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From the 7/16/2021 release of VAERS data:

Found 479,813 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 211 out of 4,799

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VAERS ID: 1371448 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-26
Onset:2021-06-02
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Menstruation delayed
SMQs:, Fertility disorders (broad)

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

Write-up: Delayed period. Arrived over 10 days late


VAERS ID: 1371449 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0481321A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Discomfort, Fatigue, Injection site pain, Nausea, Neck pain, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None, only birth control and vitamin D at 7:30pm the night prior.
Current Illness: No
Preexisting Conditions: Chronic nausea, bulging disc lumbar spine L4-L5, arthritis lumbar spine L4-L5, digestive issues,
Allergies: Macrolids.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Slow onset of fatigue starting around 7pm. Appetite fine, but heavy body feeling, body aches, feverish feeling (fever unknown). Took 800mg Ibuprofen around 8:30pm with excellent results and relief from body and severe pain at injection site. Nausea and queasiness slow onset around 11:30pm. Took Mirtazapine and went to bed around 12:30am. Woke up at 9am and have general pain at injection, body aches, particularly in the forearms, biceps, and lower back. Feverish feeling (fever unknown), fatigue, chills, neck soreness (more on the left).


VAERS ID: 1371464 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / UNK LA / 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: Pfizer for the patient''s 2nd dose instead of Moderna. There were no other signs and symptoms noted.


VAERS ID: 1371473 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Feeling hot, Hypersensitivity, Swelling, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Pollen
Diagnostic Lab Data: 06/03/2021 Discharged from hospital at 0500 with the diagnosis: Allergic reaction, initial encounter.
CDC Split Type:

Write-up: Allergic Reaction (Hives, Body internally warm, vomiting, swelling)


VAERS ID: 1371477 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 1 RA / IM

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

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

Write-up: Pt is having no adverse effects, but received vaccine at age 14.


VAERS ID: 1371484 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Nausea, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, nausea, vomiting, body aches


VAERS ID: 1371501 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: Patient received the 2nd COVID vaccine (Pfizer, Lot #: EW0187 and expiration date: 08/31/2021) around 1439 on the left arm. Patient walked up to the observation desk around 1449, during her 30 minute observation period, with complaints of "dizziness, rapid heart rate, and feeling hot." Patient was conscious, alert, and oriented x4 and claimed symptoms began 2 minutes status post vaccine administration. Patient denied any reaction after receiving the 1st dose of Pfizer vaccine and denied experiencing any chest pain, headache, nausea, vomiting, or diarrhea. EMTs had patient sit in the anti- gravity chair for further evaluation. Nurse responded to EMTs with patient. At 1455, EMT obtained baseline vital signs, while patient was sitting: blood pressure: 124/70, heart rate: 72, respiratory rate: 15. Pupils were equal, accommodating, and reactive to light. Skins were warm, dry, and normal. Chief complaint of "dizziness, rapid heart rate, and feeling hot" was reassessed and patient stated that symptoms had subsided. Patient explained that the symptoms had a sudden onset, but lasted less than 1 minute. Patient has a history of migraines and an allergy to Penicillin. Patient stated that she had a similar reaction after receiving a dose of Benadryl, earlier this year. Patient told EMTs that she had eaten toast, tofu, and salad about an hour and a half prior to coming to the vaccination site, with limited fluid intake. EMTs gave the patient a water bottle to sip on. At 1502 a second set of vital signs were obtained by EMT, while the patient was sitting: blood pressure: 116/68, heart rate: 74, respiratory rate: 15. Pupils were equal, accommodating, and reactive to light. Patient was advised to stay an additional 30 minutes in observation for continued evaluation. Patient stated she "felt better" and all symptoms had improved. Final set of vital signs were taken at 1514 by EMT, while patient was standing: blood pressure: 114/64, heart rate: 72, respiratory rate: 12. Pupils were equal, accommodating, and reactive to light. Skins were warm, dry, and normal. Patient was negative for orthostatic pressures. At 1540, patient stated she "felt normal and that all symptoms were gone." Patient had finished the water bottle provided. Patient was then educated on expected/ adverse reactions, when to follow up with her primary care provider, and the use of V- Safe. Patient ambulated with a steady gait on her own accord out of the facility.


VAERS ID: 1371507 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse reaction, Anxiety, Electrocardiogram, Hypoaesthesia, Palpitations, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine 100 mcg (0.1 mg) oral tablet: 1 tab(s), PO, Daily
Current Illness: None Known
Preexisting Conditions: GERD (gastroesophageal reflux disease) Hypothyroidism Kidney calculus Perimenopausal symptoms Scoliosis Spider varicose vein Thyroid disorder Urinary calculus
Allergies: Cipro
Diagnostic Lab Data: EKG - No abnormalities
CDC Split Type:

Write-up: Acute anxiety; Adverse effect of COVID-19 vaccine; Heart palpitations; Numbness and tingling of right arm and leg


VAERS ID: 1371510 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Electrocardiogram normal, Hypoaesthesia, Palpitations, Paraesthesia, Vaccination complication
SMQs:, Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine 100 mcg (0.1 mg) oral tablet: 1 tab(s), PO, Daily
Current Illness: None Known
Preexisting Conditions: GERD (gastroesophageal reflux disease) Hypothyroidism Kidney calculus Perimenopausal symptoms Scoliosis Spider varicose vein Thyroid disorder Urinary calculus
Allergies: Cipro
Diagnostic Lab Data: EKG - No abnormalities
CDC Split Type:

Write-up: Acute anxiety; Adverse effect of COVID-19 vaccine; Heart palpitations; Numbness and tingling of right arm and leg


VAERS ID: 1371528 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-05-03
Onset:2021-06-02
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Right upper extremity DVT


VAERS ID: 1371553 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Starting about 3 am on 6/2/21 she had a severe headache that lasted about 24 hours. During the day on 6/2/21 she noticed a lump on the left side of her neck that is tender to touch. This was diagnosed as a swollen lymph node.


VAERS ID: 1371556 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Nausea
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: c/o nausea shortly after taking her 2nd dose of vaccine. denies headache, SOB, dizziness and other adverse reaction symptoms. PMH includes pulmonary HTN, DM, and low saturation (hypoxia). O2 PRN at home. Allergy is shellfish and she had Epipen handy. No hhives, itching or swelling of throat noted. Pt. continuously look weak. V/S. BP 201/135, forearm 116/86. manual 146/92. BS 242mg/dl. Ambulance was called with patient permission. pt. transported to ED for futher evaluation.


