; Test Name: Heart rate; Result Unstructured Data: Test Result:elevated to about 90 bpm; Test Name: Heart rate; Result Unstructured Data: Test Result:resting heartrate of 60; Test Date: 20210420; Test Name: Saliva; Test Result: Negative
CDC Split Type: USPFIZER INC2021444343

Write-up: fainted; aches; headache; fever; nauseous; excessively sweating; heartrate was elevated to about 90 bpm vs resting heartrate of 60 and remained elevated for the next 12 hours; This is a spontaneous report from a contactable consumer reporting for himself. A 29-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE) (lot number ER8735/expiration date: not provided), via an unspecified route of administration, on 20Apr2021 at 08:30 (at the age of 29 years old) as a single dose in the left arm for COVID-19 IMMUNIZATION. The patient previously received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE) (lot number /expiration date: not provided), via an unspecified route of administration, on 04Jan2021 at 12:00 (at the age of 29 years old) as a single dose in the left arm for COVID-19 IMMUNIZATION. Relevant medical history included was not provided. The patient did not have any known allergies to medications, food, or other products. Prior to the vaccination, the patient was not diagnosed with COVID-19. Concomitant medication included melatonin, fish oil, calcium. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. On 21Apr2021 at 02:00, the patient fainted, experienced aches, headache, fever, nauseous, excessively sweating, and heartrate was elevated to about 90 bpm vs resting heartrate of 60 and remained elevated for the next 12 hours. The patient went to the emergency room due to the events and received treatment for these events which included fluids. The clinical course was as follows: after experiencing expected side effects (aches, headache, fever), the patient got up to use the restroom in the middle of the night. About 1-2 minutes after getting up, he fainted. The patient awoke shortly after on the floor and felt nauseous and was excessively sweating. His heartrate was elevated to about 90 bpm vs resting heartrate of 60 and remained elevated for the next 12 hours. The outcome of the events was recovering. Since the vaccination, the patient had been tested for COVID-19 (saliva test) on 20Apr2021, and the result was negative.


VAERS ID: 1294692 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-17
Onset:2021-04-21
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 LA / -

Administered by: Work       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VITAMIN C [ASCORBIC ACID;BIOFLAVONOIDS NOS;HESPERIDIN;MALPIGHIA GLABRA;ROSA CANINA;RUTOSIDE]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Cancer
Allergies:
Diagnostic Lab Data: Test Date: 20210421; Test Name: Nasal Swab; Test Result: Positive
CDC Split Type: USPFIZER INC2021444348

Write-up: Tested positive for COVID-19 21Apr2021; Tested positive for COVID-19 21Apr2021; This is a spontaneous report from a contactable consumer. A 46-years-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE) dose 2 via an unspecified route of administration, administered in Arm Left on 17Mar2021 15:00 (Batch/Lot Number: EN6203) as SINGLE DOSE for covid-19 immunisation . Medical history included prior cancer (nonspecific) from an unknown date and unknown if ongoing. Patient was not pregnant. Historical vaccine included BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), dose 1 at 03:00PM on 24Feb2021, Lot EL3247 for covid-19 immunization. Concomitant medication(s) included ascorbic acid, bioflavonoids nos, hesperidin, malpighia glabra, rosa canina, rutoside (VITAMIN C [ASCORBIC ACID;BIOFLAVONOIDS NOS;HESPERIDIN;MALPIGHIA GLABRA;ROSA CANINA;RUTOSIDE]) taken for an unspecified indication, start and stop date were not reported. The patient received Dose 2 on 17Mar2021 then had fever 16Apr that resolved in 2 days. Three days later she experienced loss of smell. Patient was tested positive for COVID-19 21Apr2021. Outcome for events vaccination failurewas unknown , 21apr2021. Outcome for tested positive for covid-19, fever , loss of smell was recovering. The patient underwent lab tests and procedures which included sars-cov-2 test (nasal swab): positive on 21Apr2021.


