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

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



Case Details (Reverse Sorted by Onset Date)

This is page 212 out of 4,799

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VAERS ID: 1374277 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Asthenia, Crying, Diarrhoea, Hypopnoea, Illness, Pain, Palpitations, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Noninfectious diarrhoea (narrow), Respiratory failure (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: Synthroid, Zoloft, lorazepam, Tylenol pm
Current Illness: None
Preexisting Conditions: Chronic kidney disease
Allergies: None
Diagnostic Lab Data: I could not afford going to ER or clinic
CDC Split Type:

Write-up: I became very sick with fever at 3am. I was vomiting and diarrhea at the same time for hours. I was weak, had a fever of 101, my heart was racing and my breathing shallow. This went on for hours. 24 hours later body aches, stomach hurts, temp 100. 36 hours later body aches, crying


VAERS ID: 1374284 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Sore arm and extreme tiredness
Other Medications: Amlodipine 10MG, Trazodone 50 MG, Levonorgestrel .03mg, Ozempic 1 MG.
Current Illness:
Preexisting Conditions: Diabetes, migraines
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives


VAERS ID: 1374308 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Breast pain
SMQs:, Lipodystrophy (broad)

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

Write-up: Sharp stabbing pain/throbbing under left breast.


VAERS ID: 1374354 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Injection site hypoaesthesia, Injection site paraesthesia, Loss of consciousness, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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 noted
Current Illness: None noted
Preexisting Conditions: None noted
Allergies: None noted
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed out at the discharge table 15 minutes after Pfizer COVID-19 vaccine. Medical assistant at discharge table able to catch patient and patient was assisted to ground by clinic staff. Patient skin warm to touch and pale. BP @ 1700 147/77, HR 68, RR 16, O2 saturation 94 % on roomair. Patient complains of dizzyness and numbness tingling sensation to vaccinated left arm. Patient verbalized eating a small meal this am, exercising , and not drinking fluids. Ice pack applied to patients neck. Patient drinks water and sports drink. Doctor present to assess patient. Patient observed in discharge area an additional 30 minutes. Patient ambulated for 5 minutes in the discharge area per physician instructions. Patient stable, denies any dizzyness, or numbness to left arm. BP @1727 was 149/85, HR 76, RR 18, O2 saturation 96% roomair. Patient ambulated independently to exit with family.


VAERS ID: 1374360 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Diarrhoea, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: No
CDC Split Type:

Write-up: The evening of vaccination at 9:30 I started having chills and shaking, I started throwing up really bad, I was in bed for like 31 hours and have had diarrhea.


VAERS ID: 1374377 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Injection site pain, Injection site swelling, Lymphadenopathy
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness:
Preexisting Conditions: Type 2 diabetes mellitus with hyperlipidemia, Anxiety, Depression, Polymyalgia rheumatica, Body mass index 36.0-36.9, adult
Allergies: Venlafaxine
Diagnostic Lab Data:
CDC Split Type:

Write-up: mild swelling and tenderness at the injection site, small pea-sized lumps in her left armpit


VAERS ID: 1374382 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-25
Onset:2021-06-02
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Extreme fatigue, nausea, headache, chills


VAERS ID: 1374383 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Syringe issue
SMQs:, Medication errors (broad)

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

Write-up: Vaccinator states that she "likely used an empty injection device and that the patient most likely did not receive the vaccine. Vaccinator further states that patient came into the bay with 2 siblings. When she had completed the immunizations and they went to the observation area, she found her count still had one additional dose. She believes she used the empty syringe, previously given to the sister and that patient did not receive his vaccine. She immediately spoke with the medical coordinator for the POD and explained the situation. We spoke with the patients father as well as our on site pediatric medical consultant. The consultant felt that the dose should be re-administered at two to 4 weeks. The father was reluctant to commit to a second dose if there was any chance at all that his son had received the vaccine. Medical coordinator spoke with Pfizer rep who cited ACIP as recommending another dose ASAP. She also spoke to the patients mother who wanted 100 percent proof that he had not received the vaccine prior to giving him another dose. She was advised to follow up with patients pediatrician who could order quantitative antibody bloodwork as well as advise her moving forward as that office is now giving Pfizer vaccine as well.


VAERS ID: 1374440 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular 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: Pt c/o dizziness, nausea. BP 111/67, HR 89, RR 20. Pt stable and released from the vaccination site.


VAERS ID: 1374447 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

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: Pt c/o pain in the Left Arm. BP 108/73, HR 84. Pt stable and released from the vaccination site.


VAERS ID: 1374469 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Muscular weakness, Pallor, Presyncope, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Pt w/ dizziness, pre-syncope, shakes, muscle weakness, pallor. BP 121/72, HR 83, RR 16. Pt stable and released from the vaccination site.


VAERS ID: 1374512 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Bowel movement irregularity, Cough, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (broad)

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

Write-up: Throwing up, cough runny bowls


VAERS ID: 1374643 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Expired product administered, Headache, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Medication errors (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received 1 dose of Janssen Covid-19 vaccine in left arm. That evening it was determined that vaccine had been expired after its initial 1 puncture on 6-1-21. After original puncture vial had been stored under refrigeration and a time frame of 28 hours had past . Patient was contacted on 6-3-21 notifying him of the error. Patient stated that he was experiencing "normal" side effects, ie. drowsiness, headache and chills. Patient has previously had Covid-19 in December of last year. Advised patient to consult with MD on whether to re-vaccinate due to no studies available per Janssen''s Medical Info center.


VAERS ID: 1374656 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-20
Onset:2021-06-02
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Platelet count decreased, Ultrasound scan abnormal, White blood cell count increased
SMQs:, Haematopoietic thrombocytopenia (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient without a prior history or risk factors for DVT, developed acute DVT left leg confirmed by U/S; WBC mildly elevated and platelets were low. Treated with DOAC


VAERS ID: 1374681 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 LA / IM

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

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

Write-up: I had a fever, chills, and a headache. My symptoms started around 10 pm the night I received the 2nd vaccine( 6/2) and lasted until the next morning (6/4) I couldn''t get out of bed.


VAERS ID: 1374699 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: patient report difficulty breathing and was admitted into hospital


VAERS ID: 1374701 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO186 / 2 LA / IM

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

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

Write-up: Headache, fever, body aches


VAERS ID: 1374714 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lip swelling, Oral herpes, Pain in jaw, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal infections (narrow), Osteonecrosis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient got the injection around 11 AM and experience swelling of the lip and cheek at 6pm. Patient thought it was onset of a cold sore and followed up later after she was experiencing pain trying to chew. The doctors told her there was nothing they could give her and to monitor for severe anaphylaxis per patient mother.