VAERS ID: 1371576 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Feeling abnormal, Head discomfort, Headache, Pain, Pyrexia, Tenderness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (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: pt had the flu vax in 2012 and developed flu like symptoms that lasted about week.
Other Medications: Claritin
Current Illness:
Preexisting Conditions:
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt was feeling very tired the day of getting the vax. Next day she went to work but later started feeling bad like she had the flu. She developed a severe headache, fever and body aches and pains. She went home and went to bed. She woke up next day with a headache so she contacted her PCP. She spoke with the nurse was advised to take ibuprofen. Pt is taking the ibuprofen which seems to help but she is still having head pressure and her head is very sore to touch. She is feeling extremely tired.


VAERS ID: 1371582 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Back pain, Fatigue, Feeling cold, Morning sickness, Nausea, Pain in extremity, Parosmia, Retching, Vomiting
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Arthritis (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: Montelukast, Singulair, Topamax, Qudexy, Vitamin D 50,0000.
Current Illness: None.
Preexisting Conditions: Migraines.
Allergies: None.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: She got her vaccine, she had a sore arm, but otherwise had no reaction. The next morning at 10:00 AM she felt extremely tired as if she had not slept in days. Then she got extremely cold and had to wrap up with a blanket. She started making lunch for the children, and had made chicken nuggets for one of them, and the smell made her extremely nauseous and was throwing up 4 different times, and felt like she had morning sickness. She had to call the parents to pick up the children, and went to bed at 4:00 PM yesterday and woke up at 6:00 AM this morning. She has extremely aching of joints, low back in the waist area. She had a temp of 100.0, and when she took it this morning it was 97.9. She did not eat yesterday, and the smells again have given her dry heaves and has not eaten anything since the vaccine. She is still having the nausea and the queasy feeling, as well as back aches. She has been taking OTC Motrin for the symptoms.


VAERS ID: 1371584 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
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: PATIENT REQUESTED DOSE OF JANSSEN VACCINE, Pt provided Immunology report indicated on 05/11/2021 had negative covid antibody test even after 2 doses of moderna vaccinE. Per prescriber. PATIENT was recommended to get J&J vaccine. REPORTING THIS SINCE IT IS OUTSIDE OF NORMAL GUIDELINES.


VAERS ID: 1371590 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Hypoaesthesia oral, Paraesthesia, Paraesthesia oral
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre 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: Vitamin D, Women''s daily multivitamin, Biotin
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data: Just had physical tests done like following object with eyes, checking my smile, wiggle eyebrows, etc.
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA Started getting a tingly/numb face and tongue at 7:10 pm on my way home from the vaccination clinic. Call PCP and was told to call 911 since the tingly feeling was mostly on the left side of face and that is a sign of a stroke. Emergency personnel did not notice any other signs of stroke but recommended visit to ER. Went to ER where the doctor on site performed some physical tests to check for stroke and other issues. Nothing else was found, I was sent home with instructions to follow up with PCP. Met with doctor from PCP office on 6/3/21. No change in face numbness since the previous day. Instructed to drink lots of water and take motrin. Still have numbness in face.


VAERS ID: 1371592 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site pruritus, Injection site rash, Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)

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

Write-up: Patient reporting itching, hives, and rash on same arm as injection. Hives resolved with benadryl and time, however, rash is still present.


VAERS ID: 1371613 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site pain, Lethargy, Pain, Sleep disorder
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Medium, Systemic: Body Aches Generalized-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Unable to Sleep-Medium


VAERS ID: 1371623 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Medium


VAERS ID: 1371679 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Hyperventilation
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (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: Lidocaine 5 % patch; Seroquel 25mg; Mirtazapine 15mg; Melatonin 5 mg; Xulane patches; Cetirizine 10mg; Refresh tears 0.5%; Azelastine 0.05%; Azelastine 137 mcg nasal spray; Saline nasal spray 0.65% ; Ketotifen 0.025%; Flonase 50mcg; Halobet
Current Illness:
Preexisting Conditions: PTSD; Psoriasis; Anxiety Depression
Allergies: Kiwi
Diagnostic Lab Data:
CDC Split Type:

Write-up: Anxiety attack and hyperventilation syndrome


VAERS ID: 1371684 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Malaise, Muscle rigidity, Nervousness, Seizure, Snoring, Trismus
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dystonia (narrow), Parkinson-like events (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (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: UNKNOWN
Current Illness: NONE LISTED
Preexisting Conditions: NONE DISCLOSED
Allergies: NONE LISTED
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PATIENT WASN''T FEELING WELL AFTER VACCINE (WAS A LITTLE NERVOUS) AND ASKED FOR SOME WATER. PATIENT SAT DOWN IN WAITING AREA WHILE I WENT TO GET HIM A DRINK. WHEN I CAME BACK PATIENT WAS RIGID AND LOCK JAWED AND NOT BREATHING. WHEN WE GOT PATIENT TO FLOOR HE WAS RESPONSIVE TO A STERNUM RUB AND HAD A PULSE. AT THIS TIME HE STARTED TO PRODUCE SNORE LIKE NOISES, CONVULSED FOR LESS THAN A MINUTE THEN CAME BACK TO. EMT''S CAME AND CLEARED PATIENT. PATIENT STATED HE HAS A VASOVAGAL REFLEX HOWEVER HAS NOT HAD AN INCIDENT IN MANY YEARS. IT IS UNKNOWN IF THIS IS WHAT PATIENT EXPERIENCED OR A REACTION TO THE VACCINE.


VAERS ID: 1371699 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-05-31
Onset:2021-06-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 25 mcg Vitamin D3(Nature''s Made Brand) 2,000 IU
Current Illness: N/A
Preexisting Conditions: Underactive thyroid Insufficient Vitamin D
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Rash developed underneath injection arm, near the armpit area. Rash developed approximately 48 hours after injection and caused a stinging sensation along with redness., Rash was about 4 inches wide. After 24 hours the rash subsided with no burning or discomfort and appeared to be clearing. No topic creams or substances used on rash nor the injection site.