VAERS ID: 1231439 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-12
Onset:2021-04-20
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site rash, Pain in extremity, Pain of skin
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (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: Escitalopram, 15mg daily Methylphenidate, 18mg daily Melatonin, 6mg daily Blisovi 24 Fe (birth control)
Current Illness:
Preexisting Conditions:
Allergies: Welbutrin
Diagnostic Lab Data:
CDC Split Type:

Write-up: - Sore arm from 18hours after injection until ~2.5 days after injection - Delayed cutaneous hypersensitivity ("covid arm"): a firm red lesion around the injection site and soreness from up upper left arm down into my hand 7 days, 15 hours after injection (1 hour ago from inputting info here)


VAERS ID: 1231441 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-17
Onset:2021-04-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA HUFPP / 2 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Injection site rash, Injection site swelling, Injection site warmth, Post-acute COVID-19 syndrome
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), 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: Sertraline HCL, Cetirizine HCL, Methylphenidate, Valacyclovir,
Current Illness:
Preexisting Conditions: HSV-2
Allergies: Environmental only: pollen, animal dander, dust mites, mold, hay fever
Diagnostic Lab Data:
CDC Split Type:

Write-up: Covid arm (?) Swelling, rash, and warmth developing at the site of the injection beginning 3 days after vaccination number 2


VAERS ID: 1231570 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-19
Onset:2021-04-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Headache, Injection site pain, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Serataline, Ibuprofen,
Current Illness:
Preexisting Conditions: SVT - Supraventriculartachicardia (heart condition)
Allergies: Demerol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, fever, muscle/body ache, headache, pain at injection point. Took Ibuprofen


VAERS ID: 1231571 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-07
Onset:2021-04-20
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysmenorrhoea, Heavy menstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Joint pain, fever chills,
Other Medications: Collagen Vitamin D, Vit C, zinc, selenium,
Current Illness: Hashimotos Thyroiditis
Preexisting Conditions: Hashimotod thyroid it if
Allergies: Nkda
Diagnostic Lab Data: Will be checking fsh, LH, estrogen and testosterone with MD
CDC Split Type:

Write-up: Severe menstrual cramps/pain and Heavy period began abruptly 8 days early at 5:30am.. Previously every 28 days and light s/p endometrial ablation.


VAERS ID: 1231696 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-19
Onset:2021-04-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Ehler''s-Danlos Syndrome
Allergies: peanuts, tree nuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: hives, itching across right torso


VAERS ID: 1231697 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-20
Onset:2021-04-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Dysmenorrhoea
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: Fluoxetine, amitriptyline, multi-vitamin, vitamin c, vitamin d, biotin, vitamin b12
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderate to severe menstrual cramps (outside of cycle)


VAERS ID: 1231977 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-20
Onset:2021-04-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea, Electrocardiogram, Fall, Lethargy, Miosis, Nausea, Pallor, Unresponsive to stimuli, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Plavix, warfarin, unknown others.
Current Illness: Patient denies
Preexisting Conditions: Prostate Cancer
Allergies: PCN
Diagnostic Lab Data: EKG by EMS 4/20/21
CDC Split Type:

Write-up: Lethargic, pale, glassy and pinpoint eyes to unresponsive, limp and falling to the right side. Client laid on ground due to unresponsiveness and unable to obtain vitals, client gasped when laid flat then reported nausea, rolled to side client started vomiting. EMS called, EKG ran, client refused services. Walked out of clinic.


VAERS ID: 1231979 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-11
Onset:2021-04-20
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

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

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

Write-up: Headache, right sided. Mild-moderate severity. Persistent.


VAERS ID: 1231983 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-20
Onset:2021-04-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Injury associated with device, No adverse event
SMQs:, Medication errors (broad)

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

Write-up: patient had no adverse event. I was stuck by needle upon capping needle.


VAERS ID: 1232008 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-04-20
Onset:2021-04-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PANTOPRAZOLE, MULTI-VITAMIN, APPLE CIDER VINEGAR,BLACK ELDERBERRY & CALCIUM
Current Illness:
Preexisting Conditions:
Allergies: NO
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT STATED FELT NUMBNESS/TINGLING STARTING IN FINGERTIPS & HAND AND PROGRESSED UP HER ARM TO SHOULDER. SHE WAS GIVEN BENADRYL TO HELP ABATE REACTION. SHE STATED FOR OBSERVATION FOR 30 MINUTES POST-VACCINATION. THE NUMBNESS HADN''T STOPPED WHEN SHE LEFT BUT SHE DID STATE IF THE REACTION CONTINUED INTO TOMORROW SHE WOULD GO TO SEE A DOCTOR.