VAERS ID: 1374719 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: After sitting for a few minutes he was able to walk to the car.
CDC Split Type:

Write-up: He was given the shot standing up. After the shot he pulled down his sleeve started walking to the doorway hit the wall and fell to the floor. He was immediately wiped down with a wet cloth and a fan was placed beside him. I was wiping his face and stomach with the cloth.


VAERS ID: 1374727 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 05DC21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Fluid retention, Headache, Injection site erythema, Injection site pain, Injection site swelling, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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: Amlodipine Besylate 5mg blood pressure Benazepril HCL 20mg Propecia 1mg (Finasteride) Aspirin 81mg Fish oil 1280mg ? D3 1000 IU (x2) Magnesium 500mg B6 100mg Ubiquinol CoQ10 100mg Curcumin Turmeric 400mg 3/2017 Kyolic garlic extract 600
Current Illness: None
Preexisting Conditions: High Blood Pressure Elevated Creatinine levels Elevated Cholesterol
Allergies: Penicillin Statin Drugs
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: After 12 hours headache started and pain in left arm (injection site), 17 hours 100 degree fever and fatigue, 22 hours 5:30pm 6/2/21 extreme chills and fatigue went to bed 3 covers and 2 shirts, still could not get warm. 9:30 pm chills stopped went back to sleep. Woke up at 1:30am 6/3/21 called off work as total body aches and fatigue set in, stayed in bed until noon 6/3/21 ate some food and noticed redness on most of upper left arm. 4pm 6/3/21most symptoms returned to normal and I was able to get up and take a shower. 6/4/21 Feeling much better but all of upper left arm is now red and swollen, so much so that it appears to be retaining fluid. Have been using cold pack and taking Ibuprofen.


VAERS ID: 1374735 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site vesicles
SMQs:

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

Write-up: Patient got blisters on the injection site nearby the given shot location (1 cm distance)


VAERS ID: 1375065 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO169 / 1 LA / IM

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

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

Write-up: Pfizer-BioNTech COVID-10 Vaccine EUA Fever (spiked up to 101.6 three times), chills, headache, body ache, some nausea from 6/2/2021 12:30 PM through 6/4/2021 7:00 AM.


VAERS ID: 1375133 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Peripheral swelling, Skin irritation, Skin warm, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: unknown
Preexisting Conditions: COPD, Hyperlipidemia, DM
Allergies: Aspirin, Betadine, Gabapentin, Glipizide, Hydrochlorothiazide, Latex, Morphine, Sulfa
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Local irritation to left deltoid including erythema, tenderness, warmth and swelling. She was advised to use OTC Benadryl 25mg every 4-6 hours, Advil OTC as needed and cold compress. Follow up with PCP in 5 days for recheck.


VAERS ID: 1375154 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Crying, Fatigue, Gait disturbance, Hallucination, Mobility decreased, Ocular hyperaemia, Pain in extremity, Visual impairment
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Inlyta, Xarelto, Lisinopril, levothyroxine,
Current Illness:
Preexisting Conditions: RCC
Allergies: penicillin, gluten sensitivity
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt says the next day after taking the vax his arm was a little sore but when he stood up he had a hard time moving around, he was hyperventilating and he felt very exhausted. He got a severe pain in his left hip. He said the pain was so intense he could barely move so he took a low dose pain killer. He was in so much pain he curled up in a fetal position and rock back and forth. He says he was crying and in a hallucination state for about an hour. After that the he said the symptoms seemed to be getting better but was completely exhausted. His eyes were red and had trouble with his vision. On 6/4/2021 he still has some pain and has an ache inside the bone, gets winded w/ moving around but says his symptoms seemed to be improving.


VAERS ID: 1375288 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

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

Write-up: Client had chills, fever, headache and was throwing up after the 1st dose of the Pfizer vaccine. She was sick most of the day after the vaccine was administered.


VAERS ID: 1375293 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Dyspnoea, Rash
SMQs:, Anaphylactic reaction (narrow), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Desvenlafaxine ER 50MG Once a day, Quetiapine 50 MG Once a day
Current Illness: N/A
Preexisting Conditions: ADHD, Depression, Anxiety
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash all over body within 1 hour of the shot, Severe Lower Back pain Rash got worse and trouble breathing day after the shot


VAERS ID: 1375313 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-25
Onset:2021-06-02
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain, no definite pericarditis, but less than 1 week after vaccine


VAERS ID: 1375322 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
SMQs:, Medication errors (narrow)

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

Write-up: Mom had called us stating that two doses of the Pfizer were administered too close to each other within 2 weeks time frame. 1st dose was administered 05/19/2021, 2nd dose 06/02/2021


VAERS ID: 1375323 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-24
Onset:2021-06-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tranzadone, lisinopril, chlorthalid, lamotragine, hydoxyz Pam.
Current Illness: N/A
Preexisting Conditions: High blood pressure Depression
Allergies: Sulfa, pristiq
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Severe dizziness with nausea and vomiting for multiple days. Bed rest


VAERS ID: 1375330 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Hypersomnia, Impaired work ability, Injection site pain, Injection site swelling
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (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: Metformin, Lisinopril, Carvedilol, Atorvastatin, Zyrtec, Dicyclomine, Ibuprofen, B12, Turmeric
Current Illness: None
Preexisting Conditions: Diabetes (Controlled), IBS, High Blood pressure (Controlled)
Allergies: Morphine, Percocet
Diagnostic Lab Data:
CDC Split Type:

Write-up: Major fatigue the next day. It kept me from working. I slept majority of the day. Pain and swelling at injection site lasting for 2 days. Bad headache lasting two days.


VAERS ID: 1375335 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-04-02
Onset:2021-06-02
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER EN6206 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER ER 8732 / 2 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Chills, Fatigue, Injection site pain, Pain, Pyrexia, SARS-CoV-2 test negative
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: I have had gout a couple of years back but it had been resolved by the time I had the first dose on March 12, 2021 and second dose on April 2, 2021.
Allergies: None
Diagnostic Lab Data: I had a covid test and the result was negative. The test was done this morning, June 4.
CDC Split Type:

Write-up: 1) Pain around the location of the first shot. The pain went away after a couple of days. 2) Chills, fatigue, and body ache after the second shot. They all went away after 2 days. However, 2 days ago (June 2, 2021) - that is 2 months after the second shot (April 2, 2021), I started to have chills, fatigue, body ache, and some low fever (99.5), the same exact feelings that I had right after the second shot! I took one pill of ibuprofen and it helped with the body ache. However, fatigue did not go away until 2 days later (June 4, 2021). I was worried and thought I had caught covid, so I got tested, and the result was negative! Today, June 4, 2021, I got up and felt like myself again! What is the possibility that the side effect keeps coming back like this? I asked the nurse, who informed me about my negative result, this question, and she said that I might have caught a bug! I told her that it was unlikely I would have recovered quickly if that had happened!