VAERS ID: 1371710 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
SMQs:, Medication errors (broad)

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

Write-up: Pt received Moderna for 1st dose and Pfizer for 2nd dose - as of 6-2-21 8pm, pt had reported no adverse event, told pt to get in touch with us if any issues, tried to contact pt again on 6-3-21 2pm


VAERS ID: 1371721 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Mobility decreased
SMQs:, Parkinson-like events (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: mom called and came into pharmacy on 6/3/2021 to inform us that daughter was having limited mobility in arm and was not able to raise arm unless assisted by using other arm. mom brought in article and picture of arm marking where vaccine was possibly given


VAERS ID: 1371722 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
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: Patient received 2nd Pfizer shot 2 weeks after the first shot instead of 3 weeks after (1st shot was on 5/19/21).


VAERS ID: 1371731 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Contusion, Fall, Loss of consciousness, Presyncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Nurse administered the 2nd dose of Pfizer vaccine to patient and within 5 minutes after administration patient slide from the chair and fell on the floor with a vaso- vagal reaction. Patient loss consciousness for a brief seconds while on the floor, one small bruising noted on R knee, no head strike. VS taken while on the floor BP 127/50, HR 100, O2sat 99% on room air. Rapid response called and patient was taken to the ED for further evaluation.


VAERS ID: 1371750 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / N/A RA / IM

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

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

Write-up: Medication expired 05/26/2021, no s/s or adverse reaction


VAERS ID: 1371755 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Headache, Nausea, Retching, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Got the 2nd dose at 5:15pm June 1st. Woke up at 2:30am with a splitting headache and moderate nausea. Both symptoms last all day. Around 6pm, I start violently vomiting regularly (about 20-30 minutes in between) until around 11pm. Couldn?t keep anything down, including water, Tylenol, and pepto to try to ease the nausea, so there was really nothing to throw up but stomach acid. Otherwise it was dry retching for hours on end. Finally fell asleep after 11pm with mild discomfort in my stomach. Woke up the following morning (today) with just some mild stomach aches and soreness with a slight headache. I could keep down water this morning for the first time in 24 hours.


VAERS ID: 1371762 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-30
Onset:2021-06-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Angiogram normal, Blood test, Chest pain, Dyspnoea, Echocardiogram, Electrocardiogram PR segment depression, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Full blood count, Headache, Myocarditis, Pain, Pain in extremity, Pericarditis, Troponin increased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Chronic kidney disease (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Not on any prescribed medications
Current Illness: No significant PMH
Preexisting Conditions: NO PMH
Allergies: NKDA / No food allergies
Diagnostic Lab Data: Patient had blood work drawn - CBC/Chemistry, troponins trended, EKG, and echo-cardiogram. On date of presentation (6/2/2021) Troponins were elevated (1.490), positive EKG changes (EKG showed ST elevations/ PR depressions inferior/ lateral leads concerning for pericarditis- date 6/2/2021), Patient had a TTE with normal LV systolic function (performed 6/3/2021).
CDC Split Type:

Write-up: 18 yo male with no significant PMH presented to the hospital on 6/2/2021 with c/o chest pain and SOB. Per patient and his mother at bedside, he received the second dose of Pfizer vaccine on Sunday. Day after had mild headache, aches, arm pain and abdominal pain. Last night woke up with chest pain and SOB. They called his pediatrician who recommended they come to the ER for evaluation. In ED was found to have elevated troponin and EKG changes. CTA negative for PE. EKG showed ST elevations/ PR depressions inferior/ lateral leads concerning for pericarditis. Patient was seen by cardiology and diagnosis of myo/pericarditis was made. Patient was prescribed Aspirin 325 mg TID and Protonix 40 mg QD for GI prophylaxis. Patient will follow up with the cardiologist 1 week after discharge for further management and medication adjustments.


VAERS ID: 1371773 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / UNK LA / IM

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

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: May 11, 2021, Intramuscular, COVID19 ( Pfizer-BioNTech) Glands on left side of my face were swollen very large for about 6 hour
Other Medications: Famotidine, Aspirin, Vitamin D
Current Illness: None
Preexisting Conditions: None
Allergies: Shellfish, Sulfa drugs, Cipro, and Iodinated Glycerol.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: At around 3:00 am on June 2, 2021, I experienced chills and an extreme headache. I took Tylenol and layed down.


VAERS ID: 1371774 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Humira injections and Norgestimate and Ethinyl Estradiol tablets
Current Illness:
Preexisting Conditions: Ulcerative Colitis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 24 hours after the first does, broke out in a rash along legs and arms.


VAERS ID: 1371775 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Pt received 2nd dose Pfizer @1330 & noted to have fainting episode @1335 in observation area. Woke up with TRN support & was transferred from chair to w/c. Brought to triage area, noted w/dizziness, cool sweat & pale complexion. Pt state he has history of fainting in past. Denied CP, SOB & other abnormal sx. BP 105/57; HR 84; O2 Sat 97%) Monitored patient for 15 min & increased hydration/fluids. Pt was stable & released from vaccination site


VAERS ID: 1371778 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Electrocardiogram, Impaired driving ability, Laboratory test, Loss of consciousness, Nausea, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: gastroenterologic illness (nausea and vomiting overnight) reported to us after vaccination
Preexisting Conditions: unknown
Allergies: none reported
Diagnostic Lab Data: Assessment at ED on 6/2. EKG, lab work performed, per chart notes.
CDC Split Type:

Write-up: Patient experienced brief LOC approximately 5 minutes after vaccination. Vital signs stable on waking, HR 64, SpO2 99%, BP WNL. Allowed to rest with cool packs to neck and chest, given snacks and juice/water to drink. Later, case reported feeling nauseated and vomited 2 times. Called EMS as she did not have anyone who could give her a ride and we did not feel safe allowing her to drive herself home.


VAERS ID: 1371786 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Arthralgia, Chills, Cold sweat, Faeces soft, Headache, Hot flush, Injection site pain, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: fish oil 1,000; Zinc 100 mg, D3 2,000Ui, Vitamin C1,000. Osteo Bi-flex
Current Illness:
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine EUA pain in injection area at 5am (6/2/21) with severe headache, joint pain and chills (took 1,000mg of acetaminophen). Chills, hot flashes and cold sweats, body aches, fever, nauseas, soft stool (took 1,000mg acetaminophen). Went to bed around 1:30pm and slept. Felt better in the evening hours with a remaining slight headache and light body aches taking 500mg of acetaminophen at 5pm.


