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

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



Case Details (Reverse Sorted by Onset Date)

This is page 212 out of 8,010

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VAERS ID: 1753834 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-23
Onset:2021-09-11
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Polymerase chain reaction
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: History of RA on chronic steroids
Allergies:
Diagnostic Lab Data: Cycle threshold 19.8 on admission.
CDC Split Type:

Write-up: Patient admitted to the hospital for COVID 19. Reporting per Moderna COVID vaccine EUA.


VAERS ID: 1753845 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-01
Onset:2021-09-11
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: Patient admitted to the hospital for COVID 19. Reporting per Moderna COVID vaccine EUA.


VAERS ID: 1754016 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 - / -

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

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

Write-up: Upper eye lid began to swell.


VAERS ID: 1754317 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-09-09
Onset:2021-09-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Sciatica
SMQs:, Retroperitoneal fibrosis (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: Chronic lower back pain. Sciatica


VAERS ID: 1754737 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-09-08
Onset:2021-09-11
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

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

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

Write-up: Three days after the vaccine was administered, the patient began to experience severe upper sternal chest pain. It did not radiate, and he said that taking deep breaths seemed to cause more pain. He did not seek any medical care for this, and by the next day, the pain was significantly improved, with the pain completely resolving by the 3rd day.


VAERS ID: 1755925 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-13
Onset:2021-09-11
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023D / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Dyspnoea, Fatigue, Feeling abnormal, Headache, Hypoaesthesia, Nausea, Palpitations, Pyrexia, Vaccination site pain
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

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

Write-up: I have numbness from my elbows down to my hands, numbness from my knees down to my feet; Feels strange; Rapid heartbeat; shortness of breath; Joint aches; A massive headache; Fever (unknown temp); Nausea; Felt super super tired; Injection site pain; This spontaneous case was reported by a consumer and describes the occurrence of HYPOAESTHESIA (I have numbness from my elbows down to my hands, numbness from my knees down to my feet), FEELING ABNORMAL (Feels strange), PALPITATIONS (Rapid heartbeat), DYSPNOEA (shortness of breath) and ARTHRALGIA (Joint aches) in a 57-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 058E21A and 023D) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 13-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 10-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 11-Sep-2021, the patient experienced HYPOAESTHESIA (I have numbness from my elbows down to my hands, numbness from my knees down to my feet), FEELING ABNORMAL (Feels strange), PALPITATIONS (Rapid heartbeat), DYSPNOEA (shortness of breath), ARTHRALGIA (Joint aches), HEADACHE (A massive headache), PYREXIA (Fever (unknown temp)), NAUSEA (Nausea), FATIGUE (Felt super super tired) and VACCINATION SITE PAIN (Injection site pain). At the time of the report, HYPOAESTHESIA (I have numbness from my elbows down to my hands, numbness from my knees down to my feet) and FEELING ABNORMAL (Feels strange) had not resolved and PALPITATIONS (Rapid heartbeat), DYSPNOEA (shortness of breath), ARTHRALGIA (Joint aches), HEADACHE (A massive headache), PYREXIA (Fever (unknown temp)), NAUSEA (Nausea), FATIGUE (Felt super super tired) and VACCINATION SITE PAIN (Injection site pain) outcome was unknown. No Concomitant medications were reported. No Treatment details were reported.


VAERS ID: 1756707 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone, C-reactive protein normal, Chest X-ray normal, Chest pain, Costochondritis, Echocardiogram, Electrocardiogram normal, Pain, Palpitations, Pruritus, Pulmonary calcification, Pulmonary valve stenosis, Troponin normal
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prednisone 50mg 1 tab PO daily x 5 days, Famotidine 20mg 1 tab PO BID, Benadryl 25mg 1 cap PO q6hr prn allergies, PRN epi-pen =$g all prescribed by Emergency Department. Patient is also on Vitamin D3 5000 1 cap PO daily
Current Illness: Hypertension, vitamin D deficiency, UTI, CKD2
Preexisting Conditions:
Allergies: BenzaClin, Spironolactone, Scented lotions detergents
Diagnostic Lab Data: pls see #18
CDC Split Type:

Write-up: 9/20/2021: 27-year old female who was seen in our clinic after her ED visit at Medical Center ED on 9/11/2021 for chest pain s/p her 1st shot of pfizer covid vaccine. Was sent to ER from the vaccine clinic. 12-lead ekg =$g NSR. CXR =$g no acute cardiopulmonary disease. Patient was d/c home from the ED with prednisone 50mg 1 tab PO daily for 5 days, diphenhydramine 25mg 1 cap PO q6hr PRN itching, famotidine 20mg 1 tab PO BID and epinephrine (epipen) 0.3mg/0.3mL inject 0.3mL into the muscle as needed for allergic emergencies (anaphylaxis). States, "At night, I feel like my heart is coming out of my chest". When bending her back backwards, it worsens the pain. Resting or leaning forward help to relieve the pain. Denies any dyspnea, dizziness, lightheadness, palpitations, abdominal pain, n/v. 9/30/2021: Patient feels better after taking OTC ibuprofen PRN pain. No chest pain at this time. Has been taking OTC ibuprofen PRN pain with full relief of chest pain. CXR and 12-lead EKG in the ED were normal. Labs were ordered and reviewed. Trop - neg, CRP - stable, TSH - stable, ESR - normal. Echocardiogram =$g normal EF 65%. There is mild pulmonic stenosis with calcification. Patient''s cardiac workup is unremarkable. Patient''s chest pain is most likely costochondritis. Patient to take OTC tylenol BID PRN pain or OTC ibuprofen PO BID with food PRN pain. Patient may take her 2nd Pfizer vaccine completion. Patient saw Cardiology Dr a few days ago Patient to f/u with Cardio for pulmonic stenosis follow-up.


VAERS ID: 1756934 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Impaired driving ability, Muscle tightness, Pain
SMQs:, Dystonia (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: Pt stated that he started to have neck muscle tightness ( at 7 on scale 1-10) day after Covid 19 Pfizer. On going for 21 days. Gets knots in the neck . His driving is limited due to difficulty turning his neck ( pain when turning). Constan
Current Illness:
Preexisting Conditions:
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated that he had on going pain for 21 days , starting day after covid shot. He has neck muscle tightness ( 7 on scale 1-10). He gets knots in the neck. His driving is limited due to pain in the neck when turning. He has to take OTC Advil for his constant pain when in it is unbearable, happens later part of the day. He has headache toward the back of his head.


VAERS ID: 1757195 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-28
Onset:2021-09-11
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Computerised tomogram normal, Ear pain, Headache, Lymphadenitis, Pain, Respiratory tract congestion, SARS-CoV-2 test negative, Skin mass, Upper-airway cough syndrome
SMQs:, Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Honey
Diagnostic Lab Data: Physical exam, ear exam, CT scan without contrast, blood draw, Covid rapid test all done on 9.12.2021 at ER visit. Ct scan showed that it was negative for mastoiditis. Covid test came back negative. Blood work came back normal. Diagnosed with lymphadenitis by the left ear.
CDC Split Type:

Write-up: 9/11/2021 began to have Congestion, ear pain, , post nasal drip and painful lumps on left side of ear all around. Felt throbbing of ear pain and head pain. 9/12/2021 Went to urgent care and was directed to go to ER to rule out mastoiditis.


VAERS ID: 1757253 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-08-30
Onset:2021-09-11
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute coronary syndrome, Arterial catheterisation, Electrocardiogram, Myalgia, Myocarditis, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D3, 5000 IU, every other day Fexofenadine, OTC, one daily Multivitamin, One-A-Day Men''s
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NSAID medications Tylenol Aspirin Nightshade food group
Diagnostic Lab Data: EKG (multiple), 09/22 - 09/23 Radial Artery Catheterization, 09/22
CDC Split Type:

Write-up: Myopericarditis, extreme fever (105+ degree), muscular soreness, acute coronary syndrome


VAERS ID: 1757357 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Dizziness, Fatigue, Formication, Mobility decreased, Muscle spasms, Muscle twitching, Paraesthesia, Pruritus, Somnolence, Tremor, Vision blurred
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (broad), Arthritis (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: benazepril 40mg in the morning every day zoloft 200mg in morning every day
Current Illness: none
Preexisting Conditions: high blood pressure
Allergies: none
Diagnostic Lab Data: none yet. I will be scheduling blood work with my primary doctor soon.
CDC Split Type:

Write-up: LOT FC3184 was my 2nd pfizer shot. the day after i was very tired, could not get out of bed and body joint pain all over body. It was painful to have the sheets on top of me while asleep. This minimized over the next few days. during the next 2 weeks, I struggled to stay awake during the work weeks and constantly taking over the counter pain relievers to reduce the body joint pains but unsuccessful. Starting September 24 to now I have been suffering random joint pains, pins and needles from my fingers down to my toes, I feel I have bugs crawling on me with itching from my legs and back to my arms, I feel dizzy at times and get very fatigued and tired, my hands legs and feet get spasms or twitching and shaking, I feel overall weak and feels like my vision gets cloudy. Since September 24th it has not changed or has not gotten any better.


VAERS ID: 1757399 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Colorado  
Vaccinated:1951-09-08
Onset:2021-09-11
   Days after vaccination:25571
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Confusional state, Decreased appetite, Dizziness, Fatigue, Gait disturbance, Laboratory test normal, Lethargy, Pyrexia, Somnolence, Weight decreased
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81 mg, atrovastatin 40 mg, metoprolol 25 mg, omega-3.
Current Illness: Non_Hohgkin''s Lymphoma
Preexisting Conditions: Non-Hodgkin''s Lymphoma
Allergies: None
Diagnostic Lab Data: All tests performed in the hospital did not show the source of the fever and above symptoms.
CDC Split Type:

Write-up: Fever above 100F for five days, chills, weakness, dizziness, inability to walk without support, low appetite, some mental confusion, sleepiness, lethargy. After a week, very slow improvement. As of the time of this report, 10/03/2021, still very weak, easily fatigued, lost 12 lbs.


VAERS ID: 1757420 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-06
Onset:2021-09-11
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fish oil, b complex, glucosamine, d3, turmeric
Current Illness: No
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Developed shingles 5 days after second dose


VAERS ID: 1757561 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-08-31
Onset:2021-09-11
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Pain in extremity, Peripheral swelling, Superficial vein thrombosis, Ultrasound scan
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Embolic and thrombotic events, venous (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin 10mg daily, cholecalciferol 4000 IU daily, ascorbic acid 1000 mg daily.
Current Illness: None
Preexisting Conditions: Slightly elevated triglycerides
Allergies: None
Diagnostic Lab Data: Ultrasound of right leg from groin down performed on 9/15/2021. No other lab work related to this issue.
CDC Split Type:

Write-up: Symptoms: swelling, pain and erythema of right lower extremity. Started on or about 9/11/2021. Urgent Care visited on 9/15/2021 at local HCF. Diagnosed as superficial thrombophlebitis. Treatments recommended: Elevate leg above level of heart, warm compresses, NSAID as needed (eg, ibuprofen), anti-embolism stocking. Leg slowly improved, but not yet back to normal.