VAERS ID: 1375375 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-31
Onset:2021-06-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin, Tylenol, Metoprolol 25mg, Bupropion 150mg, Donepezil HCL 10 mg, Pravastatin 40mg, Aspirin, Alenpruonol, Garlic, Biotin
Current Illness: No
Preexisting Conditions: Parkinson''s
Allergies: No, just bee stings
Diagnostic Lab Data: No
CDC Split Type:

Write-up: After vaccination just sore arm, two days later tremors started in arms, head and hands, This lasted a couple of days and today she seems better.


VAERS ID: 1375563 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

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: We do not have this information at this time.
Current Illness: None reported.
Preexisting Conditions: None reported.
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received a Johnson & Johnson Covid vaccine 51 minutes passed the 6 hour expiration time. My pharmacy intern had just arrived to work and I handed him the baggie with the vial and the paper which stated the storage information and expiration time written on it directly from the refrigerator. Since I did not look at the paper directly or draw up the dose myself I personally did not realize the vial had expired. Patient has been called and a voicemail has been left with no reply. Patient has not reported any adverse reactions. We have spoken with the manufacture and they stated they have no data from studies on use beyond the 6 hour window. When asked about re-vaccination they stated to use professional judgement.


VAERS ID: 1375568 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041BLIA / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Back pain, Crying, Joint range of motion decreased, Musculoskeletal stiffness, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: Asthma Blood Clot
Allergies: Allergic to Prescription medicine-Keflex. Also, allergic to food; dairy products & Shellfish, iodine, Sulfer, latex, animal dander.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Symptoms: June 02, 2021 (Day 1)?..Stiff Neck, left shoulder pain with restricted movement. June 02, 2021 (Day 2)??Stick Neck, Shoulders, Pain. Restricted left arm & shoulder movement. Crying pain was so bad. Nausea. Also back pain & body pain.


VAERS ID: 1375587 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Dizziness
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

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

Write-up: Patient(pt) received the first dose of Pfizer vaccine around 15:30pm. Pt had symptoms of weakness, dizziness, and lightheadedness right after the vaccination. Pt''s father, coordinator, and I assisted pt to sit down on the closest chair. I checked pt''s blood pressure (BP) immediately with reading of 71/33 mmHg, HR 50. 8 ounces of water was given to pt. Patient declined to lie down. put another chair to have pt leaned on. Pt was alert and oriented during the observation. About 10 minutes later, pt stated he felt a little better and started to drink water and eat candy bar, Pt finished 8 ounces of water and one candy bar. Second bottle of 8 ounces of water given to pt. BP checked again with reading of 113/73mmHg, HR 71, O2 Sat 98%. No nausea, vomiting, accessory muscle use, labor breathing, facial edema, edematous lips, or rash noticed. Pt was alert and oriented with clear speech. Pt finished the second bottle of 8 ounces water. 20 minutes after receiving Pfizer covid vaccine, pt was able to ambulate without assistance. Re-checked pt''s BP with reading of 95/59 mmHg, HR 70, O2 Sat 98%. Pt''s father denied that pt has any type of allergy to medications or vaccines but stated patient is always afraid of needles, and he fainted last time with his mother after receiving vaccine. Patient stated he wanted to go home. ER precautions given to pt''s father. Side effects and allergy reactions of Pfizer covid vaccine discussed with pt''s father and educated pt''s father to give pt Tylenol for fever, body aches, or arm pain as needed, increase water intake, have enough rest, and avoid NSAIDs use. Pt''s father verbalized understanding. Patient ambulated with steady gait to their car. Pt and his father left at 15:53pm.


VAERS ID: 1375597 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-11
Onset:2021-06-02
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 1 AR / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 - / SYR

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

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

Write-up: Headache , pain in arm, slight fever


VAERS ID: 1375643 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-25
Onset:2021-06-02
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

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

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

Write-up: Local skin vaccine reaction, delayed. 4 cm x 5 cm. Started day 8 after vaccination and worsened on day 10.


VAERS ID: 1375692 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Unknown  
Location: California  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: 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: USJNJFOC20210604979

Write-up: EXPIRED VACCINE ADMINISTERED; This spontaneous report received from a pharmacist concerned a 27 year old of unspecified sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A expiry: 30/JUN/2021) dose was not reported, administered on 02-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUN-2021, the subject experienced expired vaccine administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of expired vaccine administered was not reported. This report was non-serious. This case, from the same reporter is linked to 20210606143.


VAERS ID: 1375698 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: 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: USJNJFOC20210606143

Write-up: EXPIRED VACCINE ADMINISTERED; This spontaneous report received from a pharmacist concerned a 27 year old of unspecified sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A, expiry: 30-JUN-2021) dose was not reported, administered on 02-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUN-2021, the subject experienced expired vaccine administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of expired vaccine administered was not reported. This report was non-serious. This case, from the same reporter is linked to 20210604979.


VAERS ID: 1375701 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Indiana  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Expired product administered, Poor quality 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: Comments: No known allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210607394

Write-up: EXPIRED VACCINE USE; OUT OF SPECIFICATION PRODUCT USE; This spontaneous report received from a pharmacist concerned a 45 year old male. The patient''s pre-existing medical conditions included no known allergies. The patient received covid-19 vaccine (suspension for injection, intramuscular, batch number: 042A21A,expiry: 06-JUN-2021) dose was not reported, administered on 02-JUN-2021 15:41 for prophylactic vaccination. No concomitant medications were reported. On 02-JUN-2021, the subject experienced expired vaccine use. On 02-JUN-2021, the subject experienced out of specification product use. The action taken with covid-19 vaccine was not applicable. The outcome of the expired vaccine use and out of specification product use was not reported. This report was non-serious.


VAERS ID: 1375705 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Incorrect dose administered, Poor quality product administered, Wrong technique in product usage process
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: USJNJFOC20210607539

Write-up: PATIENT GIVEN DILUTED JNJ VACCINE BY ACCIDENT; WRONG TECHNIQUE IN DRUG USAGE PROCESS; POOR QUALITY DRUG ADMINISTERED; This spontaneous report received from a pharmacist concerned a 32 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 204A21A expiry: 23-JUN-2021) .3 ml, administered on 02-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUN-2021, the subject experienced subject given diluted JNJ vaccine by accident. On 02-JUN-2021, the subject experienced wrong technique in drug usage process. On 02-JUN-2021, the subject experienced poor quality drug administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the patient given diluted JNJ vaccine by accident, wrong technique in drug usage process and poor quality drug administered was not reported. This report was non-serious. This case, from the same reporter is linked to 20210608711 and 20210607725.