VAERS ID: 1371795 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site pain, Injection site rash, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin, omega3, probiotic
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever to 101.9 all day on 6/2/21, red painful circular rash around injection site on 6/3/21


VAERS ID: 1371823 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-28
Onset:2021-06-02
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: SARS CORONAVIRUS 2, PCR RAPID, V : SARS COV-2 DETECTED
CDC Split Type:

Write-up: Asymptomatic, COVID-19 PCR positive beginning on 6/2/21.


VAERS ID: 1371851 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain, Dizziness, Fatigue, Feeling hot, Haematochezia, Rectal haemorrhage, Thrombosis
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal haemorrhage (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Vestibular disorders (broad)

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

Write-up: 06/02/21 - Moderna vaccine administered at 3:30pm. Waited 15 mins at the HD without any reported side effects. When driving home, client states she felt dizzy. Developed fatigue around 5pm. At 8pm went to have a bowel movement and large amounts of red blood with small clots passed from rectum. Client states she had to flush 3 times d/ t the amount of blood. No stool passed. No other episodes reported. Client does state that around 2-3 am she was up to use the restroom and noted small amount of dried blood spots in her undergarment. Client states that she does have a h/o hemorrhoids since the birth of her baby but states this "definitely" was not related. Client reported feeling hot during the night with mild abdominal cramping but states she is to start her menstrual cycle soon. PHN questioned if she felt this was her menstrual cycle and client clearly states the blood was coming from her rectum. No further episodes of passing blood reported and states that she is feeling better today. Client states that she does not have a h/o of blood in stool except on occasion scant amounts from hemorrhoids. PHN encouraged client to report this finding to her PCP as well and that the PHN was going to report this to VAERS. No other s/s of bleeding reported to the PHN.


VAERS ID: 1371855 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Pain, 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: Pantoprazole, spironolactone, propranolol, furosemide, met forming, lactulose
Current Illness: Liver disease, type 2 diabetes
Preexisting Conditions: Liver disease, type 2 diabetes
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Light headed, body aches, fever


VAERS ID: 1371858 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

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

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

Write-up: Vaccine was not diluted. Patient received 0.3 milliliters of undiluted BioNTech solution.


VAERS ID: 1371868 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

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

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

Write-up: Vaccine was not diluted. Patient received 0.3 milliliters of undiluted BioNTech solution.


VAERS ID: 1371876 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 not diluted. Patient received 0.3 milliliters of undiluted BioNTech solution.


VAERS ID: 1371926 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Fear of injection, Heart rate increased, Loss of consciousness, Nervousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Pt lost consiousness in chair & staff brought patient to floor. C/O dizziness & fast heart rate. Was nervous & doesn''t like needles. BP 102/54; HR 69; RR 18. Pt was provided water; laid in supine position w/extremities lifted. Chest stable & conscious. Alert & able to verbalize name & location. Monitored for 30 minutes. Informed to seek medical attention if sx start again.


VAERS ID: 1371928 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Pallor, Seizure, Somnolence, Vision blurred
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Seizure for 2 second, blurry vision, pale skin, fatigue, and drowsiness


VAERS ID: 1371937 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Angioedema, Rash maculo-papular, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (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: Bactrim DS
Current Illness: cellulitis right calf
Preexisting Conditions: none
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diffuse maculopapular rash, urticaria, lip angioedema


VAERS ID: 1371968 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Chills, Dizziness, Dyspnoea, Fatigue, Headache, Heart rate increased, Night sweats, Pain
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall XR 30mg, adderall IR 10mg, xanax .5mg, diazepam 5G suppository
Current Illness: None
Preexisting Conditions: Endometriosis, pelvic floor dysfunction
Allergies: Citric acid, weeds grasses
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pounding headache, night sweats, body aches, chills, dizzy ness, chest pain, fatigue, shortness of breathe and increased resting heart rate. Average RHR 67 when sitting heart rate never went below 90bpm


VAERS ID: 1371983 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-05-14
Onset:2021-06-02
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin 500 mg, Celecoxib 100 mg, Ozempic 1 mg, Amlodipine 10 mg, Atorvastatin 20 mg,
Current Illness:
Preexisting Conditions: diabetes
Allergies: Anectine anesthesia
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tested positive for COVID on 6/3/2021


VAERS ID: 1371991 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-23
Onset:2021-06-02
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Unevaluable event
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: Patient was only tested at our mobile testing site.
Current Illness: Patient was only tested at our mobile testing site.
Preexisting Conditions: Patient was only tested at our mobile testing site.
Allergies: Patient was only tested at our mobile testing site.
Diagnostic Lab Data: Patient was only tested at our mobile testing site.
CDC Split Type:

Write-up: Patient was only tested at our mobile testing site.


VAERS ID: 1372026 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 4 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Extra 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: unknown - patient lives at Nursing Home.
Current Illness: Per nursing home director of nursing - patient was admitted to them on 4/9/2021 and had been in and out of the hospital prior to that time.
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Pt was brought in to local health dept for what we thought was the 2nd Moderna shot. After patient was dosed, the immunization from the web was given to CNA and it was discovered at that time that patient had previously been vaccinated on 1/30/2021, 3/18/2021, 4/21/2021 and 6/2/2021. This nurse called back to the nursing home to verify information (DOB/name), also called PCP and Hospital where patient was in and out of, along with the Health Department. Spoke with the Health Dept and they did verify that they dosed this patient on the first 2 dates mentioned above. Consents were faxed to the Health Dept. This nurse called back to Nursing home speaking to director of nursing each time and reported this event. Director of nursing stated they would monitor the patient closer. Director of nursing stated that she didn''t know if the web was checked upon admission into their facility on 4/9/2021. Nurse further called patient''s PCP and family to inform what happened. This nurse called state to report incident and find out what else needed done. County Administrator was also informed.


VAERS ID: 1372035 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra 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:

Write-up: miscommunication with patient who did not mention she wanted the hep b vaccine, but instead received a dose of COVID shot. later learned that this was her 3rd dose as she completed 2nd shot a month ago. Incident report was created and PCP was notified


VAERS ID: 1372053 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Joint swelling, Peripheral coldness, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer Covid 19 vaccine: first vaccine
Other Medications: Nexplanon implant, Emgality pen 120mg/ml once per month, Imitrex prn
Current Illness: None
Preexisting Conditions: Migraine headaches, Depressive disorder, Carpal tunnel syndrome
Allergies: Ibuprofen, Keflex
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt reported coolness in both arms and hands, and also felt like her shoulders were swelling. She then said she felt as though her wrists and lower forearms were getting swollen. No trouble breathing or swallowing. No swelling of mouth lips or tongue. No hives or rash. No redness or warmth at injection site.