VAERS ID: 1758685 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-21
Onset:2021-09-11
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0021B21A / 2 LA / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1758894 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-02-26
Onset:2021-09-11
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Adenovirus test, Angiogram pulmonary abnormal, Aortic arteriosclerosis, Arteriosclerosis coronary artery, Asthenia, Bordetella test negative, COVID-19, Cardiac telemetry normal, Chest X-ray normal, Chlamydia test negative, Computerised tomogram thorax abnormal, Coronavirus test negative, Cough, Dizziness, Dyspnoea, Electrocardiogram normal, Emphysema, Enterovirus test negative, Fibrin D dimer increased, Hiatus hernia, Human metapneumovirus test, Human rhinovirus test, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Lung disorder, Mycoplasma test negative, Osteoarthritis, Presyncope, Respiratory viral panel, SARS-CoV-2 test positive, Scan with contrast abnormal, Splenic artery aneurysm, Splenic calcification, Syncope, Viral test negative, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ALPRAZolam (XANAX) 0.5 mg tablet aspirin 81 mg tablet atorvastatin (LIPITOR) 40 mg tablet levothyroxine (SYNTHROID) 88 mcg tablet lisinopriL (ZESTRIL) 5 mg tablet omeprazole (PriLOSEC) 20 mg capsule predniSONE (DELTASONE) 10 mg tablet
Current Illness:
Preexisting Conditions: Nervous Cerebrovascular accident (CVA), unspecified mechanism (CMS/HCC) Lumbar radiculopathy Polymyalgia rheumatica (CMS/HCC) Paralysis of right vocal cord Syncope and collapse Respiratory Chronic obstructive pulmonary disease (CMS/HCC) Circulatory Cerebral arterial aneurysm Benign essential hypertension Genitourinary Left kidney mass Renal cell carcinoma of left kidney (CMS/HCC) CKD (chronic kidney disease), stage III (CMS/HCC) Musculoskeletal Osteoporosis Lumbar herniated disc Lumbar spondylosis Spondylosis of cervical region without myelopathy or radiculopathy Endocrine/Metabolic Hyperlipidemia Hypothyroidism Prerenal azotemia Other Recurrent major depressive disorder (CMS/HCC) Anxiety Depression Ground glass opacity present on imaging of lung Controlled substance agreement signed H/O left nephrectomy
Allergies: Keflex [Cephalexin]Other (document details in comments)
Diagnostic Lab Data: 09/13/21 1958 Respiratory virus detection panel Collected: 09/13/21 1812 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result Detected Critical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected Procedure Component Value Ref Range Date/Time X-ray chest 1 view - Portable Resulted: 09/14/21 1009 Order Status: Completed Updated: 09/14/21 1009 Narrative: XR CHEST 1 VW PORT IMPRESSION: No acute findings. NB: Radiography can be negative in the early of stage of COVID 19 pneumonia. END OF IMPRESSION: INDICATION: syncope, vomiting, cough Cough. COVID 19 positive 9/13/2021. TECHNIQUE: Portable AP projection of the chest was acquired. COMPARISON: 4/20/2021. 10/20/2017. 11/14/2008. FINDINGS: EKG wires and tubing project over the thorax. An implanted geometric metallic device again projects at the base of the neck on the left, and has been present since 2008. The heart size is normal. The vascular distribution is normal. Aortic calcifications are present. Splenic arterial calcifications including calcified splenic aneurysm are again seen. The lungs are clear. No pleural effusion is identified. There is no evidence of pneumothorax. Mild thoracic dextrocurve and bilateral AC arthrosis are noted. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. CT angiogram chest pulmonary embolism with and without contrast (Abnormal) Resulted: 09/13/21 2247 Order Status: Completed Updated: 09/13/21 2247 Narrative: PROCEDURE INFORMATION: Exam: CTA Chest Without And With Contrast Exam date and time: 9/13/2021 9:03 PM Age: 74 years old Clinical indication: Shortness of breath; Additional info: Syncope, elevated d-dimer covid+. Syncope, covid positive, elevated d-dimer TECHNIQUE: Imaging protocol: Computed tomographic angiography of the chest without and with contrast. 3D rendering (Not supervised by radiologist): MIP and/or 3D reconstructed images were created by the technologist. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. Contrast material: Contrast volume: 80 ml; Contrast route: INTRAVENOUS (IV); COMPARISON: CT CHEST WO CONTRAST 11/17/2020 10:57 AM FINDINGS: Pulmonary arteries: Normal. No pulmonary emboli. Aorta: Moderate atherosclerotic changes within the aorta. Lungs: Patchy airspace disease identified at left base as well as both upper lobes, may represent early developing covid pneumonia. Underlying pulmonary emphysema. Pleural spaces: Unremarkable. No pneumothorax. No pleural effusion. Heart: Moderate to severe coronary atherosclerosis. Mediastinal space: Mild hiatal hernia. Lymph nodes: Unremarkable. No enlarged lymph nodes. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. Other findings: No acute filling defect. IMPRESSION: No acute pulmonary emboli. Patchy airspace disease identified at left base as well as both upper lobes, may represent early developing covid pneumonia.
CDC Split Type:

Write-up: ED to Hosp-Admission Discharged 9/13/2021 - 9/15/2021 (2 days) MD Last attending ? Treatment team Syncope and collapse Principal problem Presenting Problem/History of Present Illness/Reason for Admission Syncope and collapse [R55] AKI (acute kidney injury) (CMS/HCC) [N17.9] Syncope, unspecified syncope type [R55] COVID-19 virus infection [U07.1] 74-year-old female past medical history of stable cerebral aneurysm, routinely follows in the outpatient setting, COPD, essential hypertension, polymyalgia rheumatica, vertigo presented to the ER with near syncopal episodes. Still feeling very weak for the past 3 to 4 days she was going to the bathroom she felt dizzy and was about to pass out. In the ED she was tested positive for COVID-19, CT angiogram of the chest was negative for PE given her elevated D-dimer, her orthostatic vitals were positive, she was hydrated her blood pressure medications were adjusted. She was told to follow-up with her PCP in the outpatient setting for further blood pressure medication adjustment if required. Also a Zio patch was placed on her to rule out any arrhythmia while in the hospital telemetry and EKGs were unremarkable. She was discharged home in a stable condition. Patient does not require any oxygen for her COVID-19.


VAERS ID: 1759089 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea, Fatigue, Headache, Injection site pain, Laboratory test normal, Pain, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: denies any
Current Illness: denies any
Preexisting Conditions: denies any
Allergies: denies any
Diagnostic Lab Data: Any test/results were performed in ER
CDC Split Type:

Write-up: 9/10- soreness to vaccinated arm 9/11-tired, headache, body aches (continued until Tuesday) 9/14-tachycardia, some breathing difficulty ( to emergency room on Wed. 9/15- evaluated and Diagnosis "all normal") 9/16-tachycardia again(ER again, evaluated, can''t find anything, was referred to a cardiologist)


VAERS ID: 1759178 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Allergic respiratory symptom, Bronchitis, Eye pruritus, Immediate post-injection reaction, Nasopharyngitis, Rhinorrhoea, Throat irritation
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (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: Magnesium Carbonate supplement, multivitamin, Calcium chew
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Visited urgent care
CDC Split Type:

Write-up: Immediately had cold symptoms which got worse like allergies. Itchy eyes. Scratchy throat. Runny nose. Turned to bronchitis


VAERS ID: 1759331 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-12
Onset:2021-09-11
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 2 UN / SYR

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1759484 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-30
Onset:2021-09-11
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Anticoagulant therapy, COVID-19, Chest X-ray abnormal, Dyspnoea, Pulmonary thrombosis, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Losartan 50mg Tamsulosin 0.4mg Temazepam 30mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Hospitalized for 3 days total.
CDC Split Type:

Write-up: Patient described shortness of breath and stomach pains. Sent to Emergency room via EMS and tested positive for COVID-19 Delta variant 12 days after vaccine. Upon X-ray of chest, small blood clot located into right lower lobe. Admitted into hospital for observation and released 2 days later with blood thinner and antibiotics. No other symptoms reported.


VAERS ID: 1759542 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Crying, Depression, Ear discomfort, Fatigue, Headache, Hypersomnia, Pain in extremity, Rhinorrhoea
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: sore arm, runny nose, ear popping, headaches, a couple days after went into a very deep depression, crying everyday, severe fatigue (sleeping for a large part of the day)


VAERS ID: 1760970 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-04-05
Onset:2021-09-11
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Catheterisation cardiac abnormal, Chest X-ray, Chest discomfort, Chest pain, Coronary artery dissection, Electrocardiogram, Fatigue, Hypertension, Myocardial infarction, Troponin increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: multi vitamin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: EKG Chest/Lung XRAY Blood work 9/13/2021 showed troponin levels elevated Heart Cath 9/14/2021 showed the large tear in main artery (SCAD) no known cause
CDC Split Type:

Write-up: Spontaneous Coronary Artery Dissection which led to a heart attack and hospitalization from Sept 13-Sept 16. Fatigue and unusual tiredness when physically exercising and mowing grass began April 10th and continued everytime with extreme physical activity until heart attack. In the beginning wondered if adverse effect from vaccine then wrote it off getting older. slight chest pains more of a discomfort began on Sept 11, then got worse on Sept 13th blood pressure was extremely high so went to emergency room at hospital tests were run and diagnosed with heart attack caused by Spontaneous Coronary Artery Dissection (SCAD)


VAERS ID: 1761355 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Blood urine present
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow)

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

Write-up: Pt began to experience blood in urine day after vaccination. Continues to occur intermittently with urination since that time. Occ has blood spotting in underwear. No pain with urination. No other complaints.


VAERS ID: 1761526 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 RA / IM

Administered by: Pharmacy       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None required
CDC Split Type:

Write-up: There was no adverse event at all reported. Vaccine was administered to an 11 year old minor who was not eligible to receive the vaccine under pharmacy protocol/standing order guidelines. Wrong birthday was provided by the parents intentionally to get the vaccine sooner than his actual age. Wrong birth year of 2009 was given instead of his actual birth year of 2010. Month and date wad give correctly. Pfizer vaccine is currently approved for 12 years and older.


VAERS ID: 1761690 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-21
Onset:2021-09-11
   Days after vaccination:113
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 09/11/2021 PCR+ COVID-19 test at Medical Center
CDC Split Type:

Write-up: Breakthrough COVID-19 case with unknown symptom status. Hospitalized 9/11/2021 for unknown duration


VAERS ID: 1762103 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-09
Onset:2021-09-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Pain in extremity, Thrombosis, Ultrasound Doppler abnormal, X-ray limb normal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: I had a visit with a knee doctor, they took x-rays didn''t find anything, sent me to the clinic for ultra sound and they found the blood clot in the upper thigh of my left leg. I''ve been doing Lovenox shots 2 x a day for the last 2 weeks.
CDC Split Type:

Write-up: My leg started hurting 2 days later and 2 weeks later they found a blood clot in my left leg


VAERS ID: 1762261 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dysstasia, Ophthalmological examination abnormal, Vertigo
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Optic nerve disorders (broad), Corneal disorders (broad), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec
Current Illness: None
Preexisting Conditions: None
Allergies: Allergic to cigarette smoke, tree pollen, and dust.
Diagnostic Lab Data: I went to see my doctor on Tuesday September 14th 2021 at 10am. The doctor preformed a number of standard eye test on me and I failed them all she was able to determine right away that I have vertigo. She prescribed Meclize.
CDC Split Type:

Write-up: About 24 hrs. after receiving my 2nd dose of the Pfizer vaccine, I developed extreme dizziness to the point where is could not stand up straight without falling over.


