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

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



Case Details (Reverse Sorted by Onset Date)

This is page 210 out of 8,010

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VAERS ID: 1709032 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-09-07
Onset:2021-09-11
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 3 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram cerebral, Arteriogram carotid, Blood lactic acid, Blood magnesium, Chest X-ray, Computerised tomogram head, Coordination abnormal, Differential white blood cell count, Electrocardiogram, Full blood count, Metabolic function test, Muscular weakness, Paraesthesia, Reflex test, Respiratory viral panel, SARS-CoV-2 test, Scan with contrast, Troponin I, Urine analysis
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Alendronate Sodium 70 mg Oral EVERY 14 DAYS, Takes one every other Saturday. Aspirin 81 mg Oral DAILY Coenzyme Q10 150 mg Oral DAILY Cyclobenzaprine HCl 10 mg Oral 3 TIMES DAILY PRN Eszopiclone 3 MG TAKE 1 TABLET BY MOUTH DAILY AT BEDTI
Current Illness: ? CAD (coronary artery disease) ? Cancer 2003 skin CA - nose ? Chronic anticoagulation 1-30-15 Plavix & baby aspirin for anticoagulation because he has 2 cardiac stents that were placed in 12/2014. ? Diverticulosis of large intestine 08/08/2018 ? H/O idiopathic urticaria ? Hyperlipidemia ? Hypertension ? Immune deficiency disorder ? Lupus ? Myocardial infarction 2013 ? Non-functioning gallbladder 1-30-15 ? Osteoporosis ? Pericardial effusion ? Status post colonoscopy with polypectomy 08/08/2018 ? Thyroid disease
Preexisting Conditions: ? CAD (coronary artery disease) ? Cancer 2003 skin CA - nose ? Chronic anticoagulation 1-30-15 Plavix & baby aspirin for anticoagulation because he has 2 cardiac stents that were placed in 12/2014. ? Diverticulosis of large intestine 08/08/2018 ? H/O idiopathic urticaria ? Hyperlipidemia ? Hypertension ? Immune deficiency disorder ? Lupus ? Myocardial infarction2013 ? Non-functioning gallbladder 1-30-15 ? Osteoporosis ? Pericardial effusion ? Status post colonoscopy with polypectomy 08/08/2018 ? Thyroid disease
Allergies: Morphine Sulfate Nausea And Vomiting High Allergy 3/4/2020 Past Updates... Neosporin [Neomycin-bacitracin Zn-polymyx] Hives High Allergy 8/21/2017 Past Updates... Latex Rash Low Allergy 1/30/2015 Past Updates... IF LEFT ON TOO LONG Adverse Reactions/Drug Intolerances Ambien [Zolpidem Tartrate] Nausea Only, Myalgia/Myopathy High Side Effect 3/20/2015 Past Updates... Nausea and leg aching Other Hives High Side Effect 3/20/2015 Past Updates... Imuran [Azathioprine] Nausea And Vomiting Medium Intolerance 8/21/2017 Past Updates... Morphine Nausea And Vomiting Medium Side Effect 9/3/2012 Past Updates... Morphine Sulfate Nausea And Vomiting Medium Intolerance 7/13/2021 Past Updates... Hydrochlorothiazide Other (See Comments) Not Specified Intolerance 9/4/2012 Past Updates... UNSURE Per Dr. Lipitor [Atorvastatin] Other (See Comments) Not Specified Intolerance 2/24/2017 Past Updates... Myalgia''s Hytrin [Terazosin] Dizziness Low Intolerance 12/14/2014 Past Updates... Hytrin [Terazosin Hcl] Dizziness Low Side Effect 9/4/2012 Past Updates... Deletion Reason: Erroneus Entry
Diagnostic Lab Data: 0948 EKG 12-lead 1011 Aspirin 324 mg 1022 Comprehensive metabolic panel Magnesium CBC and differential Whole Blood Lactic Acid Troponin I 1027 CT Head or Brain wo Contrast 1043 Sodium Chloride 70 mL Iohexol 60 mL 1059 XR Chest 1 View 1100 CT Angiography Head Neck w wo Contrast 1101 Urinalysis with Reflex Testing 1136 Clopidogrel Bisulfate 300 mg 1155 Placed in Observation Transferred to MedSurg 1209 Respiratory Filmarray Panel, With SARS-CoV-2 09/16 1013 EKG VIEW RHYTHM STRIP
CDC Split Type:

Write-up: presented to ED on 9/11/2021 with complaints of right upper extremity weakness and discoordination. The patient stated he awoke this morning and noticed paresthesias of his right arm, had a tingling sensation from his right shoulder down into his fourth fingers excluding his thumb and when he attempted to hold his comb he was unable to coordinate his grip and was also unable to hold a fork to eat his breakfast. He denied any headache/dizziness/change in vision, no facial droop or dysarthria. This morning, he noticed paresthesias of his right arm and incoordination. Patient states that he has tingling from his shoulder down into his 4 fingers excluding his thumb and when attempting to hold his comb he could not angle his comb correctly to comb his hair. Similarly he had difficulty with his toothbrush and not being able to "get it to do what I want". No headache. No fever chills. He has not been ill as of late.


VAERS ID: 1709040 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Asthenia, Chest discomfort, Dizziness, Dyspnoea, Feeling abnormal, Feeling hot, Loss of consciousness, Lymphadenopathy, Pain, Visual impairment
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), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Around 5:30 pm on 9/11/21 She got dizzy, hot, weak, short of breath, her chest got very tight, she saw spots then saw just solid white and then she passed out for a moment. Sat for a while and someone got her water and after a while she started feeling better. She described it as a very scary feeling and moment and a feeling it was a feeling of like she was dying but thankfully she did not. We did not go to ER or doctor because she started feeling better. Later that night under her left arm she started having pain and swelling of her glands, that is the arm she had injection in, it stayed very painful for quiet a few days. She is still having some pain under that arm and a small swollen gland but it is getting better. We wanted to report this because we are afraid if she gets the 2nd injection that something terrible might happen to her. This is such a sad situation that these kids are being put into to be forced into these shots just to attend college abs have to put there lives in jeopardy and possibly bad harm or possible death. I don''t think she should have to take the 2nd vaccine. She is still recovering from the reaction and tye being scared for her life that this has caused her.


VAERS ID: 1709056 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-08
Onset:2021-09-11
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abnormal loss of weight, Chills, Decreased appetite, Dehydration, Diarrhoea, Fatigue, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

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

Write-up: Fever of 103 Loss of appetite which led to weight loss (7lbs in 3 days) Chills Severe fatigue Severe nausea Vomiting Diarrhea Dehydration


VAERS ID: 1709141 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain lower, Angina pectoris, Chest pain, Headache, Injection site pain
SMQs:, Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (narrow)

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

Write-up: Got first dose on Saturday 9/11/21. Within half hour had a headache, and within 1 hour began having heart pain deep within my chest. A few hours later began having some bilateral lower abdominal pain. Left shoulder pain and these other symptoms persisted consistently until Tuesday when most of them resolved except for the heart and chest pain, which has been persistent in sitting, standing, and lying positions. Wednesday went to Urgent care and doctor said she believed the heart and chest pain was from the vaccine, and she prescribed meloxicam. I''ve been taking that but my heart and chest pain have not resolved. Reported adverse reaction to vaccine provider today 9/17/21 at 2:30 pm. I submitted a report of my symptoms. Pharmacist recommended following up with a doctor and not getting the second dose of the vaccine unless my symptoms fully resolve and I am fully cleared by a doctor.


VAERS ID: 1709656 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

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

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

Write-up: vaccine was administered after being improperly. the should have been moved for the freezer on 9/2, but was not removed until 9/8 and was administered to the patient


VAERS ID: 1709843 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-25
Onset:2021-09-11
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Nasal congestion, Nasopharyngitis, Oropharyngeal pain, SARS-CoV-2 test positive, Sinus congestion
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin; calcium; Lisinopril; Simvastatin; Sotalol; Sildenafil; Novolin; Tamsulosin; Metformin
Current Illness: none
Preexisting Conditions: type 2 diabetes; hypertension; diabetic retinopathy; crohns; frequent PVC''s; hypercholesterolemia
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: cold symptoms for about 5 days starting on 9/11/21 (sore throat, sinus congestion, nasal congestion). Note wife also tested positive for COVID same day he did


VAERS ID: 1710183 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Norvasc, tumeric, D3, men''s multi-vitamin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: fever (100.5 degrees), fatigue --- 36 hours


VAERS ID: 1710189 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC 3180 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Chest discomfort, Chest pain, Discomfort, Sleep disorder, Throat irritation, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (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: Nature Made Vitamin C Vitamin D
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: Hospital has not contacted me yet after I made them aware of the adverse effect. I am currently waiting for additional steps and instructions.
CDC Split Type:

Write-up: I had a "heavy" burning sensation in my throat, chest and lower back. I had "sharp" pains in my chest and lower back. I also had a "heavy" feeling on my chest feeling similar to compressions (cpr) and my throat felt like someone was physically strangling me. My throat felt very tight. This event woke me out of my sleep at 3:38am on Saturday, 11, 2021. The first 30 minutes was the worse. It was close call to driving to the E.R. or calling 911. (I reported this to The Occupational Health Dept. where I received the vaccine).


VAERS ID: 1711070 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, Chest discomfort, Electrocardiogram normal
SMQs:, Anaphylactic reaction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Had an EKG and an X-Ray of my chest area done. Nothing came up. My PCP recommended that I go to an emergency room to get blood tests done but I chose not to go.
CDC Split Type:

Write-up: Received a Pfizer shot at a pharmacy. Two or three days after the second dose, I began feeling a tightness in my chest.


VAERS ID: 1712015 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Headache, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101192152

Write-up: Arm is hurting across.; Headache; Right side of my chest really hurts.; Hard to breathe.; This is a spontaneous report from a contactable consumer or other non hcp (patient). A 51-years-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: solution for injection, lot number and expiration date was not reported), via an unspecified route of administration on 10Sep2021 (Age at vaccination was 51 years) as dose 2, single for covid-19 immunization. The patient medical history was not reported. The patient did not have any other medical condition. There were no concomitant medications. The patient did not receive any other vaccine. Previously patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: solution for injection, lot number and expiration date were not reported), via an unspecified route of administration, on 20Aug2021 as dose 1, single for COVID-19 immunization. On 11Sep2021 patient was stated that he gets his second shot last night. Today, patient woke up, his arm was hurting across and headache, but his right side of his chest really hurts. It''s kind of, hard to breathe and his chest hurts really bad on that side, Not his heart side. The right side where, he got the shot. Patient went to the pharmacist and she doesn''t know. Patient got a little worse, since this morning but not much but he can tell it''s still strong. So, If it doesn''t go away then quick here he will go to the hospital cause there''s something wrong. The patient did not perform any lab test. The patient did not receive any treatment for the events. The outcome of all the events was unknown. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.


VAERS ID: 1712020 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 LA / -

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:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101192436

Write-up: Metallic taste within minutes of injection; This is a spontaneous report from a contactable other healthcare professional, the patient. A 34-year-old non-pregnant female patient received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: 301358a) via an unspecified route of administration in the left arm on 11Sep2021 at 11:30 (at the age of 34-years-old) as a single dose for COVID-19 immunisation. The patient did not have any medical history. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within 4 weeks prior to the COVID-19 vaccine. The patient did not take any concomitant medications. On 11Sep2021 at 11:45, within minutes of injection, the patient experienced metallic taste. The event did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Therapeutic measures were not taken as a result of the event. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the event metallic taste within minutes of injection was resolving at the time of this report.


VAERS ID: 1712043 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Diarrhoea, Dizziness, Fatigue, Headache, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101194741

Write-up: vomiting; diarrhea; dizziness; Tiredness; Fever; Headache; Chills; This is a spontaneous report from a contactable consumer reported for herself. A 31-years-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot number: FC3182, Expiration date: unknown), via an unspecified route of administration, administered at an unspecified anatomical location on 10Sep2021 (age at vaccination was 31 years) as dose 2, single for COVID-19 immunization. The patient''s medical history and concomitant medications were unknown. The patient previously received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot number and Expiration date: was not reported) via an unspecified route of administration, administered at an unspecified anatomical location on an unspecified date as dose 1, single for COVID-19 immunization. On 11Sep2021 on Saturday patient woke up with a headache that last with the whole day, dizziness, tiredness, Chills and Fever, candex diarrhea and vomiting at night. On 11Sep2021, after the second dose the patient experienced vomiting, diarrhea, dizziness, tiredness, fever, headache and chills. The medication that patient took was pain medication, over the counter pain medication just one pill but it didn''t help it is Acetaminophen and it was 500 milligrams. Therapeutic measures were taken as a result of vomiting, diarrhea, dizziness, tiredness, fever, headache and chills. The outcome of the events was unknown.


VAERS ID: 1712072 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Headache, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101198208

Write-up: Dizzy; Nausea; Headache; Shaking; This is a spontaneous report from a contactable consumer, the patient. A 14-year-old non-pregnant female patient received second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EP7533) via an unspecified route of administration in the left arm on 11Sep2021 at 11:00 (at the age of 14-years-old) as a single dose for COVID-19 immunisation. Medical history included asthma. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient received unspecified concomitant medications. The patient previously received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EW0176) via an unspecified route of administration in the left arm on 08Aug2021 at 11:00 (at the age of 14-years-old) as a single dose for COVID-19 immunisation. On 11Sep2021 at 11:15, the patient experienced dizzy, nausea, shaking and headache. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events dizzy, nausea, shaking and headache was not resolved at the time of this report.