VAERS ID: 1375707 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling abnormal, Pain
SMQs:, Dementia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: The patient did not have any history of drug abuse or illicit drug use. The patient had no premedical history.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210607795

Write-up: TIRED; BRAIN FOG; ACHES; CHILLS; This spontaneous report received from a pharmacist concerned a 38 year old male. The patient''s weight was 130 pounds, and height was 62 inches. The patient''s concurrent conditions included non alcoholic, and non smoker, and other pre-existing medical conditions included the patient did not have any history of drug abuse or illicit drug use. the patient had no premedical history. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 02-JUN-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 02-JUN-2021, the subject experienced brain fog. On 02-JUN-2021, the subject experienced aches. On 02-JUN-2021, the subject experienced chills. On 03-JUN-2021, the subject experienced tired. The action taken with covid-19 vaccine was not applicable. The patient was recovering from brain fog, chills, aches, and tired. This report was non-serious. This case, from the same reporter is linked to 20210456372.


VAERS ID: 1375787 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Musculoskeletal stiffness
SMQs:, Peripheral neuropathy (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)

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

Write-up: hi, I got Pfizer covid vaccine''s first shot on 6/2 at 10:20 am. At around 10:30 pm, the left side of my face and facial bones became a bit stiff. Though I recovered next morning (on 6/3) but I still have a very slight numbness in my left jaw. So I wanted to report this adverse effect.


VAERS ID: 1375828 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-27
Onset:2021-06-02
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

Write-up: On 5/27/2021 a parent presented to pharmacy with an Immunization Consent form signed and dated requesting a Pfizer Covid vaccine for her son. The form listed his date of birth as 2/24/2009 which would make him 12 years old. On Wednesday 6/2/2021 a representative from the state immunization registry called regarding the date of birth. She stated that the date of birth was 2/21/2010. She informed me that the state would be looking into this and that I should contact the mother and inform her that we gave an immunization to her child who is underage. When I spoke to the mother she stated that patient''s dob was 2009. I told her that the immunization registry listed it as 2010 and that she should look into it. I then asked her again what the dob was and she admitted that it was 2/2010. I told her that the state would be contacting her and hung up. An hour later she called to apologize to me and said she wasn''t a bad mother. She then went on to say that she put 2010 on the form and I said he could get the shot. I corrected her and said the form has 2009 with her signature on it and that we would never give the immunization to an 11 year old. She stated it''s only 6 months no big deal. I wished her a good vacation and hung up.


VAERS ID: 1375830 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-24
Onset:2021-06-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pain, Injection site pruritus, Injection site rash, Injection site swelling, Injection site warmth, Muscle spasms, Muscle twitching, Myalgia, Neck pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Dyskinesia (broad), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi Vitamin, Vit D
Current Illness: none
Preexisting Conditions: none
Allergies: Sulfa
Diagnostic Lab Data: None to date
CDC Split Type:

Write-up: Pain at site of injection for 3 days. Muscle twitching and spasms in eye, arm, shoulder, leg starting on day 5 and continuing thru today day 11. Large raised itchy hot rash appeared on day 7 around the injection site. Extreme fatigue day 8. Constant muscle pain in legs just above knees. Pain that comes and goes in head, neck and right arm.


VAERS ID: 1375851 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site swelling, Vaccine positive rechallenge
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: had the same reaction with the first dose at a different location. He did not report that reaction on the VARs of the second dos
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient had swelling and bruising at injection site for 3 days after receiving the shot. Patient went to urgent care and was prescribed antibiotics


VAERS ID: 1375920 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO168 / 3 AR / IM

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

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

Write-up: Patient received a third dose of the vaccine. Patient was asked whether it was the first or second dose to which they replied 2nd dose. Upon attempting to enter into the LINKS database, it was discovered that this was in fact the patient''s 3rd dose.


VAERS ID: 1375928 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-18
Onset:2021-06-02
   Days after vaccination:76
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abortion spontaneous, Exposure during pregnancy, Foetal growth restriction, Maternal exposure before pregnancy, Ultrasound antenatal screen abnormal
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro Prenatal vitamin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Miscarriage confirmed via ultrasound on 6/3/21.
CDC Split Type:

Write-up: First dose moderna: 3/18/21 Second dose moderna: 4/15/21 Conceived: 4/14/21 Miscarriage at 7.5 weeks pregnant. Baby stopped growing at size 6 weeks pregnant. Due date: January 17 2022 Pregnancy confirmed 5/24/21. gestation age: 8 weeks 1 day based on LMP. Baby only measured 6 weeks 0 days on this date.


VAERS ID: 1375982 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Condition aggravated, Oxygen saturation decreased, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Chewable Aspirin, Atorvastatin, Bisacodyl Suppository, Constulose, Famotidine, Fenofibrate, Fleet Bisacodyl Enema, DuoNeb, Levetiracetam Solution, Metoclopramide Solution, Metoprolol Tartrate, Niacin, Omega-3 Ethyl Esters, Phenobarbital, Sc
Current Illness: Patient was hospitalized between 1st and 2nd COVID doses for abdomen abscess
Preexisting Conditions: Seizures, Ventilator-Dependent Respiratory Failure, Hyperlipidemia, Dysphagia, Diabetic, Stroke
Allergies: None
Diagnostic Lab Data: Blood work and chest x-ray in ER
CDC Split Type:

Write-up: Patient was sent out to the hospital on Wednesday night (June 2) due to a decrease in oxygen saturation levels. He was admitted into the ER with a diagnosis for recurrent seizures. Patient has a history of seizures, but a facility worker mentioned that the seizures did not look like the ones he would have.


VAERS ID: 1375992 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-17
Onset:2021-06-02
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Cold sweat, Decreased appetite, Vomiting
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: B complex 1 daily Benadryl 25 mg. 1 daily Diphenhydramine 25 mg. 1 daily Vitamin D3 50mcg (2000iu) 1 daily Naproxen Sodium 1 daily 220 mg B12 5000 mcg 2 daily
Current Illness: None, last illness 8/2017
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 5:40 am 6/2/2021 awakened to cold sweat. 8:00 am unable to keep morning coffee down. 11:00 eat 1/2 bagel with peanut butter, unable to keep it down. 2:00 and after further attempts at water, saltine cracker, unable to keep anything down 11:00 pm, attempt to drink sparkling water, unable to keep down. No appetite, inability to keep food down and cold sweats after vomiting each occurrence. June 3, once again able to tolerate food, energy low I assume from available energy from lack of food, progressive improvement through the day. Self managed care.


VAERS ID: 1376009 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Inflammation
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: Levothyroxine (thyroid), Escotalipram (Lexapro), Omega 3 fish oil, Tumeric, multi-vitamin
Current Illness: NA
Preexisting Conditions: Had total knee replacement in February 2021 (4.5 months ago)
Allergies: Sensitivity to Demoral, Welbutrin, Cymbalta
Diagnostic Lab Data: None. My physician has not yet responded. The symptoms are diminishing but still present 2 days following the vaccination.
CDC Split Type:

Write-up: I had a total knee replacement in February 2021. I experienced significant inflammation in that same knee, calf, ankle and foot as a result of that surgical procedure. Then just 2 days ago, following my first Covid-19 vaccination, I had/am now having an inflammatory response in that same leg (knee, calf, ankle and foot). I reported it to my surgeon Dr.