VAERS ID: 1372071 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C2A1 / 2 LA / ID

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Injection site swelling, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Allergic site reaction to first dose of vaccine lasting approx. 4 days.
Other Medications: Xyzal Allergy Medication Aleve (last dose over 24 hrs prior to injection)
Current Illness: minor upper respiratory infection beginning with allergy/sinus infection two weeks prior to second injection . Treated and relieved within one week.
Preexisting Conditions: Elevated blood pressure
Allergies: Codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme muscle pain covering full body lasting full day after second injection. Swelling at injection site. Bruised feeling at injection site. Tylenol did not help alleviate the pain. Aleve taken and seemed to help the pain, but not relieve it entirely. Muscle pain completely gone the second morning after injection. Still redness, swelling and slight "bruised" pain at injection site.


VAERS ID: 1372081 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Back pain, Chills, Discomfort, Dizziness, Migraine, Nausea, Pain, Pain in extremity, Pelvic pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: None
Current Illness:
Preexisting Conditions: Hypothyroidism Anxiety Depression
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Migraine and nausea. Dizziness. 6/2/2021 Severe body aches. Migraine around the entire head. Chills. Fever. Pelvic pain with sharp pains shooting down the thighs into knees and calves. Button feeling heavy as if birthing a child. Back pain and severe lower back pain leading to the tail bone. Cramping as if the my cycle is ongoing.


VAERS ID: 1372097 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Not none
Current Illness:
Preexisting Conditions: History of epilepsy
Allergies: NKA
Diagnostic Lab Data: Not known
CDC Split Type:

Write-up: We received an email today, 6/3/2021, from patients supervisor stating that approximately 30-45 minutes after we left the vaccine clinic, that the patient had a seizure or seizures. She does have a history of epilepsy. She was unconscious and had to be taken by ambulance to the hospital. She has recovered now and is resting at home. She was advised not to take her 2nd dose.


VAERS ID: 1372102 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site erythema, Injection site inflammation, Injection site mass, Lymphadenopathy, Oropharyngeal pain, Pain, Pain in extremity, Paraesthesia, Peripheral swelling, Pyrexia, Skin warm, Ultrasound scan normal
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: minocin
Diagnostic Lab Data: Went to ER. Ultrasound performed with negative results. Physician commented on size of swelling and temperature of the effected area. Photos of arm available but there is no option to upload online via this form.
CDC Split Type:

Write-up: Fever; chills; severe headache; fatigue; swollen lymph nodes; sore throat; body aches; LARGE, INFLAMED, RED MASS 1-2 INCHES BELOW INJECTION SITE. Extreme and sustained pain and swelling of the arm. Hot to the touch. Tingling from jawline on left side of face to fingertips of left hand persists after 50+ hours post-injection. Swelling on arm is approximately 6 inches in diameter. The red, concentrated area is approximately 3 inches wide by 2 inches high at the center of the swelling.


VAERS ID: 1372123 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 RA / SYR

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

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

Write-up: Fever, chills, body aches and headaches and arm pain.


VAERS ID: 1372146 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

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

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

Write-up: Fever 99.5 F in evening 102F next afternoon


VAERS ID: 1372311 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Chest pain, Dyspnoea, Vital signs measurement
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness:
Preexisting Conditions:
Allergies: Penicillin- patients states reaction of hives and throat closing Flower pollen- patient states swollen face and feeling itchy
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: SOB, Chest pain- pt. was monitored BP was taken read 142/82, O2 was 100% HR 91, RR24, was offered water and sat back in chair. Patient stated hx of complications in laparoscopic surgery with gallbladder that might have caused damage to heart. Pt also stated hx of mild anxiety to vaccines. Dr. checked on the patient and assessed pt heart, stated to monitor patient for 15 more minutes. pt vitals rechecked after 15 mins and read BP-138/80, HR72, O2100%, pt stated water and taking deep breaths helped her calm down. Pt has no PCP was referred to make an appointment with one to get checked up. pt stated she felt better and was good to leave.


VAERS ID: 1372320 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-05-21
Onset:2021-06-02
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Electrocardiogram, Fatigue, Headache, Muscle spasms, Myocardial infarction, Pain in extremity, Visual impairment
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Fatigue, feeling dizzy, not having good vision, leg cramping/hurting, HA, and SOB. She was diagnosed with myocardial Infarction in the ER with SOB adverse effect of the vaccine. She has no prior cardiac history


VAERS ID: 1372321 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-31
Onset:2021-06-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21-2A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysuria, Paraesthesia, Renal disorder
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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: None- advised to go to urgent care to check for UTI and kidney stones
CDC Split Type:

Write-up: Starting 6/2/21, pt felt like her kidneys "were not working properly." She states she isn''t urinating much and when she does urinate, her arms tingle. Symptoms have persisted throughout yesterday and today 6/3/21.


VAERS ID: 1372322 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Presyncope
SMQs:, Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: vasovagal response lasted for approx. 10 minutes


VAERS ID: 1372330 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-27
Onset:2021-06-02
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 RA / IM

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

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

Write-up: Patient called today, June 3, stating last night she experienced itching on the arm in which she received the vaccination. She also states the area is red. I informed her she could apply ice to the area to help with itching and told her the redness should resolve in about a week.


VAERS ID: 1372342 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Body temperature increased, Decreased appetite, Diarrhoea
SMQs:, Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Covid shot 1
Other Medications: Immunosuppressants Mycophenalate, Metropolol, thyroid medication, allopurinol, protonix, iron, norvasc, clopidogrel, loperamide, atorvastatin, synthroid.
Current Illness: Inguinal hernia caused for over zealous physical therapy; surgery scheduled 6/15/21
Preexisting Conditions: Diffuse scleroderma, kidney disease
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: 103.5 temp, extreme weakness, diarrhea, lack of appetite, going to ER by ambulance


VAERS ID: 1372346 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-28
Onset:2021-06-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM

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

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

Write-up: pt called 6/3 and stated she developed a rash on her upper back shoulder on 6/2. she noticed today 6/3 it''s across her chest. told her to keep an eye on it and see how bad it gets and might have to see dr but right now take some benadryl and hydrocortisone cream otc.