VAERS ID: 1712078 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Musculoskeletal chest pain, Pain, Pain in extremity, Peripheral swelling, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), 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: ZOLOFT
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Penicillin allergy
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101198814

Write-up: Extreme fatigue; Left arm swelling that was the size of a baseball and it hurt/itched; Left arm swelling that was the size of a baseball and it hurt/itched; Left arm swelling that was the size of a baseball and it hurt/itched; Whole body aches for three days after injection; Left upper rib pain that felt like was getting stabbed every time breathed in deep; This is a spontaneous report from a contactable nurse, the patient. A 37-year-old non-pregnant female patient received BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 11Sep2021 at 18:00 (at the age of 37-years-old) as a single dose for COVID-19 immunisation. Medical history included allergy to penicillin. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. Concomitant medications included sertraline hydrochloride (ZOLOFT) for an unknown indication and unspecified birth control medication, both from an unknown date and unknown if ongoing. On 11Sep2021 at 20:00, the patient experienced extreme fatigue, left arm swelling that was the size of a baseball and it hurt/itched, whole body aches for three days after injection and left upper rib pain that felt like patient was getting stabbed every time she breathed in deep. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the event whole body aches was resolved on 13Sep2021, while that of events extreme fatigue, left arm swelling that was the size of a baseball and it hurt/itched and left upper rib pain that felt like patient was getting stabbed every time she breathed in deep were not resolved at the time of this report. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1712080 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-20
Onset:2021-09-11
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 2 - / -

Administered by: Unknown       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:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none
Allergies:
Diagnostic Lab Data: Test Date: 20210911; Test Name: COVID-19 test; Result Unstructured Data: Test Result:Positive
CDC Split Type: USPFIZER INC202101200289

Write-up: diagnosed with Covid-19; diagnosed with Covid-19; This is a spontaneous report from a contactable consumer (patient''s mother/parent) via the Pfizer sponsored program. This consumer reported similar events for different patients. This is the third of 3 reports. This consumer (patient''s mother/parent) reported that a 31 year old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 2 via an unspecified route of administration on 20Apr2021 (Batch/Lot Number: EW0158) (at the age of 30 years) as DOSE 2, SINGLE; dose 1 via an unspecified route of administration on 20Mar2021 (Batch/Lot Number: ER2613) (at the age of 30 years) as DOSE 1, SINGLE for covid-19 immunisation. The patient medical history and concomitant medications were reported as none. It was reported that within the past 4 days (as reported), patient''s mother, father, and patient himself all have been diagnosed with Covid-19. It was stated that all three have complaints of fatigue and that patient had been more tired. The patient medical history and concomitant medications were not reported. It was reported that within the past 4 days, patient''s mother, father, and patient himself all have been diagnosed with Covid-19. It was stated that all three have complaints of fatigue and that patient had been more tired. The patient had his COVID test within days and had breakthrough COVID. Patient did the test two days ago (11Sep2021) that came back positive. Patient had a headache and sore throat so knew he had it, he never had COVID until this breakthrough. The outcome of events was unknown. It was unknown if patient has done any treatment. The patient underwent lab tests and procedures which included sars-cov-2 test: positive on 11Sep2021.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101198193 Same reporter/drug, similar event, different patient.;US-PFIZER INC-202101200288 Same reporter/drug, similar event, different patient.


VAERS ID: 1712088 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Nausea, Rash, Rash pruritic, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LITHIUM; GABAPENTIN; LEXAPRO; TYLENOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy (Known allergies: some other topical stuff); Anxiety; Bipolar disorder (Bipolar); Sunscreen sensitivity (Known allergies: Sunscreen)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101204715

Write-up: Tired; Horrible itchy hiveish rash on face and under chin and rash on jaw line and a little bit on collarbone; Horrible itchy hiveish rash on face and under chin and rash on jaw line and a little bit on collarbone; Horrible itchy hiveish rash on face and under chin and rash on jaw line and a little bit on collarbone; Nausea; This is a spontaneous report from a contactable consumer, the patient. A 61-year-old non-pregnant female patient received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FE3592) via an unspecified route of administration in the left arm on 10Sep2021 at 17:00 (at the age of 61-years-old) as a single dose for COVID-19 immunisation. Medical history included bipolar, anxiety and known allergies to sunscreen and some other topical stuff (multiple allergies). Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. Concomitant medications included lithium (MANUFACTURER UNKNOWN), gabapentin (MANUFACTURER UNKNOWN), escitalopram oxalate (LEXAPRO) and paracetamol (TYLENOL); all for unknown indications from unknown dates and unknown if ongoing. On 11Sep2021 at 12:00 (Saturday afternoon), the patient experienced horrible itchy hiveish rash on her face and under her chin and nausea. On 13Sep2021 (Monday), after 5:00, the patient saw the rash and it was bad and the rash was on her face underneath the chin and the jaw line and a little bit on the collarbone. The patient was also tired and still nauseous. The events did not result in a visit to the doctors or other healthcare professional office/clinic visit, and emergency room/department or urgent care. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events horrible itchy hiveish rash on face and under chin and rash on jaw line and a little bit on collarbone, nausea and tired was not recovered at the time of this report.


VAERS ID: 1712118 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Headache, Impaired driving ability, Pain in jaw, Performance status decreased, Stomatitis, Toothache
SMQs:, Severe cutaneous adverse reactions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Osteonecrosis (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101210572

Write-up: Severe headache; Clouded my abilities to drive and be productive; Clouded my abilities to drive and be productive; Jaws and teeth hurt a lot; Jaws and teeth hurt a lot; Small sores in the roof of mouth; This is a spontaneous report from a non-contactable consumer, the patient. A 46-year-old female patient received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 10Sep2021 at 09:00 (at the age of 46-years-old) as a single dose for COVID-19 immunisation. The patient had some unspecified medical history. The patient had unknown allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. Concomitant medications were not reported. The patient did not receive any other vaccine within four weeks prior to the vaccination. On 11Sep2021 at 03:00 (It had started about 18 hours after the vaccine), the patient experienced jaws and teeth hurt a lot. On 11Sep2021, the patient also reported small sores in the roof of mouth. On 12Sep2021 at 09:00 (about 48 hours after the first injection), the patient experienced severe headache that clouded her abilities to drive and be productive on Sunday. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Since the vaccination, the patient had not been tested for COVID-19. Therapeutic measures were taken as a result of the events which included treatment with an over-the-counter (OTC) mouthwash and prescription for headache. The clinical outcome of the events jaws and teeth hurt a lot, small sores in the roof of mouth, severe headache, clouded abilities to drive and be productive were not recovered at the time of this report. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1713218 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-01
Onset:2021-09-11
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood albumin decreased, Condition aggravated, Nephrotic syndrome, Proteinuria, Urine protein/creatinine ratio increased
SMQs:, Acute renal failure (broad), Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Proteinuria (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Minimal change disease in remission.
Allergies:
Diagnostic Lab Data: 9/13/2021 Urine protein to creat 20 g/g Serum albumin 2.1 g/dL
CDC Split Type:

Write-up: Severe relapse of Nephrotic syndrome with massive proteinuria. Patient was off of steroids since 12/2019 and was in complete remission. Proteinuria started about 4-5 weeks after 1 dose.


VAERS ID: 1713424 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Private       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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: asthma
Allergies: nuts, amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: hives to face 3 hours after 2nd vaccine


VAERS ID: 1713517 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-04
Onset:2021-09-11
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3184 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram, Blood test, Computerised tomogram, Confusional state, Dizziness, Headache, Hypoaesthesia, Lethargy, Nausea, Paraesthesia, Vertigo, Visual impairment
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (narrow), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Clopidogrel, Cetirizine, Vitamin C, Vitamin D-3, Fish Oil, Centrum Silver, Biotin, PreserVision
Current Illness: None
Preexisting Conditions: Under active thyroid, complicated migraines
Allergies: Aspirin
Diagnostic Lab Data: CT with contrast - 9/13/21 Bloodwork - 9/13/21 MRA - 9/14/21
CDC Split Type:

Write-up: Numbness/tingling right arm/hand, numbness right side of face, dizziness, confusion, nausea, vision disturbance, vertigo, headache, lethargy


VAERS ID: 1713535 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-01
Onset:2021-09-11
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chest X-ray normal, Chest pain, Electrocardiogram normal, Fibrin D dimer normal, Full blood count normal, Headache, Hypoaesthesia, Pain, Pain in extremity, Paraesthesia, Sensory disturbance, Troponin normal, Vaccination complication, White blood cell count increased
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Progesterone Blisovi Metformin ( For pcos ) Lexapro Buspar
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data: Chest X-ray ECG DDimer CBC & differential Troponin Sept 16, everything normal except higher WBC
CDC Split Type:

Write-up: I went to pharmacy to get my shot in. All was well until 3-4 days after when I began having chest pain and weird sensations in my extremeties. I started having tingling in my hands and legs that turned to numbness. I would get shoots of pain throughout my body, legs, hands, arms, feet, head. I also began feeling weak. I ended up going to the hospital to get checked out and the doctor said I was probably having an adverse reaction to the vaccine.


VAERS ID: 1713576 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Condition aggravated, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (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: None
Current Illness:
Preexisting Conditions: Anxiety
Allergies: Sesame, fennel seed, grapefruit
Diagnostic Lab Data: I have not gone to the doctor.
CDC Split Type:

Write-up: Increased heart rate. Like an anxiety attack but almost constant. It''s been over a week. Most noticed while resting, after eating, while walking and after smoking.


VAERS ID: 1713619 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Headache, Rash, Rash vesicular
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor, Quinapril
Current Illness: none
Preexisting Conditions: Hyperlipidemia, Hypertension
Allergies: Nitrofurantoin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Headache started the day after vaccination and persisted, developed vesicular rash on left scalp


VAERS ID: 1713759 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Diarrhoea, Dizziness, Headache, Hypoaesthesia, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Noninfectious diarrhoea (narrow), Sexual dysfunction (broad)

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

Write-up: Systemic: Chills-Mild, Systemic: Diarrhea-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Headache-Medium, Systemic: Nausea-Medium, Systemic: Numbness (specify: facial area, extremities)-Medium, Additional Details: PATIENT STATES SYMPTOM OF NUMBNESS FROM SHOULDER TO TIPS OF FINGERS. VERTIGO STARTED 7 DAYS LATER (9/17/21).


VAERS ID: 1713831 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-09-08
Onset:2021-09-11
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Military       Purchased by: ?
Symptoms: Menstrual disorder
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: Celexa and Wellbutrin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Missed menstrual cycle


VAERS ID: 1713909 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-24
Onset:2021-09-11
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Appendicectomy, Appendicitis, Blood test, Computerised tomogram, Ultrasound scan
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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol Probiotic Zinc
Current Illness:
Preexisting Conditions: Pcos Interstitial cystitis Asthma Allergies
Allergies: Macrobid Nickel
Diagnostic Lab Data: Ultrasound 9/11 Ct scan 9/11 Blood work 9/11
CDC Split Type:

Write-up: Started with abdominal pain at 1pm went to ER at 7:30pm. Had bloodwork sono and ct scan. Showed appendicitis. Had surgery at 7am next morning. I am a pharmacist at the pharmacy where vaccine was administered. Filling form out in case it was the cause.


VAERS ID: 1713966 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Hyperhidrosis, Pain, Thirst
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: None
Current Illness: I have had periods of excessive tiredness a week earlier.
Preexisting Conditions: Some degree of neuropathy of the feet in the evening,
Allergies: Peanuts and other nuts.
Diagnostic Lab Data: nothing yet
CDC Split Type:

Write-up: Chills followed by sweats have continued off and on for over a week. Very tired headache very thirsty body aches


VAERS ID: 1713977 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 2 RA / IM

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

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

Write-up: MODERNA COVID-19 VACCINE EUA Large red, itchy rash area around injection site that increased in size a couple of days before started looking better.


VAERS ID: 1713986 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain lower, Angina pectoris, Arthralgia, Chest pain, Headache, Inflammation
SMQs:, Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Arthritis (broad)

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

Write-up: at .5 hr had headache, at 1 hr had heart pain. few hrs later had bilateral lower abdominal pain, left shoulder pain. these resolved by day three except for chest/heart pain which has been persistent as of friday 9-17-21. pt saw urgent care wed 9-15-21, who prescribed meloxicam for possible heart inflammation from covid shot. symptoms sill persist on friday 9-17-21.


VAERS ID: 1714014 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Shot was in the upper right arm. I developed a very large (size of a softball) growth in my armpit. It seemed to be full of liquid. After a day it shrank to 20% of the size but then another identical growth occurred in my left armpit! It is 20% the size of the first one in the right arm. I have pictures of all the occurrences.