VAERS ID: 1376330 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Adenovirus test, Alanine aminotransferase normal, Aspartate aminotransferase normal, Blood creatine normal, Blood sodium normal, Chest pain, Chills, Computerised tomogram thorax normal, Cytomegalovirus test, Dyspnoea, Echocardiogram normal, Electrocardiogram ST segment abnormal, Electrocardiogram abnormal, Enterovirus test, Eosinophil percentage, Epstein-Barr virus test, HIV test, Haematocrit normal, Headache, Herpes simplex test negative, Human herpes virus 6 serology, Intensive care, International normalised ratio decreased, Lymphocyte percentage, Magnetic resonance imaging heart, Malaise, Metabolic function test, Mycobacterium tuberculosis complex test, Myocarditis, Neutrophil percentage decreased, Parvovirus B19 test, Platelet count normal, Prothrombin time prolonged, Pyrexia, SARS-CoV-2 antibody test positive, SARS-CoV-2 test negative, Troponin increased, White blood cell count decreased
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Agranulocytosis (broad), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: None: no cough/cold/URI or other illnesses
Preexisting Conditions: None
Allergies: none
Diagnostic Lab Data: 6/4: Outside hospital WBC 4.2 HCT: 39.7 Plt: 164 N: 45.2 E:2.9 L: 38.8 CMP: Na 140 Cr: 0.71 AST: 28 ALT 16 Trop: 2980 INR: 1.1 PTT: 29.1 EKG: "reported ST changes" Chest CT: negative for PE 6/4: Troponin 4.90$g$g3.07$g1.41$g1.23$g1.24 ID labs: COVID PCR negative; COVID Ab positive (qual/semi); HSV negative Pending: HHV6/Enterovirus/Parvovirus/CMV/EBV/Adenovirus PCR, EBV panel; HIV; TB Quant Gold Cardiac MRI: 1. Normal left ventricular size and systolic function. 2. Normal right ventricular size and systolic function. 3. No significant valvular disease. 4. No abnormal late gadolinium enhancement. 5. No evidence for active or remote pericarditis. Lack of evidence for active myocarditis. ECHO 6/4: without dysfunction
CDC Split Type:

Write-up: 8 hours post vaccination, developed subjective fever, chills, headache, malaise 6/2: Around 32 hours post vaccination, developed acute chest pain, shortness of breath, difficulty breathing when laying flat. Required ibuprofen. 6/3: felt better, required ibuprofen. Presented to ED on 6/4 with continued symptoms (chest pain, shortness of breath), noted to have elevated troponins. Transferred to Hospital on 6/4 to ICU for monitoring. To the floor on 6/5. Clinically doing well just on NSAIDs with slowly decreasing troponins. Dx: probable acute myocarditis per cardiology based on clinical symptoms and troponin leak


VAERS ID: 1376344 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
SMQs:, Medication errors (narrow)

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

Write-up: Greater than 45 days since 1st dose


VAERS ID: 1376355 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood pressure decreased, Fatigue, Feeling abnormal, Heart rate increased, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: In observation post vaccine within 15 minutes c/o tired and "loopy" and when being evaluated continued to have a drop in BP with and Increase in HR= became unresponsive and 911 called. NO resp issues or hives


VAERS ID: 1376421 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Abortion spontaneous, Exposure during pregnancy
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow)

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

Write-up: Patient called the pharmacy a few days after her 2nd Moderna vaccination and stated about a day after her shot she started experiencing abdominal cramps. Patient was pregnant so was very concerned and went to the hospital. Unsure how far along she was but she wanted us to know she had a miscarriage. We are unaware if this is linked to the vaccination but patient is stating that''s the only thing that has changed since her three previous pregnancies that had no issues whatsoever. Reporting this since she called the pharmacy so we were aware and since we are not aware if the hospital filed this report.


VAERS ID: 1376435 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-30
Onset:2021-06-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram normal, Chest pain, Dyspnoea, Echocardiogram normal, Electrocardiogram normal, Troponin increased
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Gabapentin - 2400 mg daily Trazodone - 50mg daily in the evening
Current Illness: None.
Preexisting Conditions: Thoracic Outlet Syndrome, formerly treated with physical and occupational therapy. Otherwise in good health and no prior heart issues.
Allergies: Allergic to penicillin and amoxicillin
Diagnostic Lab Data: Echocardiogram, EKG, angiogram- all came out normal/healthy.
CDC Split Type:

Write-up: Experienced chest pain and shortness of breath on Wednesday morning, after getting the second vaccine shot on Sunday. Went to the hospital where they reported elevated troponin levels and possible myocarditis. Troponins continued to rise over the next day and peaked at 7.2 before starting to go back down. Stayed at the hospital for two nights to be observed.


VAERS ID: 1376476 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye pain, Headache, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (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: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling in legs, and severe headache, eye pains


VAERS ID: 1376483 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Pain, Somnolence
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin
Current Illness:
Preexisting Conditions: Diabetes, history of stroke
Allergies: shrimp, fish, peanuts,some other nuts
Diagnostic Lab Data: I sent a note to my GP. Realistically, what does medicine actually DO about this? Noting item 21... I do not know if this is temporary or permanent. Neither does my doctor.
CDC Split Type:

Write-up: Wednesday, I fell asleep soon after I got home. I had a couple of hours of extremely deep sleep. (In retrospect, this makes perfect sense because neurological stress does that to me.) When I was waking up, I realized that I had the sensation of hot. I didn''t have a fever or a sunburn. Nonetheless, the nerves near the skin for much of my arms, legs, and part of my torso were saying, ''Hot''. They were all normal body temp when I checked with my hand. On Thursday, the sense of ''hot'' continued. The sensation was morphing from ''hot'' to the sore feeling one gets from a sunburn. The truth didn''t match the sensation. There is no skin damage. Touching it does not aggravate the soreness. As I type on Sunday, my inner thighs have a slightly lesser version of both ''hot'' and sore. This is also true of my arms, rest of my legs, and other parts of my body to a lesser extent. In light of health issues noted above... The sensations were the same between right and left. My glucose was normal a couple hours before the shot and when I checked soon after waking.


VAERS ID: 1376530 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Periorbital swelling, Rash macular, Tenderness, Vision blurred
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient''s extremities are red and splotchy. Patient has swelling under right eye that is sore to touch. Patient reported no issues with vision but has slight blur of vision at times that goes away when blinking. She is taking Benadryl to help with swelling and will follow up with physician if symptoms do not improve.