VAERS ID: 1762265 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19 immunisation
SMQs:, COVID-19 (narrow)

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

Write-up: Patient received Jansen vaccination on 4/8/21 at another clinic, then received Pfizer dose 1 at this pharmacy on 9/11/21, and dose 2 at another pharmacy on 10/2/21. Patient did not disclose at either visit that she had Jansen previously.


VAERS ID: 1762493 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / UNK LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Exostosis, Joint effusion, Joint swelling, Osteoarthritis, X-ray abnormal
SMQs:, Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: x-ray of the right knee on Sept 15.
CDC Split Type:

Write-up: Pain in right knee, swelling of the right knee, fluid pocket in the right knee. It''s been a month and it''s still bad. My Dr ordered an xray and it says I now have ostheoarthritis and osteophytes in my right knee.


VAERS ID: 1763090 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-31
Onset:2021-09-11
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abortion spontaneous, Blood test, Exposure during pregnancy, Ultrasound antenatal screen
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow)

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

Write-up: Received 1st dose when approximately 6.5 weeks pregnant. Had a miscarriage 11 days post vaccine. Estimated due date was 4/22/2022


VAERS ID: 1764038 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-08-13
Onset:2021-09-11
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Hemiparesis, Limb discomfort, Pain
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)

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

Write-up: This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of HEMIPARESIS (The left side of her body was not functioning.) in a 24-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 002F21A and 002F21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 13-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 10-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 11-Sep-2021, the patient experienced HEMIPARESIS (The left side of her body was not functioning.) (seriousness criterion medically significant), LIMB DISCOMFORT (She could not use her arm/She kept her arm at a 50 degree angle) and LIMB DISCOMFORT (She could not use her leg). On 16-Sep-2021, the patient experienced PAIN (Had a shooting pain from her fingertips to the very beginning of her neck). At the time of the report, HEMIPARESIS (The left side of her body was not functioning.), PAIN (Had a shooting pain from her fingertips to the very beginning of her neck) and LIMB DISCOMFORT (She could not use her arm/She kept her arm at a 50 degree angle) outcome was unknown and LIMB DISCOMFORT (She could not use her leg) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication was given. Laboratory data was mentioned as patient done the bloodwork on 24 Sep 2021 but results were not given. No treatment medication was given. It was reported that on 11 Sep 2021, the left side of her body was not functioning. She could not use her leg or arm. She kept her arm at a 50 degree angle because if she moved it, she had a shooting pain from her fingertips to the very beginning of her neck. The leg got better around 16 Sep 2021. She saw her doctor on 24 Sep 2021 and would have bloodwork done and was being sent to a neurologist to see if a nerve was hit. Date of end of reaction/event for the event the left side of her body was not functioning and she could not use her leg was reported as 16 Sep 2021. Company Comment: This case concerns a 24-year-old, female patient with no previous relevant medical history reported, who experienced the unexpected event of hemiparesis. The event occurred 1 days after the second dose of mRNA-1273. The rechallenge was not applicable since the event happened after the second dose. The benefit-risk relationship of mRNA-1273 is not affected by this report. Further information was requested.; Sender''s Comments: This case concerns a 24-year-old, female patient with no previous relevant medical history reported, who experienced the unexpected event of hemiparesis. The event occurred 1 days after the second dose of mRNA-1273. The rechallenge was not applicable since the event happened after the second dose. The benefit-risk relationship of mRNA-1273 is not affected by this report. Further information was requested.


VAERS ID: 1764603 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-10
Onset:2021-09-11
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: AMLODIPINE, ZIA, LISINOPRIL,METFORMIN, ZOCOR, TAMSULOSIN, FEXOFENADINE, ASPIRIN, IRON, VITAMIN C, MAGNESIUM VITAMIN B1, CO Q 10, FISH OIL, ZINC
Current Illness:
Preexisting Conditions: COPD, DM, CKD
Allergies:
Diagnostic Lab Data: POSITIVE COVID
CDC Split Type:

Write-up: FATIGUE, COUGH, LOSS OF APPETITE


VAERS ID: 1764610 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blister, Blood blister, Influenza like illness
SMQs:, Severe cutaneous adverse reactions (broad), Haemorrhage terms (excl laboratory terms) (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: Daily multi-vitamin
Current Illness: None
Preexisting Conditions: Foot swelling due to sitting too long
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within a few hours a swath of blisters appeared on my right ankle, and over the next 48 one appeared on my temple. The ankle blisters contained clear fluid, the one on temple contained blood. Also experience severe flu-like muscle aches and pains between 24 and 48 hours.


VAERS ID: 1764648 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:1953-10-17
Onset:2021-09-11
   Days after vaccination:24801
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Inflammation, Oedema peripheral, Skin exfoliation, Skin hypopigmentation
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Within 1 day of receiving her ''booster'' (3rd dose) of Moderna vaccine, patient developed extensive diffuse 2+ edema and inflammation of entire left upper arm extending from left shoulder to left elbow within 1 day of vaccination. As edema resolved over 5-7 days patient presented to our clinic with desquamation of the overlying skin (post inflammatory desquamation). No other rash on the body, otherwise feeling well. Desquamation resolved with topical steroids within 2 weeks. At 3 week follow up area was healed with mild hypopigmentation and no residual inflammation or edema. Patient has no history of immunosuppression or underlying autoimmune disease, wanted to get booster simply because she was afraid and felt getting it would be a good preventative practice.


VAERS ID: 1765086 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-22
Onset:2021-09-11
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adenovirus test, Anticoagulant therapy, Anxiety, Asthenia, Asthma, Blood creatinine increased, Bordetella test negative, COVID-19, COVID-19 pneumonia, Cardiomegaly, Chest X-ray abnormal, Chills, Chlamydia test negative, Condition aggravated, Cough, Decreased activity, Dizziness, Dyspnoea, Dyspnoea exertional, Enterovirus test negative, Essential hypertension, Exposure to SARS-CoV-2, Headache, Hiatus hernia, Human metapneumovirus test, Human rhinovirus test, Hypersomnia, Hypopnoea, Hypoxia, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Laboratory test, Lung hypoinflation, Mycoplasma test negative, Nausea, Nervousness, Obesity, Physical deconditioning, Pyrexia, Respiratory syncytial virus test negative, Respiratory viral panel, SARS-CoV-2 test positive, Sleep apnoea syndrome
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol 5 mg/mL nebulizer solution albuterol HFA (PROVENTIL;VENTOLIN) 90 mcg/actuation inhaler ALPRAZolam (XANAX) 0.25 mg tablet buPROPion (WELLBUTRIN) 75 mg tablet busPIRone (BUSPAR) 15 mg tablet citalopram (CeleXA) 40 mg tablet es
Current Illness:
Preexisting Conditions: Respiratory Allergic asthma Mild intermittent asthma Obstructive sleep apnea syndrome Circulatory Essential hypertension Right bundle branch block Digestive Acute pancreatitis Obesity Musculoskeletal Hiatal hernia Endocrine/Metabolic Disorder of adrenal gland (CMS/HCC) Infectious/Inflammatory COVID-19 Other Anxiety Malaise and fatigue
Allergies: Dog Dander Feathers Rabbit Cat DanderOther (document details in comments) Tree And Shrub PollenOther (document details in comments)
Diagnostic Lab Data: 09/14/21 0211 Respiratory virus detection panel Collected: 09/14/21 0103 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result Detected Critical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected Procedure Component Value Ref Range Date/Time X-ray chest 1 view - Portable [3302836427] Resulted: 09/14/21 0754 Order Status: Completed Updated: 09/14/21 0754 Narrative: XR CHEST 1 VW PORT IMPRESSION: No acute radiographic abnormality. END OF IMPRESSION: INDICATION: SOB, covid exposure. Male, 58 years COMPARISON: Chest radiograph from 9/30/2018. FINDINGS: Single frontal view of the chest shows shallow inspiratory effort. The costophrenic angles are not blunted, therefore no large pleural effusion. Mild cardiomegaly. No pneumothorax.
CDC Split Type:

Write-up: ED to Hosp-Admission Discharged 9/14/2021 - 9/16/2021 (2 days) Last attending ? Treatment team Shortness of breath Principal problem Admission Diagnosis Medical Problems Hospital Problems POA Hiatal hernia Yes Essential hypertension Yes Mild intermittent asthma Yes Obesity Yes Obstructive sleep apnea syndrome Yes COVID-19 Yes Hospital Course HPI: Patient is an 58 y.o. male patient of the Dr. with past medical history of mild intermittent asthma and kidney stones. He presents today to the ED with complaints of increasing shortness of breath, nonproductive cough, and recent exposure to COVID-19. It has been over 3 days duration, but last night it became significantly worse for him. He is unable to ambulate around his home without significant shortness of breath and feeling as though he will "pass out." No chest pain, no palpitations, no fever noted. He was vaccinated with Pfizer in the past. His wife was not. He has no issues with his perception of smell and taste, he has nausea, but no vomiting or diarrhea. No dysuria, hematuria, constipation, myalgias. He notes + headache and persistent cough. Temps in 99 range. ED workup reveals a slightly elevated creatinine, but otherwise appropriate lab panel outside of COVID-19 +. XR demonstrates hypoinflation, negative for PNA. Albuterol has not helped him at this time. Hospital Course: Please send details from H&P and follow-up note lab work and imaging In briefly this is a morbidly obese 58-year-old male history of multiple comorbid condition including asthma obesity he was completed his COVID-19 vaccination admitted here with shortness of breath cough fever chills for 3 days and he was found COVID-19 pneumonia. In addition of that he is having mild hypoxia so initially started some oxygen and remdesivir and Decadron. Fortunately patient improving totally oxygenation is 9495% in room air still having some cough but clinically she is much improving completed 3 days of remdesivir. We will continue Decadron for total of 10 days. He is clinically stable and RPM is provided he will benefit to follow-up with PCP in 7 days. Because of his obesity debility deconditioning I will put him Xarelto 10 mg p.o. daily for 4 weeks to prevent thromboembolism secondary from COVID-19 Medical Problems Hospital Problems POA * (Principal) Shortness of breath Yes Hypersomnia, unspecified Yes Hiatal hernia Yes Essential hypertension Yes Mild intermittent asthma Yes Obesity Yes Obstructive sleep apnea syndrome Yes COVID-19 Yes Medical Problems Plan: 58 year old male patient with acute shortness of breath likely secondary to COVID-19 infection, but noted history of asthma. Pt will be observed on Med Surg floor for the above. I will start patient on Dexamethasone only at this time, continue his home asthma medications, using Albuterol inhaler as well. If his oxygen sats decline and stay below 94% persistently, would recommend starting Remdesivir. He will be started on Benzonatate for cough at this time. I anticipate a 2-3 day admission. If he does not desaturate, then he should be able to go home sooner. I personally spent over half of a total 75 minutes in counseling and discussion with the patient and coordination of care as described above. VTE prophylaxis: Lovenox and SCD''s Full Code History of Present Illness Patient is an 58 y.o. male patient of the Dr. with past medical history of mild intermittent asthma and kidney stones. He presents today to the ED with complaints of increasing shortness of breath, nonproductive cough, and recent exposure to COVID-19. It has been over 3 days duration, but last night it became significantly worse for him. He is unable to ambulate around his home without significant shortness of breath and feeling as though he will "pass out." No chest pain, no palpitations, no fever noted. He was vaccinated with Pfizer in the past. His wife was not. He has no issues with his perception of smell and taste, he has nausea, but no vomiting or diarrhea. No dysuria, hematuria, constipation, myalgias. He notes + headache and persistent cough. Temps in 99 range. ED workup reveals a slightly elevated creatinine, but otherwise appropriate lab panel outside of COVID-19 +. XR demonstrates hypoinflation, negative for PNA. Albuterol has not helped him at this time. Review of Systems Constitutional: Positive for activity change and fatigue. Negative for fever. HENT: Negative for sinus pressure and sinus pain. Respiratory: Positive for cough and shortness of breath. Negative for apnea and wheezing. Cardiovascular: Negative for chest pain. Gastrointestinal: Positive for nausea. Negative for abdominal pain, diarrhea and vomiting. Genitourinary: Negative for difficulty urinating, dysuria, flank pain and frequency. Musculoskeletal: Negative for arthralgias and myalgias. Skin: Negative for color change, pallor, rash and wound. Neurological: Positive for weakness and headaches. Psychiatric/Behavioral: The patient is nervous/anxious.