VAERS ID: 1714159 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-01-21
Onset:2021-09-11
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029K20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Acute respiratory failure, Atelectasis, COVID-19, Chest X-ray abnormal, Cholecystitis acute, Computerised tomogram abdomen abnormal, Cough, Culture urine positive, Diarrhoea, Escherichia infection, Hypopnoea, Nausea, PO2 decreased, Pain, Pneumonia bacterial, SARS-CoV-2 test positive, Urinary tract infection, Urine analysis abnormal, Vomiting, White blood cells urine positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Infectious biliary disorders (narrow), Gallbladder related disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Morbid obesity, history of gastric bypass a few years ago after which he has lost about 125 pounds, obstructive sleep apnea on CPAP, history of right shoulder surgery.
Allergies: None
Diagnostic Lab Data: 9/14/21 CT abdomen: Acute cholecystitis 9/14/21 Chest xray: Shallow inspiration with right basilar subsegmental atelectasis.
CDC Split Type:

Write-up: He comes to the emergency room complaining of 2-3 days of right upper quadrant abdominal pain with nausea, vomiting, diarrhea, cough, body aches. He said he was immunized with COVID-19 in January and February of this year. He lives with his wife and children, none of whom are sick. He came to emergency room with these complaints. He tested positive for COVID-19. Also, his urinalysis was abnormal showing esterase 2+ and WBC 6-10. CT abdomen and pelvis is raising the possibility of acute cholecystitis for which the surgeon was called and will see the patient in the morning. Patient was saturating anywhere between 92% to 94% at rest, but when we did the ABG, his pO2 was only 66.% on room air. So, the patient was also started on Decadron and remdesivir. For his UTI and his COVID-19 status, he is already started on Zosyn. Admitted on 9/13/2021. Urine culture 09/13/21 E Coli . He had acute hypoxemic respiratory failure secondary to COVID 19 viral and suspected secondary bacteria pneumonia . Was on decadron , remdesivir , supportive oxygenation , CXR showed right basilar subsegmental atelectasis. Upon discharge , patient was not using oxygen. Discharged on 9/18/21


VAERS ID: 1714175 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Insomnia, Limb discomfort, Musculoskeletal discomfort
SMQs:, Rhabdomyolysis/myopathy (broad)

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

Write-up: a horrible headache, which lasted for about 36 hours and sleeplessness legs felt like they weighed 200 lbs and felt like i was carrying weight on my back.. e


VAERS ID: 1714191 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-31
Onset:2021-09-11
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZERFC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Exercise tolerance decreased, Loss of personal independence in daily activities
SMQs:, Dementia (broad), Guillain-Barre 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: zinc
Current Illness: none
Preexisting Conditions: none
Allergies: raw eggs. An adverse effect many years ago to raw eggs. I have not attempted to consume them in many decades.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Overall Weakness. Unable to perform weekly bike ride. Running about 30% to 40% slower than expected. This would not be noticeable without the extra effort needed maintain my normal cadence. I believe I have mostly recovered from this.


VAERS ID: 1714192 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-09-09
Onset:2021-09-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site coldness, Tinnitus, Unevaluable event
SMQs:, Hearing impairment (narrow)

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

Write-up: Systemic: arm has continuous "cold sensation" and a magnet sticks to arm-Medium, Systemic: Tinnitus-Medium, Additional Details: patient reports cold sensation at site of injection even 10 days later. also reports site of injection being "magnetic" where a magnet will stick to his arm


VAERS ID: 1714303 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-12
Onset:2021-09-11
   Days after vaccination:122
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest discomfort, Computerised tomogram abdomen, Electroencephalogram, Fatigue, Headache, Magnetic resonance imaging, Nausea, Urine analysis
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations: same incidents after the second Pfizer COVID 19 vaccine which occurred on May 14, 2021 and Sep. 10, 2021 reported to VAERS on Ma
Other Medications: turmeric, neuriva, stool softener
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Sep. 11, 12,13, 2021; Urine tests, blood work, CT scan abdomen, EEG, MRI
CDC Split Type:

Write-up: Nausea, headache, chest pressure, fatigue


VAERS ID: 1714467 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Extra dose administered, Fatigue, Hypoaesthesia, Influenza like illness, Lymphadenopathy, Multiple sclerosis, Muscle twitching, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Optic nerve disorders (broad), Demyelination (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin, tramadol, lumbar steroid injections
Current Illness: MS, left leg numbness, lower back pain
Preexisting Conditions: MS, left leg numbness, occasional foot drop, chronic lower back pain
Allergies: Percoset
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Adverse reactions were much stronger with the 3 vaccine. Large swollen underarm glands, increased fatigue-over & above normal MS symptoms, vomiting, body aches . This vaccine seemed to irritate my current body impact of my MS. Increased twitching, left leg-foot numbest, high level of mid-back and caused my to have flu like symptoms.


VAERS ID: 1714488 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-09-01
Onset:2021-09-11
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

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

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

Write-up: Inflamed lymph nodes in lower right abdomen


VAERS ID: 1714920 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-02
Onset:2021-09-11
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Anticoagulant therapy, Computerised tomogram thorax, Condition aggravated, Deep vein thrombosis, Pain in extremity, Pulmonary embolism, Pulmonary infarction
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Pulmonary hypertension (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: Previous provoked left lower extremity DVT in 2019 due to prolonged stasis during travel. Treatment of 6 months of oral anticoagulation was completed.
Allergies: None
Diagnostic Lab Data: 11SEP2021- CTA Chest demonstrating right lower lobe infarct and bilateral pulmonary emboli
CDC Split Type:

Write-up: No immediate reaction. 9 days following vaccination he was hospitalized with bilateral pulmonary emboli and a right lower lobe infarct. After a four day inpatient stay, he was discharged for outpatient management on oral anticoagulation for a presumed provoke DVT that led to the PE. He reports a long car ride about 4-6 weeks prior to the event and intermittent calf pain though had not been evaluated for this complaint prior to hospitalization. Hematology workup is in progress. Uncertain of the relevance of the vaccination to this event, however, given the proximity to the inpatient stay and significant health event to the date of vaccination this meets reporting criteria.


VAERS ID: 1714936 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Chest discomfort, Chest pain, Dizziness, Fatigue, Headache, Injection site pain, Pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Motrin and Allegra. Multivitamin
Current Illness:
Preexisting Conditions: Degenerative disc disease, neuropathy in legs.
Allergies:
Diagnostic Lab Data: None. Contacted 9/16 concerning side affects and was told these are common and if I was concerned that it was a more severe issue to come to urgent care/emergency. Since my side affects had reduced I did not go in due to concerns of contracting covid from the hospital.
CDC Split Type:

Write-up: 30 to 45 minutes after shot arm pain at site radiating to elbow, wrist and shoulder of left arm lasting 3 days. Followed by fatigue, headache and tightness of chest starting on the 12th. Fatigue, headache and tightness of chest worst on the 15th accompanied by dizziness and chest pain BP elevated 10 point over normal to 140/90s, pulse and O2 fine. Side affects lessened on the 16th to tightness in chest and reduced headache and subsided by the 17th.


VAERS ID: 1714978 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Dyspnoea, Headache, Laboratory test, Troponin
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Xarelto, Lasix, Nitroglycerin, Protonix, Vitamins multi and B-12, Zoloft, and Xanax
Current Illness: Multiple coronary and pulmonary arterio-venous malformations.
Preexisting Conditions: Multiple coronary and pulmonary arterio-venous malformations.
Allergies: Penicillin, amoxicillin, ceclore, augmenton, z-pack, erythromycin, shellfish, navy beans, nickel, cobalt, iodine, and CT contrast.
Diagnostic Lab Data: Chest xray, routine labs plus cardiac labs
CDC Split Type:

Write-up: Severe headache, shortness of breath, severe increase in chest pain, positive POC troponin


VAERS ID: 1715006 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-09
Onset:2021-09-11
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 02/29/2021 / UNK - / -

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

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

Write-up: Covid positive work related


VAERS ID: 1715012 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-24
Onset:2021-09-11
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / UNK - / -

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

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

Write-up: Covid positive link unknown


VAERS ID: 1715083 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Ear discomfort, Fatigue, Headache, Limb discomfort, Muscular weakness, Nausea, Paranasal sinus discomfort, Respiratory tract congestion, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: Ritalin
Current Illness: None
Preexisting Conditions: chronic sinus issues
Allergies: Amoxicillin
Diagnostic Lab Data: blood allergy test- normal
CDC Split Type: vsafe

Write-up: After leaving, I instantly felt nauseous with onset headache. It went away later. The next day I was extremely tired and fatigued. There was weakness in my legs and I was super congested. The worst headaches I have ever had. One headache was so bad I even threw up. It was worse than a migraine. Everything like sinus related, sinus pressure, ear pressure. The doctor gave me some antibiotics and a new ENT referral. I gave it a couple of days because I was able to go until Friday. The ENT gave me antibiotics, spray, steroids, and a probiotic. She also did a blood allergy test, which came back normal.


VAERS ID: 1715108 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-01
Onset:2021-09-11
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 3 LA / SYR

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

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

Write-up: My whole body has been covered in hives and whelps. It is red and burning and hot to the touch and sensitive. Urgent care gave me 5 days of steroids.


VAERS ID: 1715154 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-07
Onset:2021-09-11
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / UNK - / -

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

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

Write-up: Covid positive unknown contact


VAERS ID: 1715247 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-03
Onset:2021-09-11
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Migraine, Nausea, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine; baby aspirin; prenatal
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Covid test- negative
CDC Split Type: vsafe

Write-up: When I woke up I had a migraine and I took some Tylenol and that did not cut it. I took some ibuprofen and that did not cut it. That stayed until 11 pm. I was getting nauseous. The next day I had a little bit of coughing so I went to get tested for Covid at the pharmacy. It came back negative. I did not know if that was related to the vaccine or just a bug I caught, Since then I have had a lingering cough but nothing too concerning.


VAERS ID: 1715281 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Magnetic resonance imaging head abnormal
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin, aspirin, melatonin, aripiprazole, lisinopril, zolpidem, metformin, allopurinol, tamsulosin, venlafaxine, omeprazole
Current Illness:
Preexisting Conditions: diabetes, morbid obesity, diabetic nephropathy, fatty liver, insomnia, hypertensive chronic kidney disease, depression major recurrent, gerd, gout
Allergies:
Diagnostic Lab Data: MRI 9/11/2021
CDC Split Type:

Write-up: Left MCA territory stroke


VAERS ID: 1715310 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-19
Onset:2021-09-11
   Days after vaccination:54
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tetanus Shot in 1970 swollen arm
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Sofia SARS Antigen FIA
CDC Split Type:

Write-up: Fever, Muscle Aches, Headache, cough, Chills, Runny nose, Loss taste and smell, Fatigue


VAERS ID: 1715354 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA D62E21A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Blood test normal, Chest X-ray normal, Chest pain, Chills, Cough, Cyanosis, Dizziness, Dysphagia, Dyspnoea, Electrocardiogram normal, Feeling cold, Headache, Hypoaesthesia, Injection site bruising, Injection site erythema, Oropharyngeal pain, Paraesthesia, Peripheral coldness, Pyrexia, SARS-CoV-2 test negative, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: On Day 4 he contacted the Dr at school and she immediately requested an X-ray of Chest, EKG and blood tests, and Covid Test. All came back normal and the Covid test was negative. She has now referred him to a Cardiologist. On this day As of this day, Day 9, since the injection he has no improvement - still dealing with chest pain, difficulty breathing, headache and dizzy.
CDC Split Type:

Write-up: Nine hours after injection, pt began having abdominal pain, chest pain, trouble breathing and coughing. Hands , feet and legs became cold and turning bluish. He was trembling and shivering, and complaining he was cold. Jawline was numb, headache and dizzy, tingling in hands and feet. It was like his body went into shock. We rushed him to the ER where they administered ibuprofen and antihistamine. At the ER, his vitals were normal and no temp. After 3 hours his hands and feet were warm again and he was released. The next day he had a slight temp and a red bullseye on his arm where he received the injection. He felt worse as the week went on experiencing chest pain and trouble breathing. The bullseye on his arm turned into a bruise and spread down his arm. Sore throat and trouble swallowing from all fo the coughing on the day of the reaction.


VAERS ID: 1715485 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-09
Onset:2021-09-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Facial paralysis
SMQs:, Taste and smell disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

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

Write-up: Tongue went tasteless two days afterwards and face drooped six days later


VAERS ID: 1715486 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-19
Onset:2021-09-11
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / UNK - / -

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

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

Write-up: Covid positive household member


VAERS ID: 1715500 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-31
Onset:2021-09-11
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / UNK - / -

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

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

Write-up: Covid positive contact unknown


VAERS ID: 1715510 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-15
Onset:2021-09-11
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

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

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

Write-up: Covid positive contact unknown


VAERS ID: 1715573 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 40 mg Multi Vitamin Vitamin D Baby aspirin
Current Illness: None
Preexisting Conditions: Kidney Disease Stage 3 High BP
Allergies: Erythromycin - upset stomach
Diagnostic Lab Data: COVID 19 Test - Negative result on 9/15/21
CDC Split Type:

Write-up: Approximately 1.5 hours after receiving shot I felt a sore throat coming on. It continued to feel that way for the next few days. Then on the afternoon of 9/14/21 my mouth and throat started to blister and became very painful. I immediately started to drink ice water to help with the pain. The pain persisted for hours until I fell asleep. I woke up the next morning and the sores seemed to have resolved for the most part, but was unsure of whether or not to receive a second dose. I made an appointment with a doctor to look at and she stated most of it had resolved but noticed some irritation.