VAERS ID: 1372541 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B711A / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Injection site erythema, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trazadone, lexapro, womans multivitamin gummy
Current Illness: Covid 19
Preexisting Conditions: Migraines, ovarian cysts
Allergies: Carbona carpet cleaner, Bees,grass,trees,latex ,wheat,flax seeds,bactrim,gluten, milk,methacrylate,metformin,moth balls,gold and silver
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness at shot site,swelling, vomiting, chills,fever


VAERS ID: 1372549 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Swollen lymph nodes on side of injection


VAERS ID: 1372558 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-23
Onset:2021-06-02
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site rash, Injection site swelling, Injection site warmth, Pain, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: Light intermenstrual bleeding 10 days after second shot. One day after second shot experienced fatigue and body aches. Developed a large, swollen circular rash, warm to the touch at injection site, with arm pain. Pain lasted about 3 days, rash cleared after 7 days.


VAERS ID: 1372580 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bone pain, Chest pain, Chills, Dyspnoea, Erythema, Fatigue, Hyperhidrosis, Impaired work ability, Injection site swelling, Migraine, Mobility decreased, Nausea, Oropharyngeal pain, Pain, Pain in extremity, Paraesthesia, Skin warm
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Osteonecrosis (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Maderna, first shot.
Other Medications: Vitamin D
Current Illness: N/A
Preexisting Conditions: Osteoporosis
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Around 7:30 in the evening at work I started having a migraine. I could hardly lift my arm and the site was immediately swollen. My whole arm became red, hot and painful. I left work. I was very tired . All night long I was up nauseous, my throat hurts, pain in my chest. For a time I felt as if I couldn?t catch my breath. The worst is every bone in my body feels broke and continues to fill like my bones keep breaking over and over. The pain is unbearable. It?s 8:45 in the evening 24 hours later and I feel worse. I literally can not move my body hurts so bad. I?m sweating and then have chills. My left arm has pins and needles down to my finger tips. I have to take another day off of work tomorrow. When I got my first shot in May, a week later to the day my arm that I received the shot was very swollen, itchy, hives, red, hot, all the way down to my elbow. My son got his second shot also the same day as me and he is also sick today. Not as bad as myself, but was sent home from work. He feels like he can not breath, body aches and tired. I?m just wondering why I?m so sick?


VAERS ID: 1372759 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-05-24
Onset:2021-06-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0212C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, Injection site rash
SMQs:, Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins
Current Illness: None
Preexisting Conditions: Breast cancer 10 years ago
Allergies: Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash appeared on right arm about 1.5 weeks after injection. Not raised or hot, not too itchy.


VAERS ID: 1372776 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 2 LA / SYR

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

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

Write-up: Chills, fatigue, aches in legs


VAERS ID: 1372789 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-29
Onset:2021-06-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, Injection site rash
SMQs:, Hypersensitivity (narrow)

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

Write-up: Rash itchiness in the injection site


VAERS ID: 1372901 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-13
Onset:2021-06-02
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Hypoxia, Myocarditis, Pneumonia viral, SARS-CoV-2 test positive, Troponin increased, White blood cell count increased
SMQs:, Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Mirena IUD
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: elevated troponin to 0.45, positive Sars-CoV-2 on viral panel, WBC 21.8
CDC Split Type:

Write-up: Patient appears to have myocarditis/ viral pneumonia, hypoxia on 6/3/21 positive Sars-CoV-2 on viral panel in ED today.


VAERS ID: 1372912 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-19
Onset:2021-06-02
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Axillary pain, Breast pain, Burning sensation
SMQs:, Peripheral neuropathy (broad), Lipodystrophy (broad)

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

Write-up: I got the shot on my left arm and now I have a burning pain in my left armpit and in my left breast. It is a 4 on a 1 to 10 scale of pain. I noticed it June 2nd but today it is hard to ignore.


VAERS ID: 1372916 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / 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 stored in the freezer for 21 days, instead of 14 days. the vaccine was supposed to be removed from the freezer on 5/27 and placed in the fridge however it was not and was stored in the freezer and given to the patient.


VAERS ID: 1373103 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Chills, Diarrhoea, Ear pain, Eye pain, Headache, Pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (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: Tylenol
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: No
CDC Split Type:

Write-up: Head ache, body ache, chills, moderate fever, stomach cramps, vomiting, diarrhea weakness, ear ache, eye ache all within 4 hours of vaccine and continues on to now 48?hours


VAERS ID: 1388033 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash, Swelling face
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: Patient developed facial swelling and a rash yesterday evening, looking back she realized that she was having facial swelling after first dose of moderna


VAERS ID: 1373123 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Influenza like illness, Injection site pain, Nausea, Pain, Pyrexia, Somnolence
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Started feeling flu like symptoms around 10:30 pm about 12 hours after injection. Symptoms continued through next day. Extremely tired, body aches, nausea, groggy, low grade fever, arm sore and tender at injection site. Symptoms still continued as of 9:30pm next day


VAERS ID: 1373148 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-13
Onset:2021-06-02
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Ultrasound scan
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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: Estrogen + progesterone for IVF cycle
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: ultrasound
CDC Split Type:

Write-up: DVT of lower extremity


VAERS ID: 1373258 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Arizona  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210604714

Write-up: ITCHING; BURNING; HIVES; This spontaneous report received from a patient concerned a male of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 205A21A, expiry: UNKNOWN) dose was not reported, administered on 02-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUN-2021, the subject experienced itching. On 02-JUN-2021, the subject experienced burning. On 02-JUN-2021, the subject experienced hives. The action taken with covid-19 vaccine was not applicable. The outcome of the hives, itching and burning was not reported. This report was non-serious.


VAERS ID: 1373267 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Expired product 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: USJNJFOC20210604819

Write-up: ADMINISTRATION OF EXPIRED VACCINE; This spontaneous report received from a patient via a company representative concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 1805031 expiry: 27-MAY-2021) dose was not reported, administered on 02-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUN-2021, the subject experienced administration of expired vaccine. The action taken with covid-19 vaccine was not applicable. The outcome of administration of expired vaccine was not reported. This report was non-serious. This case, from the same reporter is linked to 20210605676.