VAERS ID: 1765153 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-01
Onset:2021-09-11
   Days after vaccination:72
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: COVID 19 PATIENT STATED THEY DID NOT HAVE THEIR CARD OR ANY DATES


VAERS ID: 1765207 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-10
Onset:2021-09-11
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 UN / SYR

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

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

Write-up: COVID 19


VAERS ID: 1765215 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-30
Onset:2021-09-11
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / N/A UN / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: COVID 19


VAERS ID: 1765302 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-21
Onset:2021-09-11
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 2 - / IM

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

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

Write-up: COVID POSTIVE


VAERS ID: 1765487 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-04
Onset:2021-09-11
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrial fibrillation, Dizziness, Electrocardiogram
SMQs:, Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: One a Day Men Over 50 Vitamin, turmeric Curcumin 2 a day, Minocycline100mg twice daily,probiotic 9schwartz0 2 a day, pantropazole 40mg 1 daily, Vitamin D supplement (nature Maded3 50mcg) prevagen (supplement)
Current Illness: none
Preexisting Conditions: overwight bmi 35 5 11 230 lbs
Allergies: mold
Diagnostic Lab Data: 9-1121 EKG''s
CDC Split Type:

Write-up: AFIB 1 week later..light headed, immediate care, ambulance to hospital ...NO Previous History of any heart issues, previously walked 5-10 miles daily no issues... , 2 Day Hospital stay, continuing Treatment / cardiologist care


VAERS ID: 1766105 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Sensory disturbance
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (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 states she is having referred sensation in her face. For example, when touching the roof of her mouth with her tongue, she can "feel" a sensation on her cheek similar to a finger touching her cheek. Or when she touches the side of her nose she can "feel" a sensation on the skin beneath her eye. The sensation is not associated with pain or numbness, is just strange.


VAERS ID: 1766162 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-01
Onset:2021-09-11
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Menstrual disorder, Pain, Pyrexia, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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: Vit C, Zinc, D3
Current Illness: NA
Preexisting Conditions: Asthma
Allergies: Sulfa drugs, penicillin
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: 12 hours later, fever of 102.5, severe body chills, body ache. On 9/13, spotting occured. This has never happened before. OB/GYN said it was ok. Never got my period on my normal cycle day of the 30th (I am consistency regular and NOT pregnant). Still waiting for it.


VAERS ID: 1766437 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Lingering pain in arm still after a month I got it.


VAERS ID: 1766441 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test, Dyspnoea, Electrocardiogram, Palpitations, X-ray
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Experienced shortness of breath and heart palpitations 9 hours following vaccine.


VAERS ID: 1767101 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-08
Onset:2021-09-11
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Antinuclear antibody, Antiphospholipid antibodies, Burning sensation, Coagulation test, Pain in extremity, Pruritus, Raynaud's phenomenon, SARS-CoV-2 antibody test, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lovenox Levothyroxin
Current Illness: 2 weeks post csection
Preexisting Conditions: Dvt 2017 Asthma Hypothyroidism questionable
Allergies: No
Diagnostic Lab Data: Pending ANA, COVID spike, Lupus anticoagulant, other coagulation tests
CDC Split Type:

Write-up: Hives Raynaud phenomenon - itching, burning, pain and tenderness on hands and specially tip of my fingers


VAERS ID: 1767370 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Headache, Off label use, Pain, Pain in extremity, Tremor, Visual impairment
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Connective tissue disorder; Sulfonamide allergy
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101219336

Write-up: headache; body aches; sore arm; symptoms of L hand randomly jerking to were I could not hold my cell phon; visual abnormalities where my field of vision would shift; Vaccination was my third (booster); Vaccination was my third (booster); This is a spontaneous report from a contactable other hcp (patient). A 75-years-old non pregnant female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Batch/Lot Number: FE3592), via an unspecified route of administration, administered in Arm Left on 11Sep2021 14:30 (at the age of 75-year-old) as dose 3, single for covid-19 immunisation. Medical history included connective tissue disorder from an unknown date and unknown if ongoing, drug hypersensitivity from an unknown date and unknown if ongoing. The patient''s concomitant medications were not reported. Patient previously took BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Batch/Lot Number: not reported), via an unspecified route of administration, on an unspecified date as dose 1, single and dose 2, single for covid-19 immunisation. The patient did not receive any other vaccines within four weeks prior to the vaccination. Prior to the vaccination, the patient had COVID-19. Since the vaccination, the patient had not been tested for COVID-19. On 11Sep2021, the patient experienced vaccination was my third. On 11Sep2021 21:00, patient experienced headache, body aches, sore arm, symptoms of l hand randomly jerking to were i could not hold cell phone, visual abnormalities where my field of vision would shift. Within 2-3 days, all symptoms were gone or reduced. No treatment was taken as a result of events. The outcome of the events headache, body aches, sore arm, symptoms of l hand randomly jerking to were i could not hold cell phone, visual abnormalities where my field of vision would shift was recovered on an unspecified date in Sep2021. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1767411 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-03
Onset:2021-09-11
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Coccydynia
SMQs:, Retroperitoneal fibrosis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Penicillin allergy
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101240692

Write-up: extreme lower back/ tailbone pain; extreme lower back/ tailbone pain; This is a spontaneous report from a contactable consumer (patient). A 37-year-old non-pregnant female patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, lot number/expiry date unknown), via an unspecified route of administration, administered in arm left on 03Sep2021 08:15 as dose 1, single for covid-19 immunization. Medical history included allergies: penicillin. There were no concomitant medications. There were no other vaccines in four weeks. It was unknown if the patient had covid-19 prior to vaccination. The patient was not tested for covid-19 post-vaccination. The patient experienced extreme lower back/tailbone pain on 11Sep2021. No treatment was received for the events. The patient had not recovered from the events at the time of the report.


VAERS ID: 1768893 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, Vaccination 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 error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1768905 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Unknown  
Location: Georgia  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       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:

Write-up: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1768908 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood test, Chills, Cough, Diarrhoea, Dyspnoea, Dyspnoea exertional, Fatigue, Full blood count normal, Hallucination, Heart rate increased, Hypertension, Malaise, Mobility decreased, Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Betaxolol; Zyrtec; Flonase; Arava
Current Illness: No
Preexisting Conditions: Socratic arthritis; Asthma
Allergies: Penicillin; Sulphur
Diagnostic Lab Data: Bloodwork CBC panels looking for inflammation in my body - normal, Listen to lung, 190/20 - BP.
CDC Split Type: vsafe

Write-up: Extremely ill for 2 days, sores in my mouth and nostrils, hallucination. BP was high, diarrhea, chills, no fever weak and fatigue and couldn''t get out of bed, 11 and 12 Sep2021. I thought I was going to feel better but I didn''t saw my doctor 28 Sep2021. Gave prednisone and changed BP medicine. BP gone down but heart rate 107 this am, yesterday was 119 and 113- shortness of breath. Dry cough heart high, bp not perfect, I cant do much without having shortness of breath. Prednisone is finished and going back to the doctor soon.


VAERS ID: 1769264 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-27
Onset:2021-09-11
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest pain, Electrocardiogram, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily multi-vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: See Item 18
CDC Split Type:

Write-up: On 9/11/21 I started to experience chest pain at approximately 2330 hours thinking it may be heartburn. At approximately 0030 hours I took 4 Rolaids and nothing changed. At 0100 hours I took one Pepcid Complete and the pain did not go away. At approximately 0215 hours the pain was increasing and I have never felt this type of chest pain before. I went to hospital ER and an EKG, chest x-ray, and two blood tests were completed several hours apart. I was given morphine for pain and Zofran. I was told that everything checked out alright and I should follow up with my doctor. Throughout the day on 9/12/21, the pain started to come back and I took 12 ibuprofen and 4 acetaminophen due to the pain throughout the day. During the early morning hours on 9/13/21, the pain was just as severe, if not worse, as it was the night of 9/11/21. I then went to hospital. An EKG, chest x-ray, and blood tests were completed. The ER doctor diagnosed me with pericarditis. I was prescribed anti-inflammatory and pain narcotics. I followed up with my primary doctor on 9/14/21 and he confirmed that I had pericarditis and that it was a result of the Pfizer covid-19 vaccine (first dose).


VAERS ID: 1769683 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-17
Onset:2021-09-11
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Blood folate, Carpal tunnel syndrome, Electrocardiogram, Full blood count, Hyporeflexia, Immunoelectrophoresis, Magnetic resonance imaging head, Magnetic resonance imaging spinal abnormal, Metabolic function test, Myalgia, Neck pain, Neurological symptom, Paraesthesia, Red blood cell sedimentation rate, Romberg test positive, Spinal pain, Tenderness, Vibration test abnormal, Viral infection, Vitamin B1, Vitamin B6, Vitamin D
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Nuvigil 150mg - 1 tab SID, Paxil 30mg - 1 tab SID, levothyroxine 50mcg - 1 tab SID, hydroxyzine 25mg - 1 capsule SID prn
Current Illness: none
Preexisting Conditions: hypothyroidism, depression, anxiety
Allergies: zofran, adhesives
Diagnostic Lab Data: sedimentation rate, folate, IFE and PE serum, vitamin D, vitamin B6, vitamin B1, and comprehensive metabolic panel - 09/24/2021 (results back, other labs pending) CBC, EKG interpret, comprehensive metabolic panel, MRI w wo contrast of lumbar spine, thoracic spine, cervical spine, and brain - 09/26/2021
CDC Split Type:

Write-up: Increased crepitus in right wrist, which became symptoms of bilateral carpal tunnel within one week or so (09/11-09/20), paresthesia in right arm, right forearm, and left elbow. was seen by urgent care provider on 09/20. Between 09/20 and 09/22, symptoms progressed more in left hand and left forearm; was seen by PCP Dr. on 09/22 in the am. Within 24 hours, symptoms were worse bilaterally, with paresthesia in all extremities and neck pain. Was seen by PCP again on 09/24 afternoon, who made an emergency neurology referral and said to present to ER over weekend if any worsening symptoms. Seen by neurologist Dr. @ Clinic same day for an after hours, emergent appointment. Dr. noted "multiple neurologic symptoms, with paresthesia in upper extremities and lower extremities, myalgias after possible viral infection (negative COVID test 1 week prior)," wrist pain mostly in 3, 4, 5 digit, medial aspect of forearm, moserate left paraspinal tenderness, right trapezius and phomboid tenderness, increased vibration sensation in feet compared to hands bilateral, sensations were decreased in bilateral LE, decreased light touch, vibration, temperature sense, and prorioception. gait and station wide based when examined in small exam room. Romberg;s test positive.