VAERS ID: 1376538 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-31
Onset:2021-06-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041CZ1A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine 5 mg (Lisinopril 10 mg) (Sambucol)
Current Illness:
Preexisting Conditions: High blood pressure, Sinus
Allergies: Sulfa, Lactose to dairy
Diagnostic Lab Data: Taradol injection 6-2-2021 6:44 pm: Care Center
CDC Split Type:

Write-up: Severe migraine headache, blurred vision and dizziness and nauseous and passing out for 5 days so far


VAERS ID: 1376569 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Headache, Loss of consciousness, Nausea, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Nausea-Medium, Additional Details: Possible Vasovagal reaction, out for a very short time, then had nausea, a bit confused, shakiness, headache


VAERS ID: 1376579 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Nausea, 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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: NAUSEA, FEVER/CHILLS, SHAKES/TREMORS. PT HAS NOT TRIED ANY RX OR OTC TREATMENTS


VAERS ID: 1376615 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Lip swelling, Nasal discomfort, Pyrexia, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D, Vitamin C, testosterone enanthate, HCG 500 IU
Current Illness: None
Preexisting Conditions:
Allergies: Have had allergic reactions to NSAIDs.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: After receiving the J&J Covid vaccine I was awake all night with fever and chills, which I understand is completely normal. However the next day my upper lip and lower nose swole up in an allergic reaction. I took Benadryl and went to sleep and by the time I work up it had subsided. Two days after that incident I woke up (this morning) and my left cheek was swollen from another allergic reaction. During this time I had not eaten or taken anything out of the ordinary.


VAERS ID: 1376654 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamins, Vitamin D, Propolis
Current Illness:
Preexisting Conditions:
Allergies: Kiwi, Pollen, Dust mites
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, fever, muscle aches, which lasted for about 24 hours


VAERS ID: 1376679 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Contusion, Feeling hot, Malaise, Muscular weakness, Oral contusion, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Food allergies
Allergies: All Poultry/Foul, All Tree nuts
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 6/2, complained of feeling hot and sick, no fever. Joint aches and leg weakness 6/3 had a strange bruise like spot on the back of his neck. Continues leg aches and weakness 6/4 had a strange bruise like spot near corner of mouth. Neck was better though. Never pain at the bruise like spot sites Spot on face is fading, but still present on the face as of today. All other symptoms resolved besides the spot on his face


VAERS ID: 1376827 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-24
Onset:2021-06-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast pain, Chest pain, Headache, Hypoaesthesia, Limb discomfort, Pain, Paraesthesia, Peripheral swelling, Skin discolouration, Swelling face, Visual impairment
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Lipodystrophy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Developed swollen legs tight and discolored.. had a massage to relieve pressure on Friday.. started noticing Thirsday and at present have very bad vision changes that isn''t normal. I also have on and off cheat pains this morning with numbness in my left arm and tingling fingers. Pain move from my right under breast area to left side before subsiding. But vision problem persists with swollen face and headache.


VAERS ID: 1376856 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / IM

Administered by: Other       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT was given Modern vaccine and is 17 yrs old. No reactions.


VAERS ID: 1376930 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-12
Onset:2021-06-02
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Myocarditis, Pancytopenia, Pericarditis, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Myelodysplastic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Few hours after vaccine developed fevers for 2 days which resolved. Then 6/2/21 developed fevers, rash, chest pain, admitted to hospital 6/4/21 with fevers, rash, pancytopenia, pericarditis, myocarditis


VAERS ID: 1377031 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Chills, Diarrhoea, Dizziness, Fatigue, Flushing, Headache, Hyperhidrosis, Lethargy, Nausea, Pain, Pyrexia, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Abdominal Pain-Medium, Systemic: Body Aches Generalized-Medium, Systemic: Chills-Severe, Systemic: Diarrhea-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Fever-Medium, Systemic: Flushed / Sweating-Severe, Systemic: Headache-Medium, Systemic: Nausea-Severe, Systemic: Shakiness-Medium


VAERS ID: 1377055 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Inappropriate schedule of product administration
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: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type: NA

Write-up: 2ND VACCINE GIVEN TOO EARLY- 15 DAYS BETWEEN 1ST DOSE AND 2ND DOSE. NO EFFECTS NOTED WITH THE PATIENT.


VAERS ID: 1377088 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Injection site pain, Movement disorder, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tdap 03/03/2020 0.5 mL Left Deltoid U6378AA Sanofi Pasteur 07/04/2021 Same Symptoms as previously described, along with Muscle s
Other Medications: Amlodipine, Calcium, Magnesium, Zinc, Melatonin
Current Illness: None
Preexisting Conditions: High Blood Pressure
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: It started with soreness in the top of the left shoulder and injection site, which was to be expected. Then muscle pain and strain that starts in the inner arm traveling down the muscle to the left wrist. Left arm cannot extend to full range with out a "pulling, or ripping " feeling. The left arm is painful to the touch, and the pain gets worse when manipulated. No redness or obvious swelling. Just lasting pain through the entire left arm muscles. There is no soreness on the injection site, and no longer any soreness on the shoulder. Took Tylenol PM for three straight nights but the pain and strain is persistent and only provided a very mild temporary relief. Also tried using a cold compress that only gave minimal relief. Symptoms are still on going.


VAERS ID: 1377094 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-24
Onset:2021-06-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: multivitamin, brain bright supplement, Omega creel, doxycycline 20mg, Lexapro 20mg, Lunesta 2mg, gabapentin 900mg 3 x daily, nortriptyline 50mg, venlafaxine 37.5 mg,
Current Illness:
Preexisting Conditions: MS
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt woke up on 6/2/2021 and noticed she had a warm red spot on her left arm around the injection site. The next day it was the size of a half dollar. It continued to spread down and out on the arm and was still red and warm. She went to the walk in clinic on 6/6/2021. Her vitals were normal. She was prescribed Cephalexin 500mg antibiotic and told to FU w her doctor if it didnt get better. Pt will contact her MS specialist to let them know about the infection.


VAERS ID: 1377104 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-24
Onset:2021-06-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Joint stiffness
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Joint pain and stiffness in knees, wrists and fingers.


VAERS ID: 1377313 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-23
Onset:2021-06-02
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW9178 / 1 - / IM

Administered by: School       Purchased by: ?
Symptoms: Abdominal pain, Appendicectomy, Appendicitis, Computerised tomogram abnormal, Full blood count abnormal, Pyrexia
SMQs:, Acute pancreatitis (broad), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: penicillin
Diagnostic Lab Data: 6/2/2021 CBC showed elevated white count. 6/3/2021 CT with oral contrast confirmed appendicitis. 6/3/2021 appendectomy
CDC Split Type:

Write-up: 6/2/2021 abdominal pain with fever, diagnosis appendicitis. 6/3/2021 appendectomy


VAERS ID: 1377316 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen, albuterol inhaler, atorvastatin, biscabodyl suppository, carvidiol, Ferrous Sulfate Elixer, Gabapentin, Hydralazine, Levemir, Levothyroxine, Lisinopril, Lorazepam, Novolog, Omeprazole, Polyethelene glyco powder, sildenafil, s
Current Illness: none
Preexisting Conditions: end stage renal disease, type 2 diabetes, 2nd hyperparathyroidism, dyphasgia, muscle wasting atrophy, elipepsy, pulmonary hypertention,
Allergies: no known drug/food allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pt has no adverse events pt recieved two diffirent manufacturers of the Covid-19 vaccines, both are MRna vaccines the Pzifer vaccine (2 doses at Dialysis) and the Moderna Vaccine (2 doses at the nursing home where she ''s staying.