VAERS ID: 1373280 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Expired product 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: USJNJFOC20210605676

Write-up: ADMINISTRATION OF EXPIRED VACCINE; This spontaneous report received from a patient via a company representative concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, and batch number: 1805031 expiry: 26-MAY-2021) dose was not reported, administered on 02-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUN-2021, the subject experienced administration of expired vaccine. The action taken with covid-19 vaccine was not applicable. The outcome of administration of expired vaccine was not reported. This report was non-serious. This case, from the same reporter is linked to 20210604819.


VAERS ID: 1373759 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 AR / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Basilar artery thrombosis, Brain stem stroke, Computerised tomogram head abnormal, Lacunar stroke, Magnetic resonance imaging head abnormal, Mental status changes, Respiratory distress
SMQs:, Anaphylactic reaction (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Recent pneumonia 6 weeks prior treated with antibiotics
Preexisting Conditions: possibly uncontrolled hypertension
Allergies: None
Diagnostic Lab Data: CT, MRI
CDC Split Type:

Write-up: Pt admitted w/ respiratory distress, altered mental status due to basilar artery thrombosis causing brainstem and bilateral thalamic stroke.


VAERS ID: 1374000 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Ohio  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: METOPROLOL
Current Illness: Abstains from alcohol; Diabetes; Non-smoker
Preexisting Conditions: Comments: The patient had no known allergies and was not pregnant at the time of reporting.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210606276

Write-up: ABOUT 15 MINUTES AFTER THE VACCINE, FEELING TINGLY IN TOES/LEGS/LEFT ARM/RIGHT FINGERS AND STRONGER TINGLING IN THE LEFT FINGERS; This spontaneous report received from a patient concerned a 50 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included diabetes, non alcohol user, and non smoker, and other pre-existing medical conditions included the patient had no known allergies and was not pregnant at the time of reporting. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 1821288 expiry: UNKNOWN) dose was not reported, administered on 02-JUN-2021 16:00 for prophylactic vaccination. Concomitant medications included metoprolol. On 02-JUN-2021, the subject experienced about 15 minutes after the vaccine, feeling tingly in toes/legs/left arm/right fingers and stronger tingling in the left fingers. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from about 15 minutes after the vaccine, feeling tingly in toes/legs/left arm/right fingers and stronger tingling in the left fingers. This report was non-serious.


VAERS ID: 1374008 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 - / IM

Administered by: Military       Purchased by: ?
Symptoms: Acute myocardial infarction, Bone pain, Chest pain, Dyspnoea, Echocardiogram normal, Ejection fraction normal, Electrocardiogram normal, Intensive care, Laboratory test, Myalgia, Myocarditis, Pain in extremity, Pleuritic pain, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: OXYMETAZOLINE 0.05 % NAS SPRY [15ML]
Current Illness: N/A
Preexisting Conditions: DEPRESSION; hypothyroidism and vitamin D deficiency
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: ON 3 JUNE 2021 @ 1453, "25-year-old female who presents to the emergency department with 2 days of worsening left-sided chest pain associated with some myalgias shortness of breath she received her second covid vaccination on the first of June. she also has some bilateral anterior shin pain soreness into her arms as well. Denied any fever and a productive cough any nausea or diarrhea". Patient was admitted to ICU on 3 June for NSTEMI in setting of chest pain/SOB with elevated TnT. Significant elevation of TnT $g3K with unremarkable ECG. TIMI score 1, grace 52. Given her age etiology concerning for possible Myocarditis but will start appropriate tx for NSTEMI and order formal TTE.....Patient has been diagnosed with Myopericarditis. The patient didn''t have any significant changes on her EKG, however, she did have elevated troponins up to 3134 ng/L which trended down to 2455 ng/L on recheck. Given the pleuritic nature of her chest discomfort, MD suspected Acute Myopericarditis. She is still symptomatic and thus, MD recommended she take high-dose NSAIDs. MD would not too keen on starting her on steroids and/or colchicine unless she doesn''t get better on follow up evaluation. Echocardiogram showed intact ejection fraction. MD have sent off additional labs to look for other causes of myopericarditis. The patient should also be on a low-dose of beta blocker and ACE inhibitor. She''ll follow with her primary care provider and cardiology.


VAERS ID: 1374013 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Joint injury, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Arthritis (broad)

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

Write-up: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)


VAERS ID: 1374058 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Cough, Headache, Myalgia, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: With the first COVID19 vaccine (see item 22), had whole body muscle and joint aches for approximately 24 hours after the injecti
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Cephalosporin antibiotics.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Right deltoid muscle ache began within 1 hour after injection and resolved within 24 hours. Muscle and joint pain in entire body began on 6/2/2021 at about 3 a.m. and resolved on 6/3/2021 at about 8 a.m. Headache, chills, fever, and a dry cough began on 6/2/2021 at 4 a.m. The fever fluctuated between 99.5 degrees F and 101.3 degrees F. The chills and fever resolved on 6/2/2021 at 10 p.m. The headache resolved on 6/3/2021 at 10 a.m. The headache was frontal type pain in the forehead with sensitivity to light. The dry cough is still ongoing right now on 6/4/2021 at approximately 6:15 a.m. It is a dry, non-productive cough, worse during the day and less at night.


VAERS ID: 1374064 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Hyperaesthesia, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (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: Prenatal whole food vitamins, vitamin D supplements, and fish oil I was feeling quite touchy to the skin, body aches and fatigue
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I am 23 weeks pregnant and due on or around September 27, 2021. The evening on the same day of the vaccine (my second dose), I felt very touchy, almost tingly, sore, body aches, and fatigue.


VAERS ID: 1374065 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect route of product administration
SMQs:, Drug abuse and dependence (broad), 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: Error: Wrong Route (SC, IM, etc.)


VAERS ID: 1374082 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-22
Onset:2021-06-02
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 10mg Escitalopram 10 mg Muxinex Nasal Spray
Current Illness: None
Preexisting Conditions: Seasonal allergies
Allergies: N/A
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sore arm where shot was given


VAERS ID: 1374087 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Eye movement disorder
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Ocular motility disorders (narrow)

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

Write-up: Right after vaccine was given, patient felt lightheaded. Pharmacist gave a bottle of water and ice pack, while his wife attended to him and waited for his recovery. Meanwhile his eyes rolled few times. His wife asked me to call 911. Medic came within 15 minutes and took him to hospital while he was still conscious.