VAERS ID: 1771729 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-09
Onset:2021-09-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray, Chills, Dyspnoea, Headache, Laboratory test, Pyrexia, Ultrasound scan
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Labetalol and Vit D
Current Illness: None
Preexisting Conditions: Psoriatic arthritis, markers for RA, MTHFR, HTN and hx of blood clots.
Allergies: None
Diagnostic Lab Data: 09/16/2021: Urgent care for chest xray and UA. 09/16/21: ER visit labs 10/08/21: labs pending
CDC Split Type:

Write-up: Fevers, Headaches and Chills began 1 day after vaccination. Shortness of breath began 2 days after vaccination. 1 month later I am still experiencing these symptoms despite being treated with an inhaler and Tylenol/Motrin. 09/16/2021: Urgent care for chest xray and UA. 09/16/21: ER visit 09/24/21: started medrol dose pack 09/28/21: started inhaler


VAERS ID: 1771812 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-25
Onset:2021-09-11
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysuria, Enterocolitis, Urine analysis
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Ischaemic colitis (broad), Noninfectious diarrhoea (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: STRATTERA; Valacyclovir; FLONASE; spironolactone; ASMANEX; SPIRIVA; XOPENEX; cyclobenzaprine
Current Illness: Migraine; stomach bug of some sort
Preexisting Conditions: Environmental Allergies; Asthma
Allergies: Thimerosal; nickle; opiates; morphine; methocarbamol; onions; capsaicin
Diagnostic Lab Data: 9/11/2021 Urinalyses, (E. coli)
CDC Split Type: vsafe

Write-up: (9/11/2021) Watching a Movie and felt a need to pee, when trying to it had an annoying burning and quickly (upwards of 3hrs) got really painful. Rushed to ER and was given Keflex, Phenazopyridine. The flush took care of the pain and with the 10 day issued antibiotic, recovered completely.


VAERS ID: 1771866 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-01-08
Onset:2021-09-11
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 LA / IM

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

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

Write-up: C/O cough, nasal congestion and runny nose


VAERS ID: 1771890 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-01-08
Onset:2021-09-11
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK5730 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, Chills, Cough, Malaise, Myalgia, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test positive, Throat irritation
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: C/O cough, chills, elevated temperature, sore and scratchy throat, runny nose and congestion, myalgia, and malaise


VAERS ID: 1772170 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / IM

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

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

Write-up: 9/11/21 the patient had some hives on left arm, patient took 12.5mg benadryl, the hives went away. 9/13/21 hives on stomach and chest daily , took benadyl 1-2 times per day


VAERS ID: 1772200 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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 error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1772221 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Cardiac flutter, Chills, Fatigue, Inflammation, Pain, Pain in extremity, Piloerection, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Tachyarrhythmia terms, nonspecific (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Sore throat because of smoke/poor air quality.
Preexisting Conditions: None
Allergies: Cephalexin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: The evening of Sept 10, I began to feel achy and tired, with my right arm being very painful to move. The next day, I had a slight fever in the morning and the achiness was worse, but I expected it. By around 12:30 pm, the effects hit me like a truck. My fever spiked even more, and the achiness turned into a burning ache all along my spine and into my lower ribs that was torturous, since I couldn''t make it stop or get away from it. I was prescribed 5mg of prednisone twice a day to help calm down the inflammation and reaction in my body. The next day, my fever was broken and the ache was lessened. It had returned to just the fatigue and heart flutter. However, for about a week after Sept 10, I would get a sensation primarily on my neck and down onto my chest. It felt like the chills running through my body, except it was like needles stabbing me all over in a wave across those areas. It sometimes just randomly happen, but if something caused me to get what normally would''ve been the chills or goose bumps, I felt that sensation instead.


VAERS ID: 1772285 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       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:

Write-up: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1772289 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       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:

Write-up: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1772306 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Unknown  
Location: Georgia  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       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:

Write-up: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1774933 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Asprin Coq10
Current Illness: none
Preexisting Conditions: none
Allergies: Tree Nuts, peanuts, shellfish, latex
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 4 hours after receiving my first dose of the vaccine, the left side of my face and head went numb. This lasted for approximately 2 hours. It slowly went away and has not returned


VAERS ID: 1775012 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-04
Onset:2021-09-11
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Computerised tomogram head, Computerised tomogram neck, Dizziness, Headache, Magnetic resonance imaging head, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metoporolol er Taltz folic acid fish oil probiotic vitamin d acyclovir sulfasalzine flonase np thyroid
Current Illness: seasonal allergies
Preexisting Conditions: psoriasis psoriatic arthritis Hashimoto''s hypothyroidism
Allergies: avelox
Diagnostic Lab Data: Brain MRI 09/16/2021 Brain and neck CTA 10/08/2021 Bloodwork 09/16/2021, 09/27/2021, 10/07/2021
CDC Split Type:

Write-up: 1 week after covid booster: vertigo, dizziness, nausea, headache. Still ongoing as of 10/09/2021. Been treated by primary doctor, express med doctor, and neurologist. Received numerous medications with no relief. Also have been evaluated by a physical therapist. Have had MRI and CT to rule out other causes. PT to be scheduled.


VAERS ID: 1775086 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / 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? 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: NO ADVERSE EVENTS REPORTED BY PATIENT. Patient presented on for a 2nd dose of Moderna COVID Vaccine on 10/11/21. Upon doing a routine database check, saw a posted dose of Janssen on 3/5/21 @ different pharmacy. Confirmed with patient they had received JSN. Patient stated they thought it was okay to get the vaccine since it is a "different technology." Notified patient he should not be receiving this dose today or have received the first one, as it is not needed and has completed a series based on CDC guidelines.


VAERS ID: 1775398 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-09
Onset:2021-09-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arrhythmia, Bronchitis, Cardiac valve disease, Chest X-ray, Chest discomfort, Computerised tomogram thorax, Dyspnoea, Electrocardiogram, Fear, Laboratory test, Scan with contrast
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (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: As a child, unknown as to which ones- parents are decreased
Other Medications: Zyrtec, vitamin D, probiotic, nasal spray
Current Illness: None
Preexisting Conditions: Celiac Disease
Allergies: Aversion to sulfa meds-vomiting Bee venom Latex-skin reaction
Diagnostic Lab Data: Spoke with my GI doctor on 9/14/21 about the arrythmia and pressure on the chest post vaccine. She said follow up with PCP. Followed up with PCP when symptoms worsened and breathing was difficult and fearful of heart attack (missed work) went to urgent care 9/22/21 they did ekg. Then sent me to ER. Another Ekg, labs, chest xray and CT scan with dye. Follow up with PCP 9/27/21. Results of CT Scan showed enlargement of heart valves and inflammation in bronchial lining. As of 10/9/21 chest pressure, shortness of breath have greatly decreased. Arrythmia is still present but subdued, less intense and less frequent throughout the day. Another follow up post more labs with PCP scheduled 10/13/21. Holter monitor scheduled for 10/14/21 and echocardiogram on 10/11/21
CDC Split Type:

Write-up: Developed an arrythmia, chest pressure, tightness/constriction, shortness of breath. Got progressively worse over the next week. Spoke with my GI doctor on 9/14/21 about the arrythmia and pressure on the chest post vaccine. She said follow up with PCP. Followed up with PCP when symptoms worsened and breathing was difficult and fearful of heart attack (missed work) went to urgent care 9/22/21 they did ekg. Then sent me to ER. Another Ekg, labs, chest xray and CT scan with dye. Follow up with PCP 9/27/21. Results of CT Scan showed enlargement of heart valves and inflammation in bronchial lining. As of 10/9/21 chest pressure, shortness of breath have greatly decreased. Arrythmia is still present but subdued, less intense and less frequent throughout the day. Another follow up post more labs with PCP scheduled 10/13/21. Holter monitor scheduled for 10/14/21 and echocardiogram on 10/11/21


VAERS ID: 1776008 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-08
Onset:2021-09-11
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Peripheral swelling, Pruritus, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: my feet started itching and random bubbles on bottom of sole, big toe swelled up like a grape then the next day two little toes swelled up like grapes, each day a different toe followed by hives that filled with water and look like welts (stomache three days then arms another day then legs and buttox ) dizzy spells one time after a hive breakout hives every day since in random locations


VAERS ID: 1776400 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-19
Onset:2021-09-11
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NASOPHARYNGEAL COVID-19 PCR- POSITIVE 10/9/21
CDC Split Type:

Write-up: SYMPTOMATIC COVID-19; PROGRESSIVE SOB BEGINNING FOUR WEEKS PRIOR TO POSITIVE TEST RESULT.


VAERS ID: 1776671 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Gastritis, Impaired work ability, Intermenstrual bleeding, Polymenorrhoea
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal nonspecific inflammation (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: sertraline
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: I was treated in Hospital ER 10/5/21 for Gastritis. I did not receive treatment for the abnormal menstration. I did miss work because of both incidents.
CDC Split Type:

Write-up: I started menstrating the night of my first dose. Menstration came 2 weeks early. It was the worst menstration cycle I have ever had in my life. I have been spotting daily since 9/11/21. My period did not come during it''s usual week. Weekend of October 1 to 7 of 2021 I had a Gastritis flare up that has not occurred in 7 years. I did not have anything abnormal. It was the worst flare up I have experienced. I ended up in the ER at Hospital for relief.


VAERS ID: 1776774 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyskinesia, Fatigue, Muscle twitching, Myalgia, Palpitations, Paraesthesia, Tinnitus
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hearing impairment (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: None
Current Illness: Poison ivy treated on 8/14/21 with topical lidex
Preexisting Conditions: None
Allergies: High: Gluten Meal Not Specified: Bacitracin Methylene Disalicylate; Bisphosphonates; Effexor [Venlafaxine Hydrochloride]; Food Allergy [Food Allergies]; Lactose [Milk/dairy Products] Low: Erythromycin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Normal arm muscle ache that went away within 3-4 days. 2. Within 12-24 hours my heart was doing some flip flopping and continues to this day. It did not do that prior to. After 3 weeks it has subsided but still does it periodically. 3. Within 24 hours a short episode of ringing in my ears was followed by a constant lighter ringing in my left side that continues to this day. 4. Within 24 hours I had tingling on the left side of my face and down my left calf. 5. About day 5 my left pinky and ring finger literally jerked upwards several times and twitching began in my left calf muscle about the same time. 6. The muscle twitching continued onto the bottom side of my left foot within hours. 7. I am more easily tired and that began within than 24 -48 hours after the shot and continues to this day. 8. On about day 6 twitching began moving to my right side between the second and third week. The twitching on the right side subsided after about week 3 after the shot. I realize it may take time to have my body adjust to the vaccine but it is nearing week 4. The ringing continues, I am tired and periodically the muscle twitches as well as the heart flip flops are still there. Thank you.