VAERS ID: 1232014 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-04-11
Onset:2021-04-20
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Injection site erythema, Injection site rash, Injection site swelling, Pruritus, Rash macular
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion, Vitamin D, Emergen-C, Omega 3 with CoQ10, DairyCare (for lactose intolerance)
Current Illness: none
Preexisting Conditions: asthma, diminished (left) lung capacity (due to congenital defect)
Allergies: none
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: I woke up this morning, approx 9 days after getting the vaccine, with a red, slightly raised splotch (rash?) that is about 1 inch in diameter at the site of injection. The spot is a little itchy, but not painful.


VAERS ID: 1232045 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-20
Onset:2021-04-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: No symptoms at this time. Patient presented for appointment set up in state system. Pharmacist administered second dose too soon without noting that patient had received first dose on 4/6/21.


VAERS ID: 1232049 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-20
Onset:2021-04-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Eructation, Hyperhidrosis, Slow response to stimuli, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: not known
Current Illness: not known
Preexisting Conditions: not known/patient had hospital bracelet on right wrist dated 4/13/2021.
Allergies: not known
Diagnostic Lab Data: FSBS done when EMT''s arrived and was "WNL", B/P was 132/80, P=82, R=16, Sp02=98%. FSBS done when EMT''s arrived and was "WNL"
CDC Split Type:

Write-up: Patient sitting in lobby for recommended 15 min observation time. He burped loudly, vomited (green/yellow vomitus), slumped to his right in the chair. Patient was diaphoretic and slow to respond to verbal stimuli.


VAERS ID: 1232059 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-20
Onset:2021-04-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044B21A / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect product formulation administered
SMQs:, Medication errors (narrow)

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

Write-up: Pt received 1st dose of Pfizer on 3/30/2021. Pt came back to the clinic for 2nd dose of Pfizer on 4/20/2021 and received a dose of Moderna not 2nd dose of Pfizer.


VAERS ID: 1232065 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-19
Onset:2021-04-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Body temperature increased, Chills, Headache, Hyperhidrosis, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Fluoxetine, lamotrigine, quetiapine, yaz
Current Illness: No e
Preexisting Conditions: Bipolar
Allergies: Sulfa drugs - mild rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: Temp of 103 and still 101 after administration of acetaminophen. Headache. Body aches. Chills. Sweats. Mild nausea


VAERS ID: 1232090 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-04-17
Onset:2021-04-20
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21-2A / 1 LA / IM

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

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

Write-up: About two days after I received the vaccine, two days later in the morning I woke with hives on the left side of my body.


VAERS ID: 1232520 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-12
Onset:2021-04-20
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / N/A LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT HAVING BRUISE AROUND INJECTION SITE RED AND BLACK SINCE LAST 8 DAYS.


VAERS ID: 1232655 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-04-12
Onset:2021-04-20
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deep vein thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad)

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

Write-up: patients PCP office called to inform us that patient was positive for a DVT today. She was calling to inform us of the adverse event following her vaccination 04/12/2021. Blood clots were the reason that was reported for this vaccine to be pulled from the market the very next day 04/13/2021. Called the office back and left message with them to report as well since they have lab work and other patient information


VAERS ID: 1232806 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-08
Onset:2021-04-20
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia
SMQs:, Taste and smell disorders (narrow)

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

Write-up: All liquids are bitter tasting on back of tongue...including water


VAERS ID: 1233079 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-20
Onset:2021-04-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Chills, Dizziness, Headache, Malaise, Tinnitus
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad)

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

Write-up: I?m sick weak headaches chills ... dizzy loud ringing in ears . I?ve never been so sick in my life


VAERS ID: 1234170 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-20
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site swelling, Thrombosis, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

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

Write-up: We got a call from Doctor from ER to inform us that this patient came to the ER today & got swollen arm @ the injection site (left arm). They did the ultra sound & found there''s a clot in brachial vein on the opposite arm (right arm). Doctor said they''ll give pt Eliquist today.