VAERS ID: 1374129 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hyperhidrosis, Hypoaesthesia, Malaise, Paraesthesia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: It was the patients first COVID-19 Pfizer vaccine dose and he was sitting in the waiting room after his vaccination and came to get me to tell me that he did not feel well. He was sweating and then proceeded to vomit. We had him sit in the other exam room and gave him some water. After that he started saying his arms were tingling and going numb, when that happened I discussed with him calling EMS and instructed the PCT to call EMS. When EMS came the pt said he was feeling better and signed a refusal to go with them to the ER. The pt had a friend who was in the store with him that was going to drive him home. He was able to sit for about 30 minuets when he stated that he was feeling better and was wanting to go home. PCT walked him to the car. He was instructed that if at any time he started having symptoms again that he needed to go to the ER.


VAERS ID: 1374142 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Dissociation, Nausea
SMQs:, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: She began to feel nauseated and "distant", which she describes as being somewhat separated from her surroundings.


VAERS ID: 1374177 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Feeling cold, Feeling hot, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Arthritis (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: First Pfizer COVID vaccine 5/5/21
Other Medications: Tri-Femynor, Omeprazole
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Aches in joints, then extremely cold, followed by extremely hot with severe body sweats starting around 9PM and lasting until 6AM.


VAERS ID: 1374185 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lo Lo Estrin 1 daily Vitamin D 50,000 IU every week Calcium Lactate 250 mg 3 daily Flonase 2 sprays daily
Current Illness: None
Preexisting Conditions: Chronic sinusitis Thyroid nodule
Allergies: Penicillin, clindamycin, flagyl, codeine, pseudoephedrine, omeprazole
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 6/02/2021: 2 hives on my right eyelid. Took benadryl 25 mg upon arriving home at 17:00 and 1000mg extra strength tylenol. Used warm compress. Took another benadryl 25 mg at 23:30. At that time itching was almost gone and 1 hive was gone the other was smaller. 6/03/2021: No benadryl taken. Warm compress applied twice during day. 6/04/2021: Remaining bleb still there but very small and just slightly itchy. No benadryl taken.


VAERS ID: 1374190 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Palpitations, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (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: Birth control, Lexapro
Current Illness:
Preexisting Conditions:
Allergies: Shellfish
Diagnostic Lab Data:
CDC Split Type:

Write-up: Around 12 hours after my injection I began experiencing fever, chills, and heart palpitations. These symptoms lasted about 24 hours.


VAERS ID: 1374198 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-25
Onset:2021-06-02
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Blood magnesium, Chest X-ray, Electrocardiogram, Electrocardiogram abnormal, Full blood count, Metabolic function test, Syncope, Troponin
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall, guanfacine
Current Illness: None
Preexisting Conditions: ADHD
Allergies: NKA
Diagnostic Lab Data: 6/2/21 ER visit: Blood tests including CBC, metabolic panel, troponin and magnesium; 12 lead ECG (results - borderline LVH, possible acute pericarditis), chest xray
CDC Split Type:

Write-up: Syncope event caused ER trip where abnormal ECG resulted with possible pericarditis


VAERS ID: 1374199 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210605002

Write-up: TINGLING IN ARMS RADIATING FROM DELTOID DOWN TO FINGERTIPS; This spontaneous report received from a pharmacist concerned a 29 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 201A21A, expiry: 23-JUN-2021) dose was not reported, administered on 02-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUN-2021, the subject experienced tingling in arms radiating from deltoid down to fingertips. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of tingling in arms radiating from deltoid down to fingertips was not reported. This report was non-serious.


VAERS ID: 1374200 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Throat tightness, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol Sulfate HFA inhaler, Vit C., aspirin chewable, carvedilol, vit D3, clonidine HCL, enalapril maleate, isradipine, lantus U-100 insulin, melatonin, ptoronix, rosuvastatin, Senna-S,
Current Illness: None
Preexisting Conditions: Diabetes mellitus Type 2, Anemia, COPD, Hypertension, GERD, Major Depressive Disorder, Dysphagia, Heart Disease
Allergies: No known allergies to medications or food.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Resident reported feeling of throat "closing off" upon return to Nursing Home facility after receiving her second COVID-19 vaccine at Dr. office. Resident then vomited large amount of liquid. At that time resident denied any shortness of breath or difficulty breathing. Vital signs stable. Tylenol and Bendaryl ordered and given by Nursing Home Nurse Practitioner. Resident did not require higher level of care.


VAERS ID: 1374212 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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: Migraine, treated with Tylenol, lasted 32 hours


VAERS ID: 1374223 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Georgia  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Contusion, Fall, Pain, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Patient had no known allergies and was not pregnant at the time of reporting.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210605671

Write-up: ACHES; HAD A FALL; HAD A BRIGHT RED BRUISE; FEVER; This spontaneous report received from a patient concerned a 24 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included patient had no known allergies and was not pregnant at the time of reporting. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A, and expiry: UNKNOWN) dose was not reported, administered on 02-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUN-2021, the subject experienced aches. On 02-JUN-2021, the subject experienced had a fall. On 02-JUN-2021, the subject experienced had a bright red bruise. On 02-JUN-2021, the subject experienced fever. Treatment medications (dates unspecified) included: amoxicillin/clavulanic acid. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from fever, aches, had a fall, and had a bright red bruise. This report was non-serious.


VAERS ID: 1374227 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dyspepsia, Energy increased, Insomnia
SMQs:, Gastrointestinal nonspecific dysfunction (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: 1st COVID vaccine - patient had a sore left arm that was red and hard around the injection site that lasted for several day.
Other Medications: lisinipril 40 mg bds, hydrochlorothiazide 25mg qd, rosuvastatin 20 mg qd,
Current Illness:
Preexisting Conditions: possible connective Tissue issue, HBP,
Allergies: aspirin, coricidin,
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient said about 3 hours after taking the vaccine, he felt energized like he had taken multiple B12 shots. He has a sour stomach when he tries eating food. He was awake for 36 hours after the vaccine without any medication or caffeine. Patient stated the inflammation in his body from the gout, arthritis and lime disease is now gone. Patient hopes the reaction continues and hopes this will help his autism.


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