VAERS ID: 1777577 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-30
Onset:2021-09-11
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Rash
SMQs:, Anaphylactic reaction (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:
Current Illness:
Preexisting Conditions: Hypothyroid,ADD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: myalgias of left shoulder on side of injection. Rash on left hand


VAERS ID: 1779183 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy, Computerised tomogram head, Eyelid disorder, Facial paralysis, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Periorbital and eyelid disorders (narrow), Sexual dysfunction (broad)

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

Write-up: Patient noticed that her right eyelid would not open and the right side of her face was numb. This was at 0300 on 9/11/21. She also noted that her right side of her face was dropping and she could not smile. She immediately presented to the ER at 0345 on 9/11/21. She was diagnosed with Bell''s Palsy. She had progression of her facial drop after she presented to the ER. She was given Steroids in the ER and underwent a CT of her head (which was negative for pathology).


VAERS ID: 1779216 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-07
Onset:2021-09-11
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NDC:59267-1000- / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pruritus, Rash maculo-papular, 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: Lisinopril 10/12.5 mg daily Atorvastatin 10 mg daily Omega 3 CoEnzyme Q Ca with Vit D3
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: None
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Severe maculo papular rash on the body; itchy; pinkish with wheel formation. Will clear after taking Claritin 10 mg initially but will reappear. Now Taking Allegra 180 mg in am and Claritin 24 Hr. in PM daily for at least one week. Rash disappears only to reappear a few hours later and then goes away again.


VAERS ID: 1779567 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-12
Onset:2021-09-11
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Antibody test, C-reactive protein increased, COVID-19, Cough, Exposure to SARS-CoV-2, Multisystem inflammatory syndrome in children, N-terminal prohormone brain natriuretic peptide, Nasal congestion, Platelet count decreased, SARS-CoV-2 antibody test positive, SARS-CoV-2 test positive, Troponin
SMQs:, Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Toxic-septic shock conditions (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None documented
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Reactive SARS-CoV-2 spike and nucleocapside antibodies: 9/19/2021 ProBNP 477 9/19 Troponin 0.04 9/19 platelets 109K 9/19 ALC 600 9/19 CRP 85.8 mg/L 9/19
CDC Split Type:

Write-up: Patient developed symptoms concerning for Acute COVID-19 in mid August of 2021. He had a positive test outside of our system. He had a mild course with cough and nasal congestion (parents also had infection around the same time). He fully recovered, but developed symptoms again on 9/11/21 that culminated in admission to our hospital, and subsequent diagnosis of MIS-C on 9/19


VAERS ID: 1779582 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abortion spontaneous, Chills, Condition aggravated, Exposure during pregnancy, Haemorrhage, Joint range of motion decreased, Muscle spasms, Pyrexia, Ultrasound antenatal screen abnormal, Uterine spasm
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Termination of pregnancy and risk of abortion (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine, similar spasms
Other Medications: Prenatal vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: Latex
Diagnostic Lab Data: Ultrasound, miscarriage. Ultrasound, normal.
CDC Split Type: vsafe

Write-up: The night when I got the vaccine I felt a lot of spams on my neck all the way to my lower back. I could not turn my neck from left to right. I took Tylenol. I had the common side effects like fever and chills but I also had a lot of cramping and spasms in my lower pelvic area, I felt like it was my uterus. I started having bleeding. Even if I got up soon or put on force on those muscles to walk I would get spasms in that area. The bleeding kept going. I called the advised line and they said it was normal to bleed a little. I called back. I had an ultrasound because the bleeding continued and I ended up losing that pregnancy. I had my last ultrasound today and everything is cleared. Pregnancy history: I have 2 babies and I had a previous miscarriage prior to this. Estimated date of delivery: 05/04/2021.


VAERS ID: 1779685 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac stress test, Chest pain, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: Asthma, Anemia, lung metabolic disease, blood disorder, heart
Preexisting Conditions: Lupus
Allergies: Latex, Neomycin and Polymyxin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient has swelling and pain in her arm the same day. She then got chest pain in which she to the hospital and had stress test done by cardiologist.


VAERS ID: 1780471 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-16
Onset:2021-09-11
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Blood urine present, Computerised tomogram kidney abnormal, Cystitis noninfective, Micturition urgency, Thrombosis, Urinary tract disorder, Urinary tract infection, Urinary tract inflammation, Urinary tract pain, Urine analysis abnormal, Urine analysis normal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Allertec and Montelukast,
Current Illness: None
Preexisting Conditions: Environmental allergies
Allergies: None
Diagnostic Lab Data: The urine tests at the urgent care showed blood in the urine both times, but the cultures showed no bacteria. The blood work and urine tests y primary ordered all came back normal. The CT Renal scan showed no kidney stones, but inflammation in the tubes that lead from the kidneys to the bladder as well as the bladder. The blood work and most resent urine test ordered by my primary were on OCT 8th and the CT Renal Scan was 10/12/2021. I reported this but after I was contacted when at work and asked to be contacted at a different time, I was never contacted again to follow up. As this was all new to me and Urgent Care was closed both times when it happened, I tried finding other women that have experienced it that could offer advise and found there are several places where women are reporting having these same issues after their second covid shot. I do not know if they are reporting it to the CDC, or just talking to one another on these sites and chats.
CDC Split Type:

Write-up: Began having Urinary problems within a month when I have never had a history of urinary problems. They began September 11th and I believed it was UTI as I have never had one before and got antibiotics, but I had to go back less than a month after as it occurred again. I was told to follow up with my primary as it was not normal to have two so close together, specially after never having one before and that the symptoms I was describing sounded much more severe than a UTI and may be kidney stones as the pain was more severe than a UTI. I did and my primary informed me the cultures they did never showed any bacteria at all, but the urine test showed very high amounts of blood. He had me do a new urinary test and blood work as well as a CT Renal Scan. Both times I had sudden stabbing pain in my urethra accompanied with blood clots. Not red tinged urine, actual blood clots. This was followed by about 5 hours of intense pain that and constant sensation to urinate that did not respond to pain medication, heat, or numbing AZO pills. Then it just went away. Both times, I went to the urgent care the morning after as it occurred at night when the urgent care was closed. My primary has now made a referral to a Urologist.


VAERS ID: 1782353 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Facial nerve disorder
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Had cortisone shot in left shoulder on Aug 2, 2021, I let pharmacist know prior to getting vaccine? Estradiol vaginal cream 3grams weekly
Current Illness: None
Preexisting Conditions: None
Allergies: None know of
Diagnostic Lab Data:
CDC Split Type:

Write-up: I noticed my facial nerves are sensitive when eating/ chewing or lick lips, I can feel my facial nerves as though something is rubbing up along my jaw up to eyes and temple area, or if I scratch my nose depending which side I feel as though something is rubbing just under my bottoms eye lid. I never felt this prior to the vaccine. Please help and direct me in the right direction in getting this reaction cleared up. Thank you


VAERS ID: 1782368 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-04-05
Onset:2021-09-11
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Oropharyngeal pain, Pyrexia, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin, Vitamin B12, amlodipine, losartan, gabapentin
Current Illness: none
Preexisting Conditions: hypertension, degenerative disc disease, spinal stenosis, lumbar radiculapathy
Allergies: none
Diagnostic Lab Data: Rapid Antigen test on 9/9 was positive; PCR test confirmed positive on 9/10
CDC Split Type:

Write-up: breakthrough COVID 19 infection - PCR detected/positive on 9/10/2021. Symptoms started 9/7/2021- sore throat, low grade fever, cough, runny nose, congestion. Patient isolated for 10 days as required.


VAERS ID: 1782463 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-30
Onset:2021-09-11
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / UNK - / -

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

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

Write-up: COVID 19


VAERS ID: 1782471 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-07
Onset:2021-09-11
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / UNK - / -

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

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

Write-up: COVID 19


VAERS ID: 1782769 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-23
Onset:2021-09-11
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK - / -

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

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

Write-up: COVID 18


VAERS ID: 1784644 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-08-11
Onset:2021-09-11
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test abnormal, Fatigue, Headache, Hypersomnia, Vision blurred, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (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: Blood work (abnormalities) . provider has info.
CDC Split Type:

Write-up: Severe headache (worse lying down), blurring vision, unable to sleep, fatigue, lose of weight


VAERS ID: 1784975 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Energy increased, Therapeutic response unexpected
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: Vitamin C, Vitamin B 12, Vitamin B Complex, Fish Oil
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: There were no adverse events. I felt absolutely amazing, younger, and as if my cells were rejuvenated. I had more energy, there was a feeling of happiness, and odd relaxation.


VAERS ID: 1785223 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-08-19
Onset:2021-09-11
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Decreased appetite, Pyrexia, Restless legs syndrome
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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CARBAMAZEPINE, CLONIDINE,
Current Illness: NONE
Preexisting Conditions: EPILIPESY
Allergies: NKDA
Diagnostic Lab Data: FOLLOWED UP WITH PCP ON 10/14/21 NO TEST DONE
CDC Split Type:

Write-up: PATIENT HAD HIGH FEVER AND HAS REST LESS LEGS , HAD 2 WEEKS OF CHILLS AND LOSS OF APPETITE


VAERS ID: 1785433 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-01
Onset:2021-09-11
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Cardiac operation, Diabetes mellitus, Intensive care, Leukaemia, Myocardial infarction, Pneumonia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow), Infective pneumonia (narrow), 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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, Cardiovascular Disease, Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PUI has a host of illnesses Leukemia Diabetes had open heart surgery three heart attacks Pneumonia and is in ICU. Fully vaccinated.


VAERS ID: 1785524 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-01
Onset:2021-09-11
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Symptom onset 9/3/21. Hospitalized due to COVID. Fully vaccinated.


VAERS ID: 1785600 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-01
Onset:2021-09-11
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 - / -

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

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

Write-up: Patient hospitalized due to COVID. Fully vaccinate.


VAERS ID: 1785743 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram abdomen, Computerised tomogram neck, Computerised tomogram pelvis, Computerised tomogram thorax, Culture, Echocardiogram, Hypoxia, Pyrexia, Sepsis, Tachycardia
SMQs:, Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: crestor cosentyx rythmol indur
Current Illness: tooth infection
Preexisting Conditions: HTN OSA neurofibromatosis plaque psoriasis
Allergies: codeine
Diagnostic Lab Data: Hospitalized 4 days Cultures CT Chest.Abd pelvis Ct neck CTA chest Echocardiogram
CDC Split Type:

Write-up: FEVER SEPSIS TACYCARDIA HYPOXIA UNKNOWN ETIOLOGY


VAERS ID: 1785801 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-09-09
Onset:2021-09-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821826 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram, Fibrin D dimer
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: EKG on 9/16 and 9/23, ddimer and CRP on 9/23
CDC Split Type:

Write-up: Stabbing chest pain began morning of 9/11/21 and continued for the next week. Unrelieved by lorazepam and continued for over 14 days, eventually becoming an experience that only appears during exertion.