VAERS ID: 1715705 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 RA / IM

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

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

Write-up: Patient received Pfizer Covid 28 days after Moderna Covidvaccine. Patient should have received Moderna Covid vaccine for 2nd shot in the series


VAERS ID: 1715741 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-04
Onset:2021-09-11
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen 650mg q4hr PRN for pain albuterol 90mcg/inh q4hr prn for wheezing allopurinol 100mg daily amlodipine 10mg daily aspirin 81mg daily carvedilol 3.125mg cilostazol 100mg BID citalopram 20mg daily clonidine 0.2mg BID ferrous sulf
Current Illness: None documented
Preexisting Conditions: hypogonadism male, claudication of both lower extremities, Coronary artery disease, Insomnia, anxiety, glucose intolerance, edema, hyperkalemia, bradycardia, abnormal liver function, barrett''s esophagus, history of endarterectomy, hyperlipidemia, hypertension, diabetes, COPD, hypercholesterolemia, sleep apnea, erectile dysfunction
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated.


VAERS ID: 1715767 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-17
Onset:2021-09-11
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anosmia, COVID-19, Cough, Pain, Paranasal sinus discomfort, Pyrexia, SARS-CoV-2 test positive, Sneezing
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothoxine Sodium 50mcg, Mybetriq 25 mg, Vyvanse 40mg, Loratadine 10mg, Multivitamin, Premarin 2-3 app per week
Current Illness: None
Preexisting Conditions: ADHD, Overactive Bladdar, Seasonal Allergies
Allergies: Penicillin
Diagnostic Lab Data: Rapid Test : 9/13/21 - Positive PCR Test: 9/13/21 - Positive
CDC Split Type:

Write-up: COVID19 breakthrough case. Symptoms: Fever, aches, sinus pressure, loss of smell, coughing, sneezing Time course: Began symptoms on Sept 11, 2021 - Worse symptoms were over by 9/15/2021 & Remdesivir Injections, Steroid Injection, Tamiflu, & Antibiotic on Tuesday, 9/14/2021


VAERS ID: 1715831 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Migraine, SARS-CoV-2 test negative
SMQs:, 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: Wellbutrin
Current Illness:
Preexisting Conditions:
Allergies: Adhesive tape
Diagnostic Lab Data: COVID test today that was negative, however it is 9 days out from start of symptoms
CDC Split Type:

Write-up: The day after vaccination started with severe, migraine like headaches every day since


VAERS ID: 1715901 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Joint range of motion decreased, Neck pain, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Patient is going to be contacted by pharmacy Liability Intake team.
CDC Split Type:

Write-up: Patient received the vaccination on 09/10/2021 and waited in the pharmacy for 10-15 minutes after the immunization and reported no adverse reaction. Patient then woke up the next morning with extreme pain in his arm that went up his neck and limited his range of motion. The pain has decreased but is still present and remains limited in range of motion.


VAERS ID: 1716112 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-04
Onset:2021-09-11
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Blood creatinine increased, Blood culture negative, COVID-19, Chest X-ray abnormal, Condition aggravated, Culture urine positive, Diarrhoea, Dysuria, Hypophagia, Hypotension, Klebsiella test positive, Lung opacity, Mammogram abnormal, Micturition urgency, Nausea, Pollakiuria, Pulmonary fibrosis, SARS-CoV-2 test positive, Tachycardia, Urinary tract infection, Urine analysis abnormal, Vomiting, X-ray limb abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Accu-Chek FastClix Lancets acetaminophen (TYLENOL) 325 MG tablet ADVAIR DISKUS 500-50 MCG/DOSE diskus inhaler albuterol (PROVENTIL) (2.5 MG/3ML) 0.083% nebulization albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/A
Current Illness: diarrhea ,unspecified, Gastroesophageal reflux disease, unspecified whether esophagitis present
Preexisting Conditions: Respiratory OSA (obstructive sleep apnea)- poor tolerance to CPAP, will switch to BiPAP Sinus congestion Scimitar syndrome Allergic rhinitis Asthma, mild intermittent, well-controlled Circulatory HTN (hypertension) Hypertension Congenital heart disease in adult SVT (supraventricular tachycardia) Digestive Morbid obesity Infectious/Inflammatory Left wrist tendinitis De Quervain''s tenosynovitis, left COVID-19 virus infection Endocrine/Metabolic Diabetes mellitus Hypothyroidism Diabetes mellitus type 2, insulin dependent Hypercholesteremia Other Depression Excessive sleepiness Hypersomnia with sleep apnea H/O surgery to heart and great vessels, presenting hazards to health History of cardiac radiofrequency ablation (RFA) Closed fracture of proximal end of right humerus with routine healing
Allergies: Ibuprofen
Diagnostic Lab Data: DR CHEST SINGLE VIEW Result Date: 9/12/2021 Narrative: EXAMINATION: Single View Chest EXAM DATE: 9/12/2021 3:31 AM TECHNIQUE: Single view chest INDICATION: Covid + COMPARISON: September 2, 2021 ENCOUNTER: Not applicable _________________________ FINDINGS: Sternotomy wires appear intact. The majority of the heart is given within the right chest, stable in size. There is no significant pulmonary vascular congestion. Some Trinity opacities within the right lower lung and some mild volume loss is similar to the prior study, likely related to scarring. No consolidation. No sizable pleural effusion. No pneumothorax. _________________________ Impression: No acute cardiopulmonary process. DR SHOULDER RIGHT MINIMUM 2 VIEWS Result Date: 9/3/2021 Narrative: EXAMINATION: Right Shoulder, Complete Minimum Two Views EXAM DATE: 9/2/2021 10:09 AM TECHNIQUE: AP, Grashey, and axillary INDICATION: s/p injury and or surgery. COMPARISON: Radiographs 8/5/2021 ENCOUNTER: Subsequent _________________________________ Impression: Overall unchanged appearance of proximal humerus fracture without significant interval change in alignment or new acute osseous abnormality. Some lucency persists at the fracture line. BCS SCREENING MAMMOGRAM BILATERAL DIGITAL Result Date: 8/17/2021 Narrative: EXAMINATION: Bilateral Digital Screening Mammography with CAD EXAM DATE: 8/17/2021 8:09 AM TECHNIQUE: Bilateral screening mammography, producing direct digital images, all views, with computer-aided detection (CAD). COMPARISON: Multiple prior studies, most recent 8/13/2020, dating back to 6/22/2010. INDICATION: Encounter for screening mammogram for malignant neoplasm of breast. _____________________ FINDINGS: Breast Density: There are scattered areas of fibroglandular density. Mammographic imaging shows no suspicious finding for breast cancer. Impression: There is no mammographic evidence of malignancy. Recommendation: Screening Mammogram Bilateral. Follow-Up Interval: 12 Months. BI-RADS Category: 1 Negative. Procedure Component Value Ref Range Date/Time Peripheral Blood Culture Collected: 09/11/21 2133 Order Status: Completed Specimen: Blood, Venous Updated: 09/16/21 2300 Cult Blood Peripheral No bacteria or yeast isolated Peripheral Blood Culture Collected: 09/11/21 2132 Order Status: Completed Specimen: Blood, Venous Updated: 09/16/21 2300 Cult Blood Peripheral No bacteria or yeast isolated Urine Culture (Abnormal) Collected: 09/11/21 1921 Order Status: Completed Specimen: Urine, clean catch Updated: 09/15/21 0646 Bacterial culture, urine $g=100,000 CFU/mL Klebsiella pneumoniae Abnormal Susceptibility Klebsiella pneumoniae Not Specified Ampicillin Resistant Ampicillin/sulbactam Susceptible Cefazolin Susceptible 1 Ceftriaxone Susceptible Ciprofloxacin Susceptible Gentamicin Susceptible Nitrofurantoin Intermediate Tobramycin Susceptible Trimethoprim/Sulfamethoxazole Susceptible 1 For uncomplicated UTIs due to E. coli, K. pneumoniae, and P. mirabilis, cefazolin predicts susceptibility to oral cephalosporins including cephalexin, cefpodoxime, cefprozil, cefdinir, and cefuroxime. Linear View COVID-19 PCR, Rapid (Abnormal) Collected: 09/12/21 0204 Order Status: Completed Specimen: Swabbed Collection from Nasopharynx Updated: 09/12/21 0229 COVID-19 PCR Detected Abnormal Not Detected Comment: COVID-19 (SARS-CoV-2) test is positive. Clinical correlation with patient history and other diagnostic information is necessary to determine infection status. This test has received Emergency Use Authorization (EUA) by the FDA, but performance has not been evaluated for asymptomatic patients. Testing was performed using a nucleic acid amplification method. The specimen source may have been changed from the original order per patient situation or symptoms. Covid 19 Result Comment See Comment Comment: COVID-19 results reported as "detected" means COVID-19 positive. Positive patients should self-isolate for 10 days or 24 hours after fever resolves and other symptoms are improving, whichever is longer: - Stay home except to get medical care and wear a facemask if you must leave - Separate yourself from other people in your home, known as home isolation - Cover your coughs and sneezes - Wash your hands often - Avoid sharing household items - Clean high-touch surfaces everyday - If you have a medical emergency and need to call 911, notify dispatch personnel that you may have COVID-19 and put on a facemask before emergency medical services arrive. If the result is "inconclusive" or "invalid" and you have not been contacted by a medical professional about your result or if you have questions about COVID-19, your symptoms, or need a return to work/school note, please contact your primary care provider (PCP).
CDC Split Type:

Write-up: Patient is a 51 yo female with PMH of hypertension, obstructive sleep apnea, type 2 diabetes mellitus, and proximal atrial fibrillation status post ablation who was admitted to Hospital for acute kidney injury and COVID infection. Patient had several days of nausea, vomiting, and diarrhea preceding her presentation. She was also unable to hold down any food or drink fluids. She also understood 3 day history of dysuria, urgency, and frequency. She was also taking her home Lasix despite poor oral intake. In the emergency department, patient was noted to be hypotensive and tachycardic. She received 4 L of IV fluid with improvement. She had a creatinine of 1.49 (normal baseline). UA was also positive. She was also noted to be COVID-19 positive. She was admitted to the general medicine service for IV fluid hydration and started on IV ceftriaxone for uncomplicated urinary tract infection. The patient quickly improved and her AKI resolved. She reported resolution of her dysuria, nausea, and vomiting. Of note, patient reports chronic diarrhea for the last 3-4 months with loose stools for which she has seen a gastroenterologist and plans to continue to follow-up with them. Patient remained in stable condition on room air with no symptoms on day of discharge. Urine culture was still pending at discharge, however given her resolution of symptoms and 3 days of IV ceftriaxone patient was not continued on any oral antibiotics on discharge. She was counseled to adequately hydrate herself and self quarantine. She was discharged home in stable condition on 09/13.


VAERS ID: 1716326 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-25
Onset:2021-09-11
   Days after vaccination:109
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chest X-ray abnormal, Cough, Decreased appetite, Diarrhoea, Dyspnoea, Exposure to SARS-CoV-2, Fatigue, Hypoxia, Laboratory test normal, Lung disorder, Nausea, Oxygen saturation decreased, Pain, SARS-CoV-2 test positive, Tachycardia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 5 MG tablet aspirin 325 MG tablet colchicine (COLCRYS) 0.6 MG tablet dexamethasone (DECADRON) 6 MG tablet fenofibrate (TRIGLIDE/LOFIBRA) 160 MG tablet hydrochlorothiazide (HYDRODIURIL) 12.5 MG tablet metFORMIN (GLUCOPHA
Current Illness:
Preexisting Conditions: Circulatory Essential hypertension Digestive GERD (gastroesophageal reflux disease) Infectious/Inflammatory COVID-19 COVID-19 virus infection Endocrine/Metabolic Type 2 diabetes mellitus without complication, without long-term current use of insulin (HCC) Hyperlipidemia Gout Other Malignant neoplasm of left breast (HCC)
Allergies: CodeineNausea and Vomiting MorphineNausea and Vomiting Norco [Hydrocodone-acetaminophen]Nausea and Vomiting Nsaids
Diagnostic Lab Data: Procedure Component Value Ref Range Date/Time DR CHEST SINGLE VIEW [340432189] Resulted: 09/11/21 1202 Order Status: Completed Updated: 09/11/21 1204 Narrative: EXAMINATION: Single View Chest EXAM DATE: 9/11/2021 11:24 AM TECHNIQUE: Portable upright AP view. INDICATION: dyspnea, covid suspected COMPARISON: 12/5/2014 ENCOUNTER: Not applicable _________________________ FINDINGS: The heart is normal in size. There is no pulmonary vascular congestion. There is mild/moderate coarse strandy and hazy/patchy bilateral airspace disease, most extensive in the lower lungs. No effusion or pneumothorax is seen. _________________________ Impression: Mild/moderate coarse strandy and hazy/patchy bilateral airspace disease consistent with a multifocal/bilateral, probable COVID, pneumonia. Procedure Component Value Ref Range Date/Time COVID-19 PCR, Rapid [290822786] (Abnormal) Collected: 09/11/21 1029 Order Status: Completed Specimen: Swabbed Collection from Nasopharynx Updated: 09/11/21 1046 COVID-19 PCR Detected Abnormal Not Detected Comment: COVID-19 (SARS-CoV-2) test is positive. Clinical correlation with patient history and other diagnostic information is necessary to determine infection status. This test has received Emergency Use Authorization (EUA) by the FDA, but performance has not been evaluated for asymptomatic patients. Testing was performed using a nucleic acid amplification method. The specimen source may have been changed from the original order per patient situation or symptoms. Covid 19 Result Comment See Comment Comment: COVID-19 results reported as "detected" means COVID-19 positive. Positive patients should self-isolate for 10 days or 24 hours after fever resolves and other symptoms are improving, whichever is longer: - Stay home except to get medical care and wear a facemask if you must leave - Separate yourself from other people in your home, known as home isolation - Cover your coughs and sneezes - Wash your hands often - Avoid sharing household items - Clean high-touch surfaces everyday - If you have a medical emergency and need to call 911, notify dispatch personnel that you may have COVID-19 and put on a facemask before emergency medical services arrive. If the result is "inconclusive" or "invalid" and you have not been contacted by a medical professional about your result or if you have questions about COVID-19, your symptoms, or need a return to work/school note, please contact your primary care provider (PCP).
CDC Split Type:

Write-up: A 71 y.o. female with history of type 2 diabetes, GERD, hypertension and hyperlipidemia who presents today with generalized weakness, fatigue and hypoxia. Patient stated she had onset of symptoms fatigue, weakness, body aches, nausea, vomiting, diarrhea, cough and decreased appetite. Patient stated sick contact was her grandson who had COVID. Patient noted the worst of her symptoms is extreme fatigue and weakness. She run an adult foster home and the last 2 nights she used a pulse oximeter which showed she would drop to the high 80s on room air overnight. She denied any shortness of breath, chest pain, calf pain, fever or chills. She did receive her COVID-19 vaccinations. She stated that she is so weak and fatigued that she could not take it anymore prompting her to be seen at Emergency Department for evaluation. Patient''s laboratory studies relatively unremarkable. She was given Zofran and able to tolerate Vernors. COVID-19 positive. Chest x-ray demonstrated mild/moderate coarse strandy and hazy/patchy bilateral airspace disease, most extensive in the lower lungs. No effusion or pneumothorax is seen. Patient''s vitals were stable on room air until she got up and became tachycardic with heart rate into the 130s-140s. She was admitted for symptom management of COVID-19. Patient was admitted under observation. She received monoclonal antibody infusion, tolerated well. She was also treated with dexamethasone 6 mg a day. She did not qualify for remdesivir. She continued to have extreme fatigue, weakness body aches and nausea. Her nausea improved with Zofran and was able to have adequate oral intake. She remained on room air and her vitals were stable. She was discharged home in stable condition with a prescription for Protonix, Zofran ODT, and dexamethasone for 8 days. She was instructed to self quarantine and call to make an appointment for with her PCP. All questions and concerns were addressed prior to discharge.


VAERS ID: 1716335 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-18
Onset:2021-09-11
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Blood culture negative, COVID-19, Chest X-ray abnormal, Cough, Dyspnoea, Lung opacity, Pleural effusion, Pneumonia viral, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 MG tablet albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler aspirin 81 MG enteric coated tablet carvedilol (COREG) 12.5 MG tablet
Current Illness: Enlarged and hypertrophic nails, Pedal edema-prn lasix use, Pressure injury of buttock, stage 2, unspecified laterality (HCC) - Primary 1. Acute nonintractable headache, unspecified headache type Acute 2. Fatigue, unspecified type 3. Pressure injury of left buttock, stage 2 (HCC) 4. Pressure injury of right buttock, stage 2 (HCC)
Preexisting Conditions: Respiratory Hypoxia Pneumonia due to COVID-19 virus Infectious/Inflammatory Arthritis of right shoulder region COVID-19 Nervous Neuropathy involving both lower extremities Genitourinary Benign bladder tumor BPH (benign prostatic hyperplasia) Other Enlarged and hypertrophic nails History of DVT of lower extremity-2014 and 2020 Pedal edema-prn lasix use History of compression fracture of spine Actinic keratosis Pressure injury of buttock, stage 2, unspecified laterality (HCC)
Allergies: Bee VenomSwelling
Diagnostic Lab Data: Procedure Component Value Ref Range Date/Time DR CHEST SINGLE VIEW [336940582] Resulted: 09/11/21 2120 Order Status: Completed Updated: 09/11/21 2123 Narrative: EXAMINATION: Single View Chest EXAM DATE: 9/11/2021 8:47 PM TECHNIQUE: Single view chest INDICATION: cough COMPARISON: Chest x-ray November 8, 2020 ENCOUNTER: Not applicable _________________________ FINDINGS: Increase in hazy perihilar opacities with subtle bony vascular prominence. Small right pleural effusion is present. No pneumothorax evident. _________________________ Impression: 1. Hazy perihilar opacities with mild pulmonary vascular distention and small right pleural effusion, differential may include mild volume overload versus developing CHF. Procedure Component Value Ref Range Date/Time Peripheral Blood Culture [336940590] Collected: 09/11/21 2012 Order Status: Completed Specimen: Blood, Venous Updated: 09/16/21 2101 Cult Blood Peripheral No bacteria or yeast isolated Peripheral Blood Culture [336940591] Collected: 09/11/21 2036 Order Status: Completed Specimen: Blood, Venous Updated: 09/16/21 2101 Cult Blood Peripheral No bacteria or yeast isolated COVID-19 PCR, Rapid [336940584] (Abnormal) Collected: 09/11/21 2010 Order Status: Completed Specimen: Swabbed Collection from Nasopharynx Updated: 09/11/21 2021 COVID-19 PCR Detected Abnormal Not Detected Comment: COVID-19 (SARS-CoV-2) test is positive. Clinical correlation with patient history and other diagnostic information is necessary to determine infection status. This test has received Emergency Use Authorization (EUA) by the FDA, but performance has not been evaluated for asymptomatic patients. Testing was performed using a nucleic acid amplification method. The specimen source may have been changed from the original order per patient situation or symptoms. See http://lab.spectrumhealth.org for additional information. Covid 19 Result Comment See Comment Comment: COVID-19 results reported as "detected" means COVID-19 positive. Positive patients should self-isolate for 10 days or 24 hours after fever resolves and other symptoms are improving, whichever is longer: - Stay home except to get medical care and wear a facemask if you must leave - Separate yourself from other people in your home, known as home isolation - Cover your coughs and sneezes - Wash your hands often - Avoid sharing household items - Clean high-touch surfaces everyday - If you have a medical emergency and need to call 911, notify dispatch personnel that you may have COVID-19 and put on a facemask before emergency medical services arrive. If the result is "inconclusive" or "invalid" and you have not been contacted by a medical professional about your result or if you have questions about COVID-19, your symptoms, or need a return to work/school note, please contact your primary care provider (PCP).
CDC Split Type:

Write-up: The patient is a 96-year-old gentleman who presented with complaints of cough and shortness of breath. Patient was felt to be suffering from viral pneumonia secondary to COVID 19. Patient was placed in the hospital and put on supplementary oxygen to maintain appropriate saturations. He was started on Decadron and remdesivir during his hospitalization. With treatment and time the patient was able to be weaned from oxygen while maintaining appropriate saturations on room air. On day of discharge the patient was feeling relatively well and was comfortable being discharged home. Questions have been answered to the patient''s satisfaction and he is being discharged in improved and stable condition.


VAERS ID: 1716340 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-21
Onset:2021-09-11
   Days after vaccination:82
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Aphasia, COVID-19, Cardiomegaly, Chest X-ray abnormal, Dyspnoea, Gait inability, Hypoxia, Lung infiltration, Lung opacity, Oxygen saturation decreased, SARS-CoV-2 test positive
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 5 MG tablet atorvastatin (LIPITOR) 10 MG tablet Calcium Carb-Cholecalciferol (CALCIUM/VITAMIN D) 600-400 MG-UNIT TABS dexamethasone (DECADRON) 6 MG tablet loratadine (CLARITIN) 10 MG tablet melatonin 3 MG tablet montelu
Current Illness:
Preexisting Conditions: Circulatory Essential hypertension Endocrine/Metabolic Hyperlipidemia Other Cognitive impairment
Allergies: No Known Allergies
Diagnostic Lab Data: Procedure Component Value Ref Range Date/Time DR CHEST SINGLE VIEW Resulted: 09/11/21 2145 Order Status: Completed Updated: 09/11/21 2147 Narrative: EXAMINATION: Single View Chest EXAM DATE: 9/11/2021 9:11 PM TECHNIQUE: Single view chest INDICATION: Shortness of breath and COVID positive COMPARISON: None ENCOUNTER: Not applicable _________________________ FINDINGS: The heart is enlarged. Patchy airspace disease is present within the left lung base. No pleural effusion or pneumothorax identified. _________________________ Impression: Left lower lobe infiltrate. Consider pneumonia. Results Procedure Component Value Ref Range Date/Time COVID-19 PCR, Rapid (Abnormal) Collected: 09/11/21 2023 Order Status: Completed Specimen: Swabbed Collection from Nasopharynx Updated: 09/11/21 2039 COVID-19 PCR Detected Abnormal Not Detected Comment: COVID-19 (SARS-CoV-2) test is positive. Clinical correlation with patient history and other diagnostic information is necessary to determine infection status. This test has received Emergency Use Authorization (EUA) by the FDA, but performance has not been evaluated for asymptomatic patients. Testing was performed using a nucleic acid amplification method. The specimen source may have been changed from the original order per patient situation or symptoms. Covid 19 Result Comment See Comment Comment: COVID-19 results reported as "detected" means COVID-19 positive. Positive patients should self-isolate for 10 days or 24 hours after fever resolves and other symptoms are improving, whichever is longer: - Stay home except to get medical care and wear a facemask if you must leave - Separate yourself from other people in your home, known as home isolation - Cover your coughs and sneezes - Wash your hands often - Avoid sharing household items - Clean high-touch surfaces everyday - If you have a medical emergency and need to call 911, notify dispatch personnel that you may have COVID-19 and put on a facemask before emergency medical services arrive. If the result is "inconclusive" or "invalid" and you have not been contacted by a medical professional from Health Authority about your result or if you have questions about COVID-19, your symptoms, or need a return to work/school note, please contact your primary care provider (PCP).
CDC Split Type:

Write-up: Patient is a 92 yo female who lives in an nursing home. She presented to the ER today with hypoxia secondary to COVID-19. She is requiring 2L''s of supplemental oxygen to maintain O2 sats over 90%. Hopsitalist service contacted for admission. We agreed to admit her for an inpatient stay, anticipating greater than a 2 midnight stay. She is vaccinated with the Johnson and Johnson vaccine. She is non-verbal, non-ambulatory at baseline. I spoke with her representative, who states patient is DNR. She consents to convalescent plasma should that treatment be indicated. She would like to be contacted prior to placing a central line or starting vasopressors should that become necessary. She did not know when symptoms started. Her chest x-ray shows possible pneumonia. Procalcitonin ordered at the time of admission. Antibiotics held pending results. Some concern for AKI versus CKD. Will bolus 500ml NSS but hold on additional IV fluids at this time as her blood pressure is good and she does not appear overly dry. We will titrate oxygen to keep O2 Sats over 92%, wean as tolerated. Convalescent plasma not ordered at the time of admission as I could not confirm onset of symptoms. Patient required 2 L of oxygen on admission. She received dexamethasone and Remdesivir. She tolerated medical management well and was able to be weaned off of oxygen. Her AKI most likely secondary to fluid volume depletion and resolved with IV fluids. Her vitals remained stable and her inflammatory markers were improving. She was discharge back to nursing home with representative for nursing services and provided a prescription for dexamethasone 6 mg for 7 days to finish the 10 day course treatment. Nursing home updated on discharge plan including scheduling follow-up with her PCP in 3-5 days, day were agreeable.


VAERS ID: 1716384 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Military       Purchased by: ?
Symptoms: Chest discomfort, Electrocardiogram, Inflammation, Lymphadenopathy
SMQs:, Anaphylactic reaction (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: right axillary lymphadenopathy after getting vaccine in right arm. inflammation caused pressure on right side of chest resulting in visit to ER to have vitals assessed and EKG completed.


VAERS ID: 1716396 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ID0809 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Cold sweat, Cough, Dizziness, Dyspnoea, Electrocardiogram normal, Fatigue, Headache, Hypersomnia, Impaired work ability, Injection site pain, Palpitations, Panic attack, Pulmonary pain
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine (88 mcg), Duloxetine (60 mg), Multivitamin, Vitamin D (2,000 units)
Current Illness: Hashimoto''s Disease, undiagnosed muscle fatigue - possible fibromyalgia
Preexisting Conditions: Chronic back pain, muscle fatigue and pain sensitivity, Hashimoto''s Disease
Allergies: Bactrim
Diagnostic Lab Data: Patient visited urgent care, where they performed a quick EKG which came back clear, and vitals looked good.
CDC Split Type:

Write-up: On 09/10/21 at 10:45 AM, patient was given first dose of Pfizer COVID-19 vaccine. Within 30 minutes, normal side effects were observed. Burning sensation at the injection site, and soreness in arm. That evening patient felt tired, and then slept for twelve hours which is unusual since she has two small children (father cared for children so she could rest). The morning of 09/11/21, patient experienced shortness of breath and pain in the lungs (COPD like symptoms), coughing, sever fatigue, headache and was lightheaded throughout the day. Lungs began to feel better by 10:50 AM, but lung pain and shortness of breath came back around 2 PM, which led patient to experience a panic attack. Severe fatigue returned that afternoon, and patient rested throughout the day. On 09/12/21 severe fatigue persisted, and patient rested and drank water to no avail. On 09/13/21 patient felt back to baseline and then at 9 PM that night experienced chest pain/pressure. On the morning of 09/15/21 patient woke up in a cold sweat and felt like there was pressure and pain around her heart. By 11 AM that morning patient experienced severe fatigue and had to take the day off of work to rest. A severe pressure headache began at 11:19 AM, which intensified by 3:30. On the afternoon of 09/15/21, patient felt like heart was pounding out of chest. Patient called PCP, who said it was likely anxiety, and anti-anxiety medication should help. Patient followed doctor''s orders, but anti-anxiety medication did not help. Patient visited urgent care on 09/16/21, where they performed a quick EKG which came back clear, and vitals looked good. As of 09/20/21 chest pain still comes and goes, and anti-anxiety medication does not help. It should be noted that though patient has experienced anxiety for years, chest pain has never been a symptom until after receiving the first dose of the vaccination.