VAERS ID: 1377357 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Erythema of eyelid, Eye infection, Eyelids pruritus, Periorbital swelling, Swelling of eyelid, Visual acuity tests
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Ocular infections (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Taken Daily: Alive 50+ Ultimate Daily Vitamin, Krill oil 1250mg, B-100 Complex, Allegra-24hr, D3 5000 I.U., E-180mg, Align 24/7, Citracal + D3, Simvastatin 5mg, Quinol-meg COQ10, Paxil 20mg, Singular 10mg, Wixela 250/50, Flonase spray
Current Illness:
Preexisting Conditions: Year round allergies, Moderate Asthma, Cholecystectomy, Hysterectomy
Allergies: Codeine, Biaxin, Sulfa drugs
Diagnostic Lab Data: Vision test (from wall)
CDC Split Type:

Write-up: Left eye infection(itchy, red, puffy, swollen) above on eyelid and underneath eye/Allergic Reaction/Covid-19 Vaccine Diagnosis: Adverse effect of other viral vaccines Prescribed: H. Cortisone 1oz - 1% cream, apply lightly and use cold compress 3x daily


VAERS ID: 1377653 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fall, General physical condition abnormal, Thirst
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: 1:08pm client c/o feeling dizzy and thirsty. Patient was offered water. 1:15pm Patient found on floor. Patient was monitored and EMS called. 162/110, HR 88. EMS arrived, patient refused transportation, was accompanied home by husband. Patient was advised to call 911 or contact medical doctor if still experiencing symptoms. Understanding verbalized. 13:40 Patient left site, accompanied by husband.


VAERS ID: 1377718 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-02-02
Onset:2021-06-02
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / N/A UN / UN

Administered by: Public       Purchased by: ?
Symptoms: Aphasia, Bell's palsy, Blood pressure increased, Corneal reflex decreased, Ear pain, Facial paralysis, Hypoaesthesia, Hypoaesthesia oral, Hypogeusia, Hyposmia, Magnetic resonance imaging head normal, Pain in jaw, Scan with contrast normal, White blood cell count increased
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Corneal disorders (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hearing impairment (broad), Osteonecrosis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan, Metformin, Carvedilol, Aciphex, Cymbalta, Wellbutrin,
Current Illness: None
Preexisting Conditions: Diabetes, Obesity, HTN
Allergies: PCN, Naproxen, Peanuts, Tree nuts, Latex
Diagnostic Lab Data: ER visit with MRI w/wo contrast to r/o stroke. Results: Normal. Labs WNL, White count 12.2. No temp. Elevated BP 210/120 upon arrival down to 165/88 at end of ER visit. DX: Bell''s palsy. Given script for 60 mg prednisone once a day for 7 days and 1gm of Valtrex three times a day for 7 days. Follow up with Primary care.
CDC Split Type:

Write-up: Began to have an earache and lower jaw ache around 10:30 AM on 06/02 while at work. Symptom''s of decreased ability to blink, smell, taste, talk, and pronounced facial droop by 3:30 pm. 1/2 face including tongue numb with full right side of face completely paralyzed by 6 pm.


VAERS ID: 1377732 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Headache, Knee operation, Pain, Sleep disorder
SMQs:, Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: When I was a young girl, 6 or 7, my grandfather contracted TB. Everyone that was local in the family had to take some kind of s
Other Medications: synthroid, pepcid, xyzal, lipitor, aspirin, multivitamin and magnesium on a daily basis. I took 10 ml of benadryl about 30 minutes prior.
Current Illness: Hypothyroidism, Type II diet and exercise controlled diabetic.
Preexisting Conditions: same as above
Allergies: penicillin, sulfa, lozol, amaprox, cardura, glucophage, micronas, thiazide, lopressor, tetracyline, ultrasound gel with menthol, ct dye (I had an anaphylactic reaction to ct dye and some type of shot I had to take when I was little because my grandfather had TB)
Diagnostic Lab Data: Did not seek medical help.
CDC Split Type:

Write-up: Around 7:00-8:00 that evening, approximately four hours after recieving the vaccine, I started having shooting pain in my head. It was mild at first, then harder and more frequent as the evening went on. It did that until late the next morning and was completely gone by around noon. This wasn''t a ''headache'' or migraine. It was shooting pain like none I had ever had in my head. I had a knee revision years ago and it also affected the knee through the night with that same type of pain. I wasn''t as concerned about the knee, but, the head was concerning. I didn''t report it because I didn''t know I had to register to check in.


VAERS ID: 1377736 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-31
Onset:2021-06-02
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 RA / IM

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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allopurinol, amitiza, aspirin, cefadroxil, fluticasone, insulin detemir, insulin regular, levothyroxine, linzess, midrodrine, multivitamin, omerazole, pravastatin, rena-vite, sevelamer
Current Illness:
Preexisting Conditions: "weak heart", vertigo, OSA, reduced mobility, postoperative nausea and vomiting, peripheral edema, nystagmus, neuropathy, lymphedema, left knee pain, "illiterate", hyperlipidemia, HTN, hx total knee arthroplasty, hep B, GERD, DM2, occasional smoker, CHF, Back pain, angina pectoris, anemia, renal cell carcinoma of right kidney, ESRD needing dialysis
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received both doses of COVID Pfizer vaccine., on 3/10/21 and 3/31/21. Pt tested positive for COVID prior to a routine unrelated procedure on 6/2/21, but was asymptomatic.


VAERS ID: 1377829 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic shock, Blood test, Burning sensation, Peripheral swelling, Pruritus, Rash, Swelling, Swelling face, Urticaria, White blood cell count increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: viibryd and alprazolam
Current Illness: None
Preexisting Conditions: None
Allergies: penicillin
Diagnostic Lab Data: blood work showing increased white blood cell counts (6/5-6/7)
CDC Split Type:

Write-up: anaphylactic shock (fully body hives/extreme swelling of faces, neck, and limbs/ full body rash/painful itching/ feeling like a very intense burn) has lasted for 5 days causing hospitalization (has not gone away yet)


VAERS ID: 1377847 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Paraesthesia, Paraesthesia oral
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

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

Write-up: Pt began experiencing tingling on left face and tongue without breathing difficulty 1 hour after vaccine administration. Went to ED and was given acute facial numbness diagnosis, provider stated that it "could represent a transient facial palsy after administration of the vaccine, however it is not unilateral."