VAERS ID: 1786548 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Body temperature decreased, Dizziness, Feeling abnormal, Hyperhidrosis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, linzess, atenolol,meloxicam, tizanidine, nortryptaline, Cymbalta, lysine, niacin
Current Illness: Pneumonia, I had it at the end of August
Preexisting Conditions: Graves, TMJ, migraines, asthma, degenerative disc disease, arthritis, tendinitis, carpal tunnel in both hands
Allergies: Lidocaine, zophran, morphine, iodine, chlorox
Diagnostic Lab Data: I did not go to my Dr about this bc I honestly didn''t see it listed as a side effect and it was coming and going that I thought they would think I was crazy if it didn''t happen while I was there. I did have an appointment with my endocrinologist a week later and told him about it but once again he had not heard of that before
CDC Split Type:

Write-up: The morning after I began to have sudden temperature drops, which would make me feel weak, lightheaded and really bad, just as it suddenly dropped, it would jump back up, once again making me feel sickly. I would have major sweats during the drops in body temperature and when it jumped back up. My temperature normally runs a bit low, avg around 96.7 to 97.5 and I feel fine with my temperature at those averages. My temperature got as low as 90.1, but mainly it was around 92 and then would jump to 98.8, which me makes me feel feverish. It did this for about 5 1/2 days after the vaccine


VAERS ID: 1708348 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047D214 / 2 LA / SC

Administered by: Private       Purchased by: ?
Symptoms: Bone pain, Chills, Facial pain, Fatigue, Headache, Myalgia, Pyrexia, Rhinalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Eosinophilic pneumonia (broad), Osteonecrosis (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: I take Oxicodone permanently for chronic pain due to bilateral Radiculopathy and Foraminal Stenosis, Fribromyalgia. Aprovasc for Hypertension, Salbutamol Spray for Asthma
Current Illness: The next day after the 2nd dose of Moderna vaccine, severe headache, intense body pain (bone and muscular) fever, chills and after 5-6 days the head pain was in the forehead, cheekbones on top of head, fatigue and everything else the same.
Preexisting Conditions: Radiculopathy+ foramidal stenosis for almost 24 years. Fibromyalgia for 4 and a half years. I always had Brochial asthma. Hypertension from 7-8 years
Allergies: None
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 2nd dose have given me adverse effect 2nd. The 1st dose it lasted 3 days of fever, headache and skeletal muscle pain. 2nd dose 8 days of fever, strong head pain, very intense pain of bones and muscle and on the 6th day pain in nose, cheek, front of head.


VAERS ID: 1710669 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: TRPFIZER INC202101199973

Write-up: The patient had blistering of urticaria.; This is a spontaneous report from a contactable consumer (parent). This is a report based on information received by Pfizer from manufacturer control number;86260 , license party for {BNT162B2}. A 13-years-old female patient received BNT162B2 via an unspecified route of administration on 10Sep2021 23:00 (Lot number was unknown; Expiry information unavailable) as DOSE 1, SINGLE for covid-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient was nonpregnant. The patient had blistering of urticaria on 11Sep2021 with outcome of not recovered. The reporter stated that there was an emergency room visit. 2 injections were made and it was relieved. On 12Sep2021, the patient complained that blistering of urticaria started again. The patient went to emergency room right away and it was being intervened again. The lot number for BNT162B2 was not provided and will be requested during follow up.


VAERS ID: 1714587 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Lethargy, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PIRITON
Current Illness:
Preexisting Conditions: Comments: The medical history was not provided by the reporter.
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBMODERNATX, INC.MOD20213

Write-up: Shaking; Lethargy; Headache; Vomiting; This case was received via (Reference number: GB-MHRA-ADR 25928312) on 12-Sep-2021 and was forwarded to Moderna on 12-Sep-2021. This regulatory authority case was reported by a consumer and describes the occurrence of TREMOR (Shaking), LETHARGY (Lethargy), HEADACHE (Headache) and VOMITING (Vomiting) in a female patient of an unknown age who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. The medical history was not provided by the reporter. Concomitant products included CHLORPHENAMINE MALEATE (PIRITON) for an unknown indication. On 10-Sep-2021, the patient received second dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 11-Sep-2021, the patient experienced VOMITING (Vomiting) (seriousness criterion medically significant). On an unknown date, the patient experienced TREMOR (Shaking) (seriousness criterion medically significant), LETHARGY (Lethargy) (seriousness criterion medically significant) and HEADACHE (Headache) (seriousness criterion medically significant). At the time of the report, TREMOR (Shaking) was resolving and LETHARGY (Lethargy), HEADACHE (Headache) and VOMITING (Vomiting) had not resolved. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. No treatment medications were provided by the reporter. The patient was not enrolled in a clinical trial. Company comment: This case concerns an unknown age female subject with no relevant medical history, who experienced the unexpected events of TREMOR, HEADACHE, VOMITING AND LETHARGY). The event of vomiting occurred approximately 1 day after the first dose. No start date was provided for other events. The rechallenge was unknown as there is no information about the second dose.The benefit-risk relationship is not affected by this report. Event terms, onset dates, outcomes and seriousness captured per SD from Regulatory Authority reporting. Event seriousness assessed as per Regulatory Authority reporting, however there was no information in the source document supporting that the events were indeed medically significant.; Sender''s Comments: This case concerns an unknown age female subject with no relevant medical history, who experienced the unexpected events of TREMOR, HEADACHE, VOMITING AND LETHARGY). The event of vomiting occurred approximately 1 day after the first dose . No start date was provided for other events. The rechallenge was unknown as there is no information about the second dose.The benefit-risk relationship is not affected by this report. Event terms, onset dates, outcomes and seriousness captured per SD from Regulatory Authority reporting. Event seriousness assessed as per Regulatory Authority reporting, however there was no information in the source document supporting that the events were indeed medically significant.


VAERS ID: 1716057 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Headache, Nausea, Pain in extremity, Pyrexia, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Headache; Shaking; Stomach ache; Aches & pains in legs; Headache temporal; Fever chills; Shivering; Nausea; This case was received via regulatory authority(Reference number: GB-MHRA-ADR 25927929) on 12-Sep-2021 and was forwarded to Moderna on 12-Sep-2021. This regulatory authority case was reported by a consumer and describes the occurrence of TREMOR (Shaking), ABDOMINAL PAIN UPPER (Stomach ache), PAIN IN EXTREMITY (Aches & pains in legs), HEADACHE (Headache), HEADACHE (Headache temporal), PYREXIA (Fever chills), CHILLS (Shivering) and NAUSEA (Nausea) in a 26-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 10-Sep-2021, the patient received second dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 11-Sep-2021, the patient experienced ABDOMINAL PAIN UPPER (Stomach ache) (seriousness criterion medically significant), PAIN IN EXTREMITY (Aches & pains in legs) (seriousness criterion medically significant), HEADACHE (Headache temporal) (seriousness criterion medically significant), PYREXIA (Fever chills) (seriousness criterion medically significant), CHILLS (Shivering) (seriousness criterion medically significant) and NAUSEA (Nausea) (seriousness criterion medically significant). On an unknown date, the patient experienced TREMOR (Shaking) (seriousness criterion medically significant) and HEADACHE (Headache) (seriousness criterion medically significant). On 11-Sep-2021, PYREXIA (Fever chills) and CHILLS (Shivering) was resolving, NAUSEA (Nausea) had resolved. At the time of the report, TREMOR (Shaking), ABDOMINAL PAIN UPPER (Stomach ache), PAIN IN EXTREMITY (Aches & pains in legs), HEADACHE (Headache) and HEADACHE (Headache temporal) had not resolved. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. Concomitant and treatment medications were not provided. The patient woke up in the middle of the night shaking uncontrollably and getting waves of hot and cold. The patient had increased breathing and heart rate. The patient experienced terrible headache and stomach ache which persisted until morning. Patient was not tested positive for COVID-19 since having the vaccine. Company comment: This case concerns a 26 year-old, female subject with no relevant medical history, who experienced the unexpected upper abdominal pain, pain in extremity, nausea and chills. The event occurred approximately 1 day after the second dose of Moderna covid-19 vaccine. The event was considered related to the study drug per the reporter''s assessment was not provided. The benefit-risk relationship of Moderna covid-19 vaccine is not affected by this report.; Sender''s Comments: This case concerns a 26 year-old, female subject with no relevant medical history, who experienced the unexpected upper abdominal pain, pain in extremity, nausea and chills. The event occurred approximately 1 day after the second dose of Moderna covid-19 vaccine. The event was considered related to the study drug per the reporter''s assessment was not provided.The benefit-risk relationship of Moderna covid-19 vaccine is not affected by this report.


VAERS ID: 1716064 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3004223 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Pain in extremity, Rash, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210907; Test Name: COVID-19 virus test; Test Result: Negative ; Result Unstructured Data: Negative
CDC Split Type: GBMODERNATX, INC.MOD20213

Write-up: arm ache; rash all over; fatigue; Rash; This case was received via RA (Reference number: GB-MHRA-ADR 25928466) on 12-Sep-2021 and was forwarded to Moderna on 12-Sep-2021. This regulatory authority case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (arm ache), RASH (Rash), RASH (rash all over) and FATIGUE (fatigue) in a 40-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) (batch no. 3004223) for COVID-19 vaccination. No Medical History information was reported. On 10-Sep-2021, the patient received first dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 11-Sep-2021, the patient experienced RASH (Rash) (seriousness criterion medically significant). On an unknown date, the patient experienced PAIN IN EXTREMITY (arm ache) (seriousness criterion medically significant), RASH (rash all over) (seriousness criterion medically significant) and FATIGUE (fatigue) (seriousness criterion medically significant). At the time of the report, PAIN IN EXTREMITY (arm ache), RASH (rash all over) and FATIGUE (fatigue) outcome was unknown and RASH (Rash) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 07-Sep-2021, SARS-CoV-2 test: negative (Negative) Negative. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. No concomitant medications reported by reporter No treatment medications provided by the reporter. Patient experienced Arm ache, fatigue and painful rash all over her leg. This case concerns a 40-year-old, female subject with no relevant medical history, who experienced the unexpected events of rash (LLT: rash), rash (LLT: rash all over), pain in extremity and fatigue. The event rash (LLT: rash) occurred 1 day after the administration of the first dose. The event start dates of rash (LLT: rash all over), pain in extremity and fatigue were not provided. The rechallenge was not applicable as the events occurred after the first dose. The events rash (LLT: rash), rash (LLT: rash all over) and fatigue are consistent with the current understanding of the mechanism of action of the vaccine. The benefit-risk relationship of mRNA-1273 is not affected by this report. Of note, the events were assessed as serious by the Regulatory Authority. However, based on medical judgement and the lack of evidence of seriousness from a clinical or regulatory standpoint, the events are not considered serious.; Sender''s Comments: This case concerns a 40-year-old, female subject with no relevant medical history, who experienced the unexpected events of rash (LLT: rash), rash (LLT: rash all over), pain in extremity and fatigue. The event rash (LLT: rash) occurred 1 day after the administration of the first dose. The event start dates of rash (LLT: rash all over), pain in extremity and fatigue were not provided. The rechallenge was not applicable as the events occurred after the first dose. The events rash (LLT: rash), rash (LLT: rash all over) and fatigue are consistent with the current understanding of the mechanism of action of the vaccine. The benefit-risk relationship of mRNA-1273 is not affected by this report. Of note, the events were assessed as serious by the Regulatory Authority. However, based on medical judgement and the lack of evidence of seriousness from a clinical or regulatory standpoint, the events are not considered serious.