VAERS ID: 1716397 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301300A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Burning sensation, Chest pain, Diarrhoea, Headache, Myalgia, Pain in extremity, Respiratory tract congestion
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: burning sensation in both arms and chest, full body muscle aches, joint pain, diarrhea for 2 days, headache still, arm pain, head congestion


VAERS ID: 1716910 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Cyanosis, Electrocardiogram, Headache, Laboratory test, X-ray
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Raspberries
Diagnostic Lab Data: EKG, X-ray, labs on both date 9/17/2021 and 9/20/2021.
CDC Split Type:

Write-up: Chest pain; blue lips; headache.


VAERS ID: 1716925 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram, Blood pressure increased, Chest discomfort, Chest pain, Computerised tomogram, Dyspnoea exertional, Heart rate increased, Ventricular enlargement
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: (INFS Pres Free 6mos-Adult(flulaval quadrivalent) 11/3/2020, numbness at left intramuscular injection site and whole left side
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: PEG, Almonds, Tamiflu
Diagnostic Lab Data: ct scan, angiogram 9/11
CDC Split Type:

Write-up: began having chest pain/ tightness and short of breath on exertion, elevated heart rate and blood pressure. No issues prior to vaccination outcome- enlarged pulmonary artery ( had no prior heart issues)


VAERS ID: 1716939 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, Chest pain, Electrocardiogram normal
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: hypertension, UTI, CKD2, vitamin D deficiency
Preexisting Conditions: n/a
Allergies: benzaclin, spirinolactone, scented lotion detergents
Diagnostic Lab Data: 12-lead EKG - normal. CXR - normal =$g both done at QMC ER
CDC Split Type:

Write-up: patient received pfizer covid vaccine dose #1 on 9/11/2021 at a vaccine clinic. patient, then, experienced a chest pain after the pfizer vaccine. patient went to the QMC ER and was evaluated for chest pain. 12-lead EKG - normal. Chest XR - normal. no labs were drawn in ER. patient followed up in our clinic today. Patient was still having chest pain and was referred to Cardiology for rule out pericarditis.


VAERS ID: 1718107 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-12
Onset:2021-09-11
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Dysuria
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: LOVASTATIN; GABAPENTIN; DULOXETINE; ALDACTONE [SPIRONOLACTONE]
Current Illness: Drug allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Painful urination; This spontaneous case was reported by a consumer and describes the occurrence of DYSURIA (Painful urination) in a 75-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 017E21A) for COVID-19 vaccination. Concurrent medical conditions included Drug allergy. Concomitant products included LOVASTATIN, GABAPENTIN, DULOXETINE and SPIRONOLACTONE (ALDACTONE [SPIRONOLACTONE]) for an unknown indication. On 12-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 09-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 11-Sep-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced DYSURIA (Painful urination). At the time of the report, DYSURIA (Painful urination) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No treatment medications were provided. it was reported patient had painful urination few minutes earlier. This case was linked to MOD-2021-316173 (Patient Link).


VAERS ID: 1718111 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-12
Onset:2021-09-11
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LOVASTATIN; GABAPENTIN; DULOXETINE; ALDACTONE 50 HCT
Current Illness: Drug allergy (Codeine)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: she had with the first dose was a sore arm that went away after 2 days; Painful urination; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (she had with the first dose was a sore arm that went away after 2 days) and DYSURIA (Painful urination) in a 75-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 017E21A) for COVID-19 vaccination. Concurrent medical conditions included Drug allergy (Codeine). Concomitant products included LOVASTATIN, GABAPENTIN, DULOXETINE and HYDROCHLOROTHIAZIDE, SPIRONOLACTONE (ALDACTONE 50 HCT) for an unknown indication. On 12-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 11-Sep-2021, the patient experienced DYSURIA (Painful urination). On an unknown date, the patient experienced PAIN IN EXTREMITY (she had with the first dose was a sore arm that went away after 2 days). At the time of the report, PAIN IN EXTREMITY (she had with the first dose was a sore arm that went away after 2 days) had resolved and DYSURIA (Painful urination) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No treatment medication details provided. This case was linked to MOD-2021-316145 (Patient Link).


VAERS ID: 1718320 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Allergy to vaccine, Body temperature, Fatigue, Malaise, Nasal congestion, Oropharyngeal pain, Pain in extremity, Pyrexia, Rhinorrhoea, Sneezing
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: temperature; Result Unstructured Data: Test Result:it went up to 99.2
CDC Split Type: USPFIZER INC202101192613

Write-up: I was sneezing a lot; I was just sneezing too much; Probably little bit of an allergy I am sneezing a lot; My temperature right now, it went up to 99.2; Do have some fever; Pain in arm; Feeling a little bit of a sore throat; I was sneezing a lot; I was just sneezing too much; Probably little bit of an allergy I am sneezing a lot; Feeling a little ill; Feeling very ill; Still I am feeling quite ill; Little bit of a runny nose; Nose is still runny; Little tired; Feeling little feverish like block nose, runny nose, little feverish; This is a spontaneous report from a contactable consumer (patient). A patient of unspecified age and gender received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Formulation: Solution for injection, Lot Number: FF2588), via an unspecified route of administration on 10Sep2021 as single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. Reporter just got Pfizer shot, the first shot that and reporter having some reaction, patient was not sure if it was exactly a reaction from Pfizer or no. The patient got it day before yesterday in the afternoon and then last to last night patient started feeling a little ill, so patient was having some pain in the arm which was natural on 11Sep2021. Patients mean after the vaccine it''s quite common and then patient was feeling a little bit of a sore throat but that went away quite fast and then patient was feeling, sneezing a lot. Yesterday morning patient woke up sort of okay. Patient was just sneezing too much and patient thought it''s probably little bit of an allergy. On 11Sep2021 patient experienced sneezing a lot and patient had little bit of a runny nose but it wasn''t, patient didn''t take this that seriously, overall patient was fine and little tired but patient just thought it''s okay it''s not a big deal it''s just part of the vaccine symptoms all rising side effects. So, then yesterday evening on 11Sep2021 around 6 or 7pm patient stated feeling very ill and patient started feeling little feverish like block nose, runny nose, little feverish. Patient said not too much and then patient just try to sleep then patient slept. Then in the morning patient woke up very earlier on 12Sep2021 at 03:00 and patient don''t have really much equipment at home but patient did try to take temperature which was not sure if the ''thermoset'' was working properly but patient think it was, so temperature right now it went up to 99.2, so patient do have some fever and nose was still runny and all that. Patient tried to gargle and all the traditional salt and water and all that, so nose was maybe little bit better because of salt water and cleaning the nose with salt water but still patient was feeling quite ill. Then patient tried to search online about the symptoms of all the side effects for the vaccine, runny nose and all was not the part of it, fever was but not a runny nose and it was written if you have a running nose you may actually have COVID itself, so patient got little bit scared and patient was just not sure if patient should actually go for a COVID test or can running nose also be a reaction of Pfizer? The patient underwent lab tests and procedures which included body temperature: it went up to 99.2. Therapeutic measures were taken as a result of little bit of a runny nose; nose is still runny, feeling little feverish like block nose, runny nose, little feverish. The outcome of feeling a little ill; feeling very ill; still I am feeling quite ill, little bit of a runny nose; nose was still runny was not recovered; feeling a little bit of a sore throat was recovered on Sep2021, while with other events was unknown.


VAERS ID: 1718553 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

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

Write-up: Systemic: Allergic: Rash Generalized-Medium, Additional Details: DEVELOPED HIVES THE NEXT DAY, THROUGHOUT THE ENTIRE BODY TO THE BOTTOMS OF THE FEET


VAERS ID: 1718871 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-25
Onset:2021-09-11
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute respiratory failure, Akinesia, Blood culture negative, Blood lactic acid, COVID-19, Cardiac failure, Chest X-ray abnormal, Clostridium test, Computerised tomogram head abnormal, Condition aggravated, Culture urine negative, Cytomegalovirus test negative, Dehydration, Diarrhoea, Echocardiogram abnormal, Ejection fraction decreased, Encephalopathy, Febrile neutropenia, Lung consolidation, Mobility decreased, Nitrite urine absent, Osteomyelitis, Pleural effusion, Pneumonia, Pollakiuria, Pulmonary congestion, Pulmonary oedema, Right ventricular dilatation, Right ventricular dysfunction, SARS-CoV-2 test positive, Sepsis, Sinusitis, Sputum culture, Staphylococcus test positive, Urine leukocyte esterase positive, Wound
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Agranulocytosis (narrow), Haematopoietic leukopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Parkinson-like events (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Accidents and injuries (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (narrow), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Outpatient Medications acalabrutinib (CALQUENCE) 100 MG capsule acetaminophen (TYLENOL) 500 MG tablet acetaminophen (TYLENOL) 500 MG tablet acyclovir (ZOVIRAX) 400 MG tablet albuterol HFA (PROAIR HFA) 108 (90 Base) MCG/ACT inhaler aspirin 8
Current Illness: Discharged from Hospital 8.10.21: s/p NSTEMI, heart failure 8.27.21: Hospital admission - osteomyelitis, dehydration, wound infection, severe sepsis (dc''d 9.3.21) 9.3.21: Admitted to rehabilitation hospital (s/p above knee amputation, unilateral) 9.11.21 - admitted to hospital; COVID-19 positive
Preexisting Conditions: Non-Hospital Essential hypertension, benign Leukocytosis Non-healing wound of lower extremity Depression Overactive bladder Cardiomyopathy, unspecified History of intracranial hemorrhage Infection of total knee replacement, initial encounter Painful total knee replacement, left Lumbar stenosis with neurogenic claudication Post-operative complication Ankle arthritis CKD (chronic kidney disease), stage II Multifocal pneumonia Peripheral vascular disease Left foot infection Hyperkalemia Postoperative anemia Soft tissue lesion of knee region Complicated wound infection NSTEMI (non-ST elevated myocardial infarction) Chronic combined systolic and diastolic heart failure Thrombocytopenia Pleural effusion
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (9.11.21 - present; febrile neutropenia); COVID-19 positive (9.11.21); Fully Vaccinated SUBJECTIVE: This is a 79 y.o. patient with a past medical history significant for cardiomyopathy, hypertension, PVD, CKD, past CVA/SAH, CLL on chemo, recent AKA presenting to the emergency department via EMS from bed for evaluation of fevers, neutropenia, concern for sepsis. Patient found to be COVID positive with questionable lower lobe infiltrate. Given neutropenia, she was started on cefepime and will be admitted for further work-up and monitoring. Upon assessment, patient resting in bed with daughter at bedside. Patient and daughter provided the history. Patient reports she was in last week for left foot/LE amputation related to chronic non-healing wound. She then went to another facility. She denies any sick contacts, states she is fully vaccinated and has been very careful. Denies SOB, no cough. Denies any new rash, pain with urination (though does report frequency). No issues at amputation site. Daughter reports wound on her bottom r/t being in bed and diarrhea - states she has been using skinguard to help. Patient also with recent MI - about 4 weeks ago. Has been taking her meds. Denies any CP, palps, swelling in legs. Labs and plan of care reviewed. All questions answered. DISPO: -continue cefepime, monitor infectious w/u -appreciate ID input -monitor renal fxn, may need to hold entresto/lasix if worsening -please ask to sign blood consent 9/12, declined 9/11 with being tired/overwhelmed ASSESSMENT / PLAN: Febrile Neutropenia -Temp 100.4 in ED, other VSS -lactic 1.6 -- $g 0.9 -CXR 9/11 vascular congestion, questionable lower lobe infiltrate on lateral view -COVID positive -recent Cdiff negative on 9/2 -UA small leuks, negative nitrites; UC pending -periph BC x2 pending -Blood cx on 8/27 admit +staph hominis but determined contaminant, was on Zosyn -s/p cefepime 2G in ED, will continue Q12h -will consult ID COVID Infection -Positive PCR on 9/11, likely hospital/facility acquired -CXR 9/11 questionable LL infiltrate -s/p dex 6mg on 9/11 -ID consulted, appreciate input -currently on room air Progress Note from 9.21.21: CHIEF COMPLAINT: Febrile neutropenia COVID-19 ASSESSMENT / PLAN: Acute hypoxic respiratory failure -Multifactorial in setting of HFrEF, recent COVID, pleural effusion, interlobular fluid and b/l patchy airspace disease -sputum culture pending -CXR 9/15 patchy perihilar consolidations pulm edema vs infecction -CXR 9/20 bilateral pneumonia vs pulmonary edema - ECHO 9/16 with EF 56% inferior septal wall is akinetic, right ventricle is mildly dilated and function is mildly decreased -MRSA positive -Pulm now signed off-- rec diuresis, abx, dex -Cardiology now signed off- discontinued Entresto, continue daily IV lasix -ID following -s/p vanco (9 days), and cefepime/ceftazidime (9 days total). Per ID monitor off antibx for now -continue lasix 40mg BID for now -On hi-flow- wean as able. No home O2 at baseline COVID Infection -Positive PCR on 9/11, likely hospital/facility acquired -Asymptomatic until 9/14/21 - now req O2 -CXR 9/11 questionable LL infiltrate -CXR 9/20 pulm edema vs pnumonia -Cont dex 6mg daily x10 days (9/15-9/25) -S/p Regeneron 9/13 per ID -ID does not feel any benefit from remdesivir -Wean off O2 as able Febrile Neutropenia - resolved -Blood cx on 8/27 admit +staph hominis but determined contaminant, was on Zosyn -Most recent fever: 9/15 PM -CXR 9/11 vascular congestion, questionable lower lobe infiltrate on lateral view -COVID positive -MRSA screen positive -C diff negative on 9/2 -UA small leuks, negative nitrites; UrCx neg -CMV blood PCR neg -BCx remain NGTD -CT head 9/13 with pansinusitits - asymptomatic -DC''d cefepime d/t encephalopathy -s/p ceftazidime/vanco-- monitor off per ID


VAERS ID: 1718960 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Burning sensation, Feeling abnormal, Headache, Pharyngeal swelling, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Dementia (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SYNTHROID, VITAMIN, TYLENOL
Current Illness:
Preexisting Conditions:
Allergies: NONE KNOWN.
Diagnostic Lab Data:
CDC Split Type:

Write-up: THERE WAS A WARM BURN FEELING IN MY CHEST AFTER RECEIVING THE VACCINE. ALSO HAD A HEADACHE THAT LASTED FOR ABOUT 3-4 DAYS WHICH ALSO GAVE A SWAY FEELING WHEN STOOD. THERE''S A CONGESTED FEEING THAT HAS MY THROAT FEELING SWOLLEN.