VAERS ID: 1234183 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-01
Onset:2021-04-20
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flaxseed oil 1000 mg, Vitamin A 2400 mcg, Vitamin C 500 mg, Vitamin D3 1000 IU
Current Illness: None
Preexisting Conditions: leukoencephalopathy, history of epilepsy and mTBI
Allergies: Allergic to zithromax, cyproheptadine, shellfish, nuts, peas, beans, poultry
Diagnostic Lab Data: None to date.
CDC Split Type:

Write-up: Fainted immediately after the shot. This is not the first time he has fainted after a shot, though.


VAERS ID: 1234195 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-09
Onset:2021-04-20
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

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

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

Write-up: I experienced headaches, prolong and abdominal cramping and fatigue. My symptoms are mild and I had a virtual call with my PCP and told me to take OTC Tylenol or Advil and to monitor my symptoms. I continue with slight headaches that come and go.


VAERS ID: 1234506 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-01
Onset:2021-04-20
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / N/A LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, Blood pressure decreased, Dizziness, Feeling hot, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Occasional women?s multi vitamin
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Blood pressure taken. 52/32 while unconscious. Gradually increased to a low normal bp.
CDC Split Type:

Write-up: Approx 5 mins after injection I felt very sick to my stomach, very hot, and began feeling faint. Around 7 mins after injection I lost consciousness. My blood pressure dropped to 52/32 according to the EMT on site.


VAERS ID: 1234866 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-10
Onset:2021-04-20
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthma, Chills, Cough, Dyspnoea, Fatigue, Feeling cold, Haemoptysis, Pyrexia, Respiratory disorder
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: After the initial "normal" side effects.. fever, fatigue, cold chills... I started having respiratory discomfort and shortness of breath. About a day or two later, I developed a chronic cough that is still currently persisting. After seeing my doctor on Sat 4/17, I was prescribed an Albuterol inhaler for asthma, which has been dormant for years. The coughing is continuous, and at times strong/violent. On the morning of Tues 4/20 I had coughed up a little bit of blood after the coughing had persisted for about 5 or 10 minutes. Asthma, chronic cough, and coughing up blood are not typical/documented side effects of received the Covid vaccine. My asthma has been dormant for years, and prior to this event, I have not had instances of chronic cough or coughing up blood.


VAERS ID: 1234875 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-09
Onset:2021-04-20
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vicodin 10-315
Current Illness: No
Preexisting Conditions: Degenerative Disc Disease
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: I felt extreme fatigue and general malaise at 14:30. I took a Vicodin for my chronic back pain and lost consciousness at 15:00. I Went to bed and woke up at 16:25. 30 min later I slept again for about 90 min. Then I woke up and walked outside for some fresh air and got this extreme ice pick pain in the left side of my head for a few seconds. Then a few seconds later again. Now it just nags a bit behind my left eye and it feels a bit off in the left side of my brain. Bright lights hurt a bit. My back pain and Sciatica is also a lot higher than normal.


VAERS ID: 1235152 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-20
Onset:2021-04-20
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Chills, Dizziness, Headache, Hyperhidrosis, Metamorphopsia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Retinal disorders (narrow), Vestibular 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nuva Ring, Arnuity Ellipta inhaler, Escilatopram, vegan B12 vitamin
Current Illness: None
Preexisting Conditions: None that I''m aware of
Allergies: Seasonal allergies only
Diagnostic Lab Data: None
CDC Split Type: Janssen 1808609 MASSVA

Write-up: I received the vaccine at about 9:30 AM. From about 8:00 pm - 8:45 pm I experienced a pattern of 30-90 seconds of normal vision, then 1-2 seconds of only being able to see light/colors/shapes (I had lasik in 2016, my prescription was -4.75, the 1-2 seconds of bad vision I experienced was like when I removed my glasses before having lasik correct my vision). This pattern of 30-90 seconds normal vision then 1-2 seconds of bad vision repeated for about 45 minutes. During this time I was also very dizzy and lightheaded. My other side effects were as expected (fever of up to 102, chills, VERY sweaty, did not have energy to remove my sweatshirt when I was hot, headache). I am only reporting this in case it is important/helpful for further studies/development of the vaccine and public health.