VAERS ID: 1716068 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3004223 / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergic reaction; Drug allergy (paracetamol); Drug allergy (amoxicillin)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBMODERNATX, INC.MOD20213

Write-up: Face oedema; This case was received via RA (Reference number: -MHRA-ADR 25928809) on 12-Sep-2021 and was forwarded to Moderna on 12-Sep-2021. This regulatory authority case was reported by a consumer and describes the occurrence of FACE OEDEMA (Face oedema) in a 31-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) (batch no. 3004223) for COVID-19 vaccination. Previously administered products included for an unreported indication: PARACETAMOL and AMOXICILLIN. Concurrent medical conditions included Allergic reaction, Drug allergy (paracetamol ) and Drug allergy (amoxicillin ). On 10-Sep-2021, the patient received second dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 11-Sep-2021, the patient experienced FACE OEDEMA (Face oedema) (seriousness criterion medically significant). At the time of the report, FACE OEDEMA (Face oedema) was resolving. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. According to the report patient had a known allergic reaction to paracetamol and amoxicillin. No relevant concomitant medication information provided. No relevant treatment medication information provided. The patient reported that it was still going on and this was not in side effects of the moderna vaccine one side of face was swollen, this was bad enough so that the patient cant go out. Company Comment: This case concerns a 31-year-old, female patient with previous relevant medical history of drug allergy, who experienced the unexpected event of Face oedema. The event occurred 1 days after the second dose of Spikevax. The rechallenge was unknown since no information about the first dose was disclosed. The medical history of drug allergy could be a confounder for face oedema. The benefit-risk relationship of Spikevax is not affected by this report.; Sender''s Comments: This case concerns a 31-year-old, female patient with previous relevant medical history of drug allergy, who experienced the unexpected event of Face oedema. The event occurred 1 days after the second dose of Spikevax. The rechallenge was unknown since no information about the first dose was disclosed. The medical history of drug allergy could be a confounder for face oedema. The benefit-risk relationship of Spikevax is not affected by this report.


VAERS ID: 1716070 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Maternal exposure during breast feeding, Maternal exposure during pregnancy, Nausea, Pain in extremity, Palpitations, SARS-CoV-2 test
SMQs:, Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Neonatal exposures via breast milk (narrow), Tendinopathies and ligament disorders (broad), COVID-19 (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? No
Previous Vaccinations:
Other Medications: FOLIC ACID
Current Illness: Breast feeding; Pregnancy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Test Result: Negative ; Result Unstructured Data: No - Negative COVID-19 test
CDC Split Type: GBMODERNATX, INC.MOD20213

Write-up: Maternal exposure during pregnancy; Maternal exposure during breast feeding; Aches & pains in legs; Painful arm; Heart pounding; Nausea; Chills; This case was received via RA (Reference number: GB-MHRA-ADR 25928834) on 12-Sep-2021 and was forwarded to Moderna on 12-Sep-2021. This regulatory authority retrospective pregnancy case was reported by a consumer and describes the occurrence of MATERNAL EXPOSURE DURING PREGNANCY (Maternal exposure during pregnancy), MATERNAL EXPOSURE DURING BREAST FEEDING (Maternal exposure during breast feeding), PAIN IN EXTREMITY (Aches & pains in legs), PAIN IN EXTREMITY (Painful arm), PALPITATIONS (Heart pounding), CHILLS (Chills) and NAUSEA (Nausea) in a 33-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Pregnancy and Breast feeding. Concomitant products included FOLIC ACID for Folic acid supplementation. On 11-Sep-2021, the patient received second dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. Last menstrual period and estimated date of delivery were not provided. On 11-Sep-2021, the patient experienced CHILLS (Chills) (seriousness criteria disability and medically significant). On an unknown date, the patient experienced MATERNAL EXPOSURE DURING PREGNANCY (Maternal exposure during pregnancy) (seriousness criteria disability and medically significant), MATERNAL EXPOSURE DURING BREAST FEEDING (Maternal exposure during breast feeding) (seriousness criteria disability and medically significant), PAIN IN EXTREMITY (Aches & pains in legs) (seriousness criteria disability and medically significant), PAIN IN EXTREMITY (Painful arm) (seriousness criteria disability and medically significant), PALPITATIONS (Heart pounding) (seriousness criteria disability and medically significant) and NAUSEA (Nausea) (seriousness criteria disability and medically significant). The delivery occurred on an unknown date, which was reported as Unknown. For neonate 1, The outcome was reported as Unknown. At the time of the report, MATERNAL EXPOSURE DURING PREGNANCY (Maternal exposure during pregnancy) and MATERNAL EXPOSURE DURING BREAST FEEDING (Maternal exposure during breast feeding) outcome was unknown and PAIN IN EXTREMITY (Aches & pains in legs), PAIN IN EXTREMITY (Painful arm), PALPITATIONS (Heart pounding), CHILLS (Chills) and NAUSEA (Nausea) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: negative (Negative) No - Negative COVID-19 test. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. Patient has not had symptoms associated with COVID-19 Patient has not tested positive for COVID-19 since having the vaccine Patient is not enrolled in clinical trial Patient was exposed to the medicine Second-trimester (13-28 weeks). Company comment- This case concerns a 33-year-old, female patient with no relevant medical history, who experienced the unexpected events of vaccine exposure during pregnancy and Breastfeeding, The patient received the 2nd dose of vaccine at 2nd trimester, The patient also experienced other unexpected events: pain in extremity, palpitations, chills and nausea. The event chills occurred the same day after the second dose of mRNA-1273 Moderna vaccine, the onset date of other events was not provided. The benefit-risk relationship of mRNA-1273 Moderna vaccine in not affected by this report. All Events was assessed as serious (Criteria MS and Disability) as per Regulatory Authority reporting, however there was no information in the source document supporting that the event was serious. This case was linked to MOD-2021-318166 (Parent-Child Link). See case MOD-2021-318166 for details regarding the child case.; Sender''s Comments: This case concerns a 33-year-old, female patient with no relevant medical history, who experienced the unexpected events of vaccine exposure during pregnancy and Breastfeeding, The patient received the 2nd dose of vaccine at 2nd trimester, The patient also experienced other unexpected events: pain in extremity, palpitations, chills and nausea. The event chills occurred the same day after the second dose of mRNA-1273 Moderna vaccine, the onset date of other events was not provided. The benefit-risk relationship of mRNA-1273 Moderna vaccine in not affected by this report. All Events was assessed as serious (Criteria MS and Disability) as per Regulatory Authority reporting, however there was no information in the source document supporting that the event was serious.


VAERS ID: 1720875 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Dizziness, Headache, Myalgia, Nasopharyngitis, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AMITRIPTYLINE; FLUOXETINE
Current Illness:
Preexisting Conditions: Comments: No medical history was provided by the reporter.
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBMODERNATX, INC.MOD20213

Write-up: Head cold; Headache; Nausea; Chills; Dizziness; Myalgia; This case was received via Regulatory Authority (Reference number: GB-MHRA-ADR 25929024) on 13-Sep-2021 and was forwarded to Moderna on 13-Sep-2021. This regulatory authority case was reported by a consumer and describes the occurrence of DIZZINESS (Dizziness), NASOPHARYNGITIS (Head cold), MYALGIA (Myalgia), HEADACHE (Headache), NAUSEA (Nausea) and CHILLS (Chills) in a 22-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. No medical history was provided by the reporter. Concomitant products included FLUOXETINE for Depression, AMITRIPTYLINE for Fibromyalgia. On 11-Sep-2021, the patient received second dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 11-Sep-2021, the patient experienced MYALGIA (Myalgia) (seriousness criterion medically significant). On 12-Sep-2021, the patient experienced DIZZINESS (Dizziness) (seriousness criterion medically significant), HEADACHE (Headache) (seriousness criterion medically significant), NAUSEA (Nausea) (seriousness criterion medically significant) and CHILLS (Chills) (seriousness criterion medically significant). On an unknown date, the patient experienced NASOPHARYNGITIS (Head cold) (seriousness criterion medically significant). At the time of the report, DIZZINESS (Dizziness), MYALGIA (Myalgia), HEADACHE (Headache), NAUSEA (Nausea) and CHILLS (Chills) had not resolved and NASOPHARYNGITIS (Head cold) outcome was unknown. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. It was reported that patient head also feels odd and sluggish, like with a bad head cold. Patient has not tested positive for COVID-19 since having the vaccine Patient was not enrolled in clinical trial No treatment medication information was provided. Company Comment: This case concerns a 22-year-old, female patient with no relevant medical history, who experienced the unexpected events of dizziness, nasopharyngitis, myalgia, headache, nausea and chills. The events of dizziness, headache, nausea and chills occurred approximately 2 days after the second dose of mRNA vaccine, and the event of myalgia occurred on the same day after second dose. The rechallenge was unknown as there''s no information available about the first dose. The events were considered related to the product per the reporter''s assessment. The events are consistent with the current understanding of the mechanism of action of the vaccine. The benefit-risk relationship of the vaccine is not affected by this report.; Sender''s Comments: This case concerns a 22-year-old, female patient with no relevant medical history, who experienced the unexpected events of dizziness, nasopharyngitis, myalgia, headache, nausea and chills. The events of dizziness, headache, nausea and chills occurred approximately 2 days after the second dose of mRNA vaccine, and the event of myalgia occurred on the same day after second dose. The rechallenge was unknown as there''s no information available about the first dose. The events were considered related to the product per the reporter''s assessment. The events are consistent with the current understanding of the mechanism of action of the vaccine. The benefit-risk relationship of the vaccine is not affected by this report.


VAERS ID: 1720879 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Foreign  
Vaccinated:2021-09-11
Onset:2021-09-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Lethargy, Lymphadenopathy, SARS-CoV-2 test
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Test Result: Negative ; Result Unstructured Data: negative
CDC Split Type: GBMODERNATX, INC.MOD20213

Write-up: Swollen lymph nodes; Lethargy; This case was received via a regulatory authority (Reference number: GB-MHRA-ADR 25929114) on 13-Sep-2021 and was forwarded to Moderna on 13-Sep-2021. Based on the current case data, this case has been classified as invalid. This regulatory authority case was reported by a consumer and describes the occurrence of LYMPHADENOPATHY (Swollen lymph nodes) and LETHARGY (Lethargy) in a patient of an unknown age and gender who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 11-Sep-2021, the patient received second dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 11-Sep-2021, the patient experienced LETHARGY (Lethargy) (seriousness criterion medically significant). On 12-Sep-2021, the patient experienced LYMPHADENOPATHY (Swollen lymph nodes) (seriousness criterion medically significant). At the time of the report, LYMPHADENOPATHY (Swollen lymph nodes) and LETHARGY (Lethargy) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: negative (Negative) negative. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. Concomitant medication were not given. Treatment information is not provided. Company Comment: This case concerns a patient with no medical history reported who experienced the unexpected events of lethargy and swollen lymph nodes. The events occurred approximately 1 day after the second dose of Spikevax. The rechallenge was unknown since no information about the first dose was disclosed. The benefit-risk relationship of Spikevax in not affected by this report. Event seriousness assessed as per Regulatory Authority reporting, however there was no information in the source document supporting that the events resulted in medically significant.; Sender''s Comments: This case concerns a patient with no medical history reported who experienced the unexpected events of lethargy and swollen lymph nodes. The events occurred approximately 1 day after the second dose of Spikevax. The rechallenge was unknown since no information about the first dose was disclosed. The benefit-risk relationship of Spikevax in not affected by this report. Event seriousness assessed as per Regulatory Authority reporting, however there was no information in the source document supporting that the events resulted in medically significant.


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