VAERS ID: 1719033 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-17
Onset:2021-09-11
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Bell's palsy, Computerised tomogram normal, Magnetic resonance imaging normal
SMQs:, Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness:
Preexisting Conditions: Asthma, Rheumatoid arthritis.
Allergies: Methotrexate, ragweed.
Diagnostic Lab Data: CT Scan - normal MRI - normal
CDC Split Type:

Write-up: Bell''s palsy on the right side of the face where injection site is located.


VAERS ID: 1719100 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 202A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Dyspnoea, Feeling hot, Muscle spasms
SMQs:, Anaphylactic reaction (broad), Dystonia (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 24 hours of chills, hot, difficult breathing, cramps in lower legs.


VAERS ID: 1719224 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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? 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: Hives


VAERS ID: 1719253 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-03
Onset:2021-09-11
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 RA / IM

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

Write-up: I felt very dizzy on the 8th day after getting the vaccination and have been feeling dizzy for 10 days now. It''s not as bad as it was when it first started but I still don''t feel like myself and feel like I have to move slower than I used to. A couple of days ago I felt almost normal again but dizziness returned the next day. I have a doctor''s appointment scheduled on 9/30/2021


VAERS ID: 1719293 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: California  
Vaccinated:2021-02-21
Onset:2021-09-11
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Cough, Fall, Headache, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: weakness, fever 100.5, cough, headache, started yesterday, denies sob or cp, was walking to restroom and had fall landing on carpet, no injury from fall, able to get him self up, usually uses walker to walk around but not when he fell,


VAERS ID: 1719321 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-16
Onset:2021-09-11
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: positive for fever, positive for chills and malaise / fatigue


VAERS ID: 1719359 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, C-reactive protein increased, Chest pain, Dyspnoea, Pain
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: None
Diagnostic Lab Data: She went to her primary care physician office where a CRP was ran and came back positive with a value of 1.36.
CDC Split Type:

Write-up: Around 24 hours after receiving second Moderna shot, the patient started experiencing shooting chest pain on left side that radiated to her back and had shortness of breath.


VAERS ID: 1719379 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-22
Onset:2021-09-11
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Oedema peripheral, Vaginal haemorrhage
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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: Larin Fe (Birth Control)
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Swollen armpit on the same arm as injection. Vaginal bleeding for 9 continuous days (not related to menstrual cycle as I am have been regular my whole life and was not within the normal time frame).


VAERS ID: 1719506 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-09-09
Onset:2021-09-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Contusion, Lymph node pain, Lymphadenopathy
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (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: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lymph node under LUE, axillary lymph node, swollen to size of baseball on 09/11/21. Has remained swollen through today''s date 09/21/21. Painful and bruised


VAERS ID: 1719515 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Arthralgia, Chills, Diarrhoea, Fatigue, Fibrin D dimer increased, Headache, Lymphocyte count decreased, Myalgia, Nausea, Neutrophil count increased, Pain in extremity, Palpitations
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Plaquenil, Tylenol, Ibuprofen
Current Illness:
Preexisting Conditions: Sjogrens autoimmune disease
Allergies: Sulfa
Diagnostic Lab Data: High D-dimer 9/13/2021 High Neutrophils 9/13/2021 Low Lymphocytes 9/13/2021
CDC Split Type:

Write-up: Headache, Muscle pain, Chills, Nausea, abdominal pain, Joint pain, diarrhea, leg pain, extreme fatigue, racing heart


VAERS ID: 1719527 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-03
Onset:2021-09-11
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Autoimmune haemolytic anaemia, Blood lactate dehydrogenase increased, C-reactive protein increased, Chest X-ray abnormal, Condition aggravated, Cough, Full blood count, Headache, Lung opacity, Pyrexia, SARS-CoV-2 antibody test positive, SARS-CoV-2 test negative
SMQs:, Haemolytic disorders (narrow), Anaphylactic reaction (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Abatacept
Current Illness: No acute illnesses reported
Preexisting Conditions: CTLA4 haploinsufficiency (aka CHAI) with history of autoimmune cytopenias (ITP, AIHA), lung nodules, LAD/splenomegaly, anterior uveitis bilateral (diagnosis 4/2020), and psoriasis (started 10/2020)
Allergies: Pencillin antibiotics
Diagnostic Lab Data: 9/18/21 CRP 18.4 mg/dL 9/18/21 CBC 5.8$g12.6/36.6<129 9/18/21 SARS-CoV-2 Ab: positive 9/18/21 LDH 602 U/L (uln is 270) 9/18/21 CXR: "Slight patchy opacity is present at the right midlung, possibly focus of pneumonia."
CDC Split Type:

Write-up: 16 Y old young man with CTLA4 haploinsufficiency (aka CHAI) with history of autoimmune cytopenias (ITP, AIHA), lung nodules, LAD/splenomegaly, bilateral anterior uveitis (diagnosis 4/2020), and psoriasis (started 10/2020) with new onset of headache (now improved), fever from 9/11-9/20, and cough since around 9/14 who had negative COVID-19 and viral testing without improvement on initial antibiotics despite new chest xray findings, but did have worsening labs including CRP and findings of early AIHA, as such was started on prednisone 30 mg BID on 9/18 in discussion with immunologist given concern about a flare of his inflammatory process related to his genetic disorder (CHAI). With start of steroids has had improved labs and clinical status. Unclear if exacerbation related to mRNA vaccine third dose given 9/3 or if other trigger but in the past 2 years has not had any other flares. Did however tolerate first two doses of mRNA vaccine without any significant adverse events.


VAERS ID: 1719762 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-31
Onset:2021-09-11
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 210310-029 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, SARS-CoV-2 test
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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: Allopurinol 100 MG TAKE ONE TABLET BY MOUTH DAILY amLODIPine-Valsartan-HCTZ 10-320-25 MG TAKE ONE TABLET BY MOUTH DAILY WITH DINNER Aspirin 81 mg Oral Daily Atorvastatin Calcium 80 MG TAKE ONE TABLET BY MOUTH DAILY Empagliflozin 25 mg O
Current Illness: Diabetes mellitus. Seen by MD on 8/31/21 for difficulty swallowing for the last 3 weeks.
Preexisting Conditions: Uncontrolled type 2 diabetes mellitus with hyperglycemia (CMS/HCC) Vitamin D deficiency Thyroid nodule Nephropathy Mixed hyperlipidemia Microalbuminuria Hypertension, essential
Allergies: Metformin
Diagnostic Lab Data:
CDC Split Type:

Write-up: 9/8/21-Patient was COVID-19 tested for preop prior to undergoing a C Scope/EGD for difficulty swallowing. Procedure was cancelled


VAERS ID: 1720067 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Electrocardiogram, Fatigue, Feeling abnormal, Headache, Hypoaesthesia, Injection site pain, Muscle twitching, Palpitations, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Sexual dysfunction (broad)

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

Write-up: Pain and swelling at the injection site; headache; dizziness; "head fog"; tiredness; muscle twitches; face numbness/tingles; chest tight; heart palpitations;


VAERS ID: 1720520 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Headache, Heart rate increased, Hypertension, Injection site pain, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Hypertension (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bariatric multivitamin, calcium, magnesium, Tylenol, lamisil
Current Illness: None
Preexisting Conditions: 1 year post bariatric surgery patient, WPW (wolff parkinson white?), depression/ bipolar disorder
Allergies: Codeine, morphine, gabapentin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fatigue, feel feverish but no fever, skin rash and marks on right lower leg (resolved after a few hours- happened2 days in a row). Headache, arm pain at vaccine site. High heart rate over 100 at rest a couple times a day. High blood pressure.


VAERS ID: 1721575 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-09
Onset:2021-09-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysmenorrhoea, Heavy menstrual bleeding, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (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? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall XR 30mg once daily Nexplanon
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: Codeine Morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: I am on nexplanon and haven?t had a period in nearly 6 years, replaced 2x now. I maybe have light spotting if anything. Not even a full 48 hours after my vaccine I wake up to the heaviest most painful period of my life, with the hugest clots I have ever seen. Concerned me quite a bit, but heard from other that they had similar experiences after the first shot. When the period ended up lasting 9 days, ended today, that?s when I knew there was an issue. Prior to nexplanon, my periods would average 3-4 days and super light flow. I have never had an issue with heavy bleeding, cramping and clots. And before im told it?s because I haven?t had an actual period in so long, NO! I know my body and that WAS NOT normal! Not to mention, reading about and being told by numerous other females that experienced this EXACT symptom after their first vaccine, that tells me it is related! This needs to be listed as a potential side effect for females or something needs to be changed in this vaccine. That reaction CANNOT be normal, nor healthy.


VAERS ID: 1721597 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-13
Onset:2021-09-11
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Anaphylactic reaction
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Latex allergy; Urticaria
Preexisting Conditions: Medical History/Concurrent Conditions: Hypersensitivity reaction
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Anaphylactic reaction; This spontaneous case was reported by a consumer and describes the occurrence of ANAPHYLACTIC REACTION (Anaphylactic reaction) in a 62-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 034C21A and 929901) for COVID-19 vaccination. The patient''s past medical history included Hypersensitivity reaction. Concurrent medical conditions included Latex allergy since 01-Jan-1994 and Urticaria. On 13-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 10-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 11-Sep-2021, the patient experienced ANAPHYLACTIC REACTION (Anaphylactic reaction) (seriousness criterion medically significant). The patient was treated with ADRENALINE [EPINEPHRINE] for Adverse event, at a dose of 1 dosage form; DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) (oral) from 11-Sep-2021 to 14-Sep-2021 for Adverse event, at a dose of every 4 hours and METHYLPREDNISOLONE ACETATE (METHYLPREDNISOLONE [METHYLPREDNISOLONE ACETATE]) (oral) on 13-Sep-2021 for Adverse event, at a dose of 4 mg. On 13-Sep-2021, ANAPHYLACTIC REACTION (Anaphylactic reaction) had resolved. Concomitant medications were not provided. Additional treatment included-oxygen. Company Comment: This case concerns a 62-year-old female patient with relevant medical history of urticaria and hypersensitivity reaction who experienced serious expected event of anaphylactic reaction. The event occurred approximately one day after the second, most recent dose of Spikevax with first symptoms occurring within 24 hours.. Rechallenge was not applicable since the event occurred after the second dose of Spikevax. The event was consistent with the current understanding of the mechanism of action of the medication . The benefit-risk relationship of drug is not affected by this report. Most recent FOLLOW-UP information incorporated above includes: On 17-Sep-2021: Follow up received on 17-SEP-2021 and patient demographic updated, event were added, product tab information added, medical history added and treatment medicines added.; Sender''s Comments: This case concerns a 62-year-old female patient with relevant medical history of urticaria and hypersensitivity reaction who experienced serious expected event of anaphylactic reaction. The event occurred approximately one day after the second, most recent dose of Spikevax with first symptoms occurring within 24 hours.. Rechallenge was not applicable since the event occurred after the second dose of Spikevax. The event was consistent with the current understanding of the mechanism of action of the medication . The benefit-risk relationship of drug is not affected by this report.


VAERS ID: 1721617 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: New York  
Vaccinated:2021-02-12
Onset:2021-09-11
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Gait disturbance
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre 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: TOPROL; CRESTOR; VITAMINS NOS; BABY ASPIRIN; STATIN [SIMVASTATIN]
Current Illness: Allergy to antibiotic (z-pack (azithromycin))
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: patient woke up finding himself having difficulty ambulating. It would take him approximately 20mins to walk towards the bathroom and with the help of a walker; This spontaneous case was reported by a consumer and describes the occurrence of GAIT DISTURBANCE (patient woke up finding himself having difficulty ambulating. It would take him approximately 20mins to walk towards the bathroom and with the help of a walker) in a 79-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 036A21A and 031L20A) for COVID-19 vaccination. Concurrent medical conditions included Allergy to antibiotic (z-pack (azithromycin)). Concomitant products included METOPROLOL SUCCINATE (TOPROL), ROSUVASTATIN CALCIUM (CRESTOR), VITAMINS NOS, ACETYLSALICYLIC ACID (BABY ASPIRIN) and SIMVASTATIN (STATIN [SIMVASTATIN]) for an unknown indication. On 12-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 12-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 10-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 11-Sep-2021, the patient experienced GAIT DISTURBANCE (patient woke up finding himself having difficulty ambulating. It would take him approximately 20mins to walk towards the bathroom and with the help of a walker). At the time of the report, GAIT DISTURBANCE (patient woke up finding himself having difficulty ambulating. It would take him approximately 20mins to walk towards the bathroom and with the help of a walker) outcome was unknown. Unknown For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Treatment medications was not reported. This case was linked to MOD-2021-316362 (Patient Link).