VAERS ID: 1235579 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-12
Onset:2021-04-20
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/a
Current Illness: N/a
Preexisting Conditions: Obesity
Allergies: N/a
Diagnostic Lab Data: Nothing yet, it just started tonight
CDC Split Type:

Write-up: Rash/redness at injection site. Itching. Feels like a lump under the skin that wasn''t there before. Just started this evening. Will put ice on it and perhaps take an anti histamine tomorrow if it still itches.


VAERS ID: 1235584 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-20
Onset:2021-04-20
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tremor, Vital signs measurement
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

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

Write-up: Patient got vaccinated at 10:32 AM. He called at 2:24 PM and said that his hand has been shaking "since 2 hours ago". He said it''s been like that for 1 hour. He self-reports that he checked his blood glucose & blood pressure and they''re all within normal. I told him to see MD ASAP. Last I heard from him was that he''s going to call an ambulance.


VAERS ID: 1235587 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-19
Onset:2021-04-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Diarrhoea, Fatigue, Pain, Pyrexia, Sleep disorder, Swelling, Tremor, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Around 12 hours after the shot, I took Tylenol for body aches and fever. I woke around 3:30 am to shaking and stomach pains then fell back asleep. I woke up again around 5:15 am to intense involuntary shaking. My family members wrapped me in blankets and applied pressure to my body until the shaking stopped. Within the next 40 minutes I vomited and had diarrhea. At the time also had body aches, chills, fever, and mild swelling of various areas if the body. I slept most of the morning and ate lunch around 1:30 pm. I took Tylenol again at 2:00 pm with the symptoms lessening over the next 5-6 hours. After that fever, chills, and body aches returned.


VAERS ID: 1235591 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-19
Onset:2021-04-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048AZ/A / UNK RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Anosmia, Decreased appetite, Headache, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Saxenda 0.6mg, Gabapentin 1600mg, probiotic, prebiotic, omega 3, magnesium
Current Illness: none
Preexisting Conditions: High bmi (37)
Allergies: Onions and alliums
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body aches, nausea, headache, lack of appetite, loss of smell for 4 hours, treated with 200 mg ibuprofen


VAERS ID: 1235598 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-19
Onset:2021-04-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Chills, Fatigue, Headache, Hyperhidrosis, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 200 MG Lamictal
Current Illness: None
Preexisting Conditions: Asthma & Bipolar
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever 102.3 F, nausea, chills, sweats, headache, fatigue, joint pain and body weakness


VAERS ID: 1235602 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-20
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Ocular discomfort, Physical examination, Vision blurred, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C, Vitamin B, MSM
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: They only really tested my vision, my blood pressure, looked in my eyes, ears, nose and throat along with listening to my lungs and arteries.
CDC Split Type:

Write-up: Started getting a blurry circle in my vision around 11am. It kept bothering me. I kept closing my eye and thinking it was just something bright I looked at that made the circle appear, but then I couldn?t really see and there was a white line that snaked around and started strobing a few different colors and my eye felt lazy and heavy. This lasted around 25-30 minutes. I have never experienced this before in my life and really freaked me out thinking I had a stroke, but could walk and talk fine and


VAERS ID: 1235603 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-12
Onset:2021-04-20
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

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

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

Write-up: Bump under the injection sight that has swelled, same size as a golf ball around. Aches a bit, and is red.


VAERS ID: 1235619 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-12
Onset:2021-04-20
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: I had no symptoms 4 days post-vaccine. Then, 8 days after receiving the vaccine, the injection site swelled again, and became red and itchy. It looks like a giant bug bite.


VAERS ID: 1235620 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-04-06
Onset:2021-04-20
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (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: Low Dose Aspirin Flecainide Acetate 50mg Metoprolol Tartrate 50mg Dutasteride.5mg Glucosamine Sulfate Potassium Cholride 1000mg Centrum SilverBiotin 10,000mcg
Current Illness: N/A
Preexisting Conditions: Atrial fibrillation
Allergies: Shellfish
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Feel winded, short of breath, with moderate physical exertion . ex briskly walking up a long flight of stairs a couple of time wearing a mask caused me to breath every hard. Seems more than normal....I had to keep the mask on Typically, with heavy physical exertion I would feel this way. Also, The first time this happened I did feel a little light headed and noticed a higher than normal heart rate.


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