VAERS ID: 1721647 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-09-07
Onset:2021-09-11
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia
SMQs:, Guillain-Barre syndrome (broad)

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

Write-up: I don''t have any energy; This spontaneous case was reported by a consumer and describes the occurrence of ASTHENIA (I don''t have any energy) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 07-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 11-Sep-2021, the patient experienced ASTHENIA (I don''t have any energy). At the time of the report, ASTHENIA (I don''t have any energy) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications reported. No treatment information was provided. Reporter did not allow further contact


VAERS ID: 1721668 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-13
Onset:2021-09-11
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Diarrhoea, Fatigue, Gait disturbance, Headache, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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.MOD20213

Write-up: stomach cramps; could barely walk towards the bathroom; Diarrhea; Severe body ache; nausea; headache; fever; body chills; feels too tired; This spontaneous case was reported by a consumer and describes the occurrence of ABDOMINAL PAIN UPPER (stomach cramps), GAIT DISTURBANCE (could barely walk towards the bathroom), DIARRHOEA (Diarrhea), MYALGIA (Severe body ache) and NAUSEA (nausea) in an 18-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 13-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 11-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 11-Sep-2021, the patient experienced ABDOMINAL PAIN UPPER (stomach cramps), GAIT DISTURBANCE (could barely walk towards the bathroom), DIARRHOEA (Diarrhea), MYALGIA (Severe body ache), NAUSEA (nausea), HEADACHE (headache), PYREXIA (fever), CHILLS (body chills) and FATIGUE (feels too tired). At the time of the report, ABDOMINAL PAIN UPPER (stomach cramps), GAIT DISTURBANCE (could barely walk towards the bathroom), DIARRHOEA (Diarrhea), MYALGIA (Severe body ache), NAUSEA (nausea), HEADACHE (headache), PYREXIA (fever), CHILLS (body chills) and FATIGUE (feels too tired) outcome was unknown. Concomitant drug was not reported. Treatment medication was not reported.


VAERS ID: 1721751 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-17
Onset:2021-09-11
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Feeling abnormal, Hyperhidrosis, Illness, Migraine, Pain, Pain in extremity, Pyrexia, Vaccination site erythema, Vaccination site swelling
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Arm was sore; arm where they injected the vaccine was still red; left arm puffy with baseball size lump; This morning she had bad sweats; body ache /arm was sore; woke up really sick the next day; migraine; feels really bad; fever; chills; This spontaneous case was reported by a consumer and describes the occurrence of ILLNESS (woke up really sick the next day), MIGRAINE (migraine), FEELING ABNORMAL (feels really bad), HYPERHIDROSIS (This morning she had bad sweats) and PAIN (body ache /arm was sore) in a 22-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. FB8448 and 047B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concomitant products included MAGNESIUM GLYCINATE (MAGNESIUM GUMMIES) for an unknown indication. On 17-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 10-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 11-Sep-2021, the patient experienced ILLNESS (woke up really sick the next day), MIGRAINE (migraine), FEELING ABNORMAL (feels really bad), PAIN (body ache /arm was sore), CHILLS (chills) and PYREXIA (fever). On 12-Sep-2021, the patient experienced HYPERHIDROSIS (This morning she had bad sweats), VACCINATION SITE ERYTHEMA (arm where they injected the vaccine was still red) and VACCINATION SITE SWELLING (left arm puffy with baseball size lump). On an unknown date, the patient experienced PAIN IN EXTREMITY (Arm was sore). At the time of the report, ILLNESS (woke up really sick the next day), MIGRAINE (migraine), FEELING ABNORMAL (feels really bad), HYPERHIDROSIS (This morning she had bad sweats), PAIN (body ache /arm was sore), PAIN IN EXTREMITY (Arm was sore), CHILLS (chills), VACCINATION SITE ERYTHEMA (arm where they injected the vaccine was still red) and VACCINATION SITE SWELLING (left arm puffy with baseball size lump) outcome was unknown and PYREXIA (fever) had resolved. No concomitant medications were provided by the reporter. No treatment information was provided by the reporter.


VAERS ID: 1721752 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Texas  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

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

Write-up: Dizzines; Fever like simptoms; This spontaneous case was reported by a consumer and describes the occurrence of DIZZINESS (Dizzines) and PYREXIA (Fever like simptoms) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 11-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 11-Sep-2021, the patient experienced DIZZINESS (Dizzines) and PYREXIA (Fever like simptoms). The patient was treated with PARACETAMOL (TYLENOL) at a dose of 1 dosage form. At the time of the report, DIZZINESS (Dizzines) and PYREXIA (Fever like simptoms) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medications provided.


VAERS ID: 1722163 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Crying, Limb injury, Muscle rigidity, Seizure, Unresponsive to stimuli, Vision blurred, Vomiting, White blood cell count
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Parkinson-like events (narrow), 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), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Ovarian cyst
Allergies:
Diagnostic Lab Data: Test Date: 20210911; Test Name: White blood cell count; Result Unstructured Data: Her white blood cells were a bit up
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: experienced seizures twice, was in complete darkness unable to see or hear; patient was unresponsive on the floor; started hysterically crying as she did not know what occurred; broke her toe and foot was all cut up/foot injury; looked totally blank and had totally unfocused eyes; became rigid; was throwing up while unconscious; This spontaneous case was reported by a consumer and describes the occurrence of SEIZURE (experienced seizures twice, was in complete darkness unable to see or hear) and UNRESPONSIVE TO STIMULI (patient was unresponsive on the floor) in a 20-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Ovarian cyst. On 10-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 11-Sep-2021, the patient experienced SEIZURE (experienced seizures twice, was in complete darkness unable to see or hear) (seriousness criterion medically significant), UNRESPONSIVE TO STIMULI (patient was unresponsive on the floor) (seriousness criterion medically significant), CRYING (started hysterically crying as she did not know what occurred), LIMB INJURY (broke her toe and foot was all cut up/foot injury), VISION BLURRED (looked totally blank and had totally unfocused eyes), MUSCLE RIGIDITY (became rigid) and VOMITING (was throwing up while unconscious). On 11-Sep-2021, SEIZURE (experienced seizures twice, was in complete darkness unable to see or hear), UNRESPONSIVE TO STIMULI (patient was unresponsive on the floor), CRYING (started hysterically crying as she did not know what occurred), LIMB INJURY (broke her toe and foot was all cut up/foot injury), VISION BLURRED (looked totally blank and had totally unfocused eyes), MUSCLE RIGIDITY (became rigid) and VOMITING (was throwing up while unconscious) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 11-Sep-2021, White blood cell count: increased (High) Her white blood cells were a bit up. The patient was on a low dose hormone birth control as concomitant medication for ovarian cysts which is gone now. No treatment information was reported. Patient experienced seizures twice on Saturday 11 Sep 2021 at around 2AM and 4:34AM. The caller stated that the patient "died before her eyes two times". The first time caller heard a crash, the patient was unresponsive on the floor. Once the caller got the patient up, patient started hysterically crying as she did not know what occurred. She broke her toe and her foot was all cut up. The patient went to the urgent care center where tests were done for 1.5 hours. Some testing were done such as EKG, neurological, bloodwork, and urine test. The second seizure occurred when patient was in the bedroom and sitting on the edge of the bed. Patient told her parents that it was happening again. She looked totally blank and had totally unfocused eyes became rigid and slipped down the bed. She was throwing up while unconscious and the caller and her husband was hitting her and yelling at her to wake up. The seizure lasted for 30 seconds for her to "switch back in". Patient stated it was complete darkness where she couldn''t see and hear. She was shocked back in to life. Patient currently sleeps with in her mother''s bed and is petrified to drive and go to sleep as she doesn''t know when she might experience another seizure. Patient had no reactions upon first dose vaccination, not even a sorearm. She is not pregnant or breastfeeding. She is healthy. Company Comment: This case concerns a 20 year-old female patient, who experienced the unexpected events of Seizure and Unresponsive to stimuli. The events occurred one day after the second dose of mRNA-1273 vaccine. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report. The events of Seizure and Unresponsive to stimuli were assessed as Medically significant based on available information, including reoccurrence of seizures twice in one day. Reporter did not allow further contact Most recent FOLLOW-UP information incorporated above includes: On 13-Sep-2021: Follow up information received on 13 Sep 2021, included reporters details, patient details, lab test, historical condition, suspect product start date, dose details, route of administration, unresponsive to stimuli, Uncontrollable crying, Toe injury, White blood cell count increased, Difficulty focusing eyes, Rigidity, fall, vomiting, Loss of personal independence in daily activities, shocked added as new events and narrative updated.; Sender''s Comments: This case concerns a 20 year-old female patient, who experienced the unexpected events of Seizure and Unresponsive to stimuli. The events occurred one day after the second dose of mRNA-1273 vaccine. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report. The events of Seizure and Unresponsive to stimuli were assessed as Medically significant based on available information, including reoccurrence of seizures twice in one day.


VAERS ID: 1722169 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Device connection issue, Incorrect dose administered
SMQs:, Medication errors (narrow)

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

Write-up: full dose was not given due to leaking; full dose was not given due to leaking/the syringe and barrel were not put on tightly so the full dose was not given due to leaking; This spontaneous case was reported by a pharmacist and describes the occurrence of INCORRECT DOSE ADMINISTERED (full dose was not given due to leaking) and DEVICE CONNECTION ISSUE (full dose was not given due to leaking/the syringe and barrel were not put on tightly so the full dose was not given due to leaking) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. UNK and 062E21A) for COVID-19 vaccination. No Medical History information was reported. On 11-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 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 11-Sep-2021, the patient experienced INCORRECT DOSE ADMINISTERED (full dose was not given due to leaking) and DEVICE CONNECTION ISSUE (full dose was not given due to leaking/the syringe and barrel were not put on tightly so the full dose was not given due to leaking). At the time of the report, INCORRECT DOSE ADMINISTERED (full dose was not given due to leaking) and DEVICE CONNECTION ISSUE (full dose was not given due to leaking/the syringe and barrel were not put on tightly so the full dose was not given due to leaking) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Patient on Saturday, 11Sept2021 and the syringe and barrel were not put on tightly so the full dose was not given due to leaking. The note said that the provider had a gut feeling that more than half of the dose was injected Concomitant medications was not provided by the reporter. Treatment information was not provided


VAERS ID: 1722179 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-11
Onset:2021-09-11
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Chills, Illness, Oral mucosal blistering, Oral pain, Stomatitis, Toothache, Vomiting
SMQs:, Severe cutaneous adverse reactions (broad), Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: mouth hurts; sores in her mouth/ mouth sores; mouth blisters started to appear; teeth felt sore; got sick; very weak; vomiting; chills; This spontaneous case was reported by a consumer and describes the occurrence of ILLNESS (got sick), ASTHENIA (very weak), TOOTHACHE (teeth felt sore), ORAL MUCOSAL BLISTERING (mouth blisters started to appear) and ORAL PAIN (mouth hurts) in a 32-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 048F21A and 049E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 11-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 10-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 11-Sep-2021, the patient experienced ILLNESS (got sick), ASTHENIA (very weak), VOMITING (vomiting) and CHILLS (chills). On 12-Sep-2021, the patient experienced TOOTHACHE (teeth felt sore). On 13-Sep-2021, the patient experienced ORAL MUCOSAL BLISTERING (mouth blisters started to appear). On 14-Sep-2021, the patient experienced ORAL PAIN (mouth hurts) and STOMATITIS (sores in her mouth/ mouth sores). The patient was treated with PARACETAMOL (TYLENOL) ongoing since an unknown date for Sore mouth, at a dose of 1 dosage form. At the time of the report, ILLNESS (got sick), ASTHENIA (very weak), TOOTHACHE (teeth felt sore), ORAL MUCOSAL BLISTERING (mouth blisters started to appear), ORAL PAIN (mouth hurts), STOMATITIS (sores in her mouth/ mouth sores), VOMITING (vomiting) and CHILLS (chills) outcome was unknown. No concomitant medications was provided by the reporter. Patient stated she has never had mouth blisters like this in the past. She stated that she doesn''t take any medications daily. She reported that she was not pregnant. Most recent FOLLOW-UP information incorporated above includes: On 14-Sep-2021: Non significant follow up On 14-Sep-2021: Follow up information added patient identities, vaccine information, Events and treatment drug were updated.


VAERS ID: 1722209 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination site pain
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: USMODERNATX, INC.MOD20213

Write-up: left arm pit area started hurting; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE PAIN (left arm pit area started hurting) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 11-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 11-Sep-2021, the patient experienced VACCINATION SITE PAIN (left arm pit area started hurting). At the time of the report, VACCINATION SITE PAIN (left arm pit area started hurting) outcome was unknown. No concomitant information was reported. No treatment information was reported.


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