VAERS ID: 1377882 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-19
Onset:2021-06-02
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / SC

Administered by: Other       Purchased by: ?
Symptoms: Aspartate aminotransferase decreased, Blood alkaline phosphatase increased, Blood creatinine decreased, Dehydration, Diarrhoea, Lymphocyte count decreased, Neutrophil count increased, Syncope, Unresponsive to stimuli, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (broad), Haematopoietic leukopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Biliary system related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (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: Sertraline HCL 25 mg x2 daily, Methylphenidate ER 20 mg once daily, 2 multivitamin gummies daily for teens.
Current Illness: None
Preexisting Conditions: ADHD inattentive type, new this year is depression and anxiety. Other than that she is healthy teenager.
Allergies: None
Diagnostic Lab Data: Creatinine low 0.51 mg/dl, Alk Phos high 116 IU/L, AST low 13 IU/L, WBC high 12.6 K/mcL, Neutros Abs high 11.19 K/mcL, Lymphocytes Absolute low 0.79 x10, EKG normal.
CDC Split Type:

Write-up: Daughter stated she had diarrhea for 3 weeks while we were at the hospital on 6/2 for IV fluids and severe dehydration. Her poop was mushy, and not diarrhea, however for her it was much softer than normal. She collapsed at home and was unresponsive, 911 was called, ER doctor determined she was severely dehydrated and administered 2 bags of IV fluids to stabilize her blood pressure.


VAERS ID: 1377896 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-27
Onset:2021-06-02
   Days after vaccination:67
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Amylase, Aspartate aminotransferase increased, Blood albumin increased, Blood alkaline phosphatase increased, Blood calcium normal, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood potassium normal, Blood sodium normal, Blood urea normal, Blood urine absent, Brain natriuretic peptide, Carbon dioxide normal, Cerebrovascular accident, Chest X-ray normal, Computerised tomogram head abnormal, Electrocardiogram normal, Haematocrit increased, Haemoglobin increased, Headache, Hemiparesis, Hypoaesthesia, International normalised ratio normal, Lipase, Mean cell volume normal, Nitrite urine absent, Platelet count normal, Protein urine absent, Prothrombin time normal, Red blood cell count normal, Specific gravity urine normal, Troponin, Troponin I, Ultrasound Doppler normal, Urine ketone body absent, Urine leukocyte esterase, Visual impairment, White blood cell count increased, White blood cells urine negative, pH urine normal
SMQs:, Liver related investigations, signs and symptoms (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Biliary system related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: nka
Diagnostic Lab Data: CBC Recent Labs Lab 06/02/21 1601 03/01/21 0800 WBC 10.3 4.7 HGB 16.4* 15.3* HCT 49.2* 45.3* PLT 222 193 MCV 93.5 92.4 RBC 5.26* 4.90 CHEMISTRY Recent Labs Lab 06/02/21 1601 04/26/21 0917 03/01/21 0800 03/01/21 0800 GLU 165* -- -- 113* BUN 16 -- -- 14 CREATININE 0.6 -- -- 0.7 NA 141 -- -- 138 K 4.2 -- -- 3.6 CL 105 -- -- 103 CO2 25 -- -- 30 CALCIUM 9.8 -- -- 9.1 LABALBU 4.4 -- -- 3.6 ALT 33 31 < $g 27 AST 17 17 < $g 15 ALKPHOS 121* -- -- 113 LABBILI 0.3 -- -- 0.4 < $g = values in this interval not displayed. GI No results for input(s): AMYLASE, LIPASE in the last 70080 hours. COAGS Recent Labs Lab 06/02/21 1601 10/21/19 0914 PROTIME 11.5 12.6 INR 0.9 1.0 CARDIAC No results for input(s): TROPONINI, TROPONIN2, TROPONIN3, TROPONIN4, BNP in the last 70080 hours. URINE Recent Labs Lab 06/02/21 1601 LEUKOCYTESUR NEGATIVE NITRITE NEGATIVE BLOODU NEGATIVE WBCU 0 to 5 SPECGRAV 1.015 KETONESU NEGATIVE PROTEINUA NEGATIVE PHUR 5.5 Imaging Review EKG Result Date: 6/2/2021 EKG Report Date: 6/2/2021 Time: 15:00:05 Previous EKG available for comparison: No The EKG showed a normal sinus rhythm with a ventricular rate of 84 bpm. PR interval normal at 140 ms. QRS duration normal at 94 ms. QT and QTC intervals are within normal range. R axis is normal at 77 degrees. There is no evidence of acute ST or T-wave changes. There is no voltage criteria for left ventricular hypertrophy. MD 6/2/2021 5:22 PM XR CHEST PA AND LATERAL 2 VIEW Result Date: 6/2/2021 EXAM DESCRIPTION: XR CHEST PA AND LATERAL 2 VIEW CLINICAL HISTORY: 69 years Female, right sided numbness COMPARISON: 10/22/2018 TECHNIQUE: PA and lateral views FINDINGS: There is no focal consolidation, pleural effusion or pneumothorax. The cardiac silhouette and pulmonary vascularity are within normal limits. Degenerative changes are seen in the thoracic spine. IMPRESSION: No acute cardiopulmonary pathology. Electronically signed by: MD 6/2/2021 4:09 PM. US CAROTID DUPLEX DOPPLER Result Date: 6/2/2021 EXAM DESCRIPTION: US CAROTID DUPLEX DOPPLER CLINICAL HISTORY: 69 years Female, right sided numbness COMPARISON: 2/1/2021 TECHNIQUE: Carotid duplex scan was performed using gray scale imaging and Doppler interrogation.NASCET criteria was utilized. FINDINGS: The peak systolic velocities in bilateral common carotid, internal and external carotid arteries are within normal limits. Peak systolic velocity for the ICA is 99.3cm/s on the right and 83.5cm/s on the left. Mild arthrosclerotic plaques are seen at the carotid bifurcations bilaterally. The vertebral arteries are patent with antegrade flow bilaterally. There has not been significant interval change. IMPRESSION: No hemodynamically significant stenosis. Electronically signed by: MD 6/2/2021 4:15 PM CT HEAD WO CONTRAST Addendum Date: 6/2/2021 ADDENDUM #1 Findings were discussed with Dr. (Name) on 6/2/2021 3:50 PM Electronically signed by: MD 6/2/2021 3:54 PM Result Date: 6/2/2021 EXAMINATION: UNENHANCED CT OF THE HEAD CLINICAL HISTORY: 69 years Female,stroke like symptoms, right sided numbness COMPARISON: There is no prior similar study available for correlation. TECHNIQUE: Axial imaging and 2-D reformatting performed without IV contrast. This exam was performed according to our departmental dose-optimization program, which includes automated exposure control, adjustment of the mA and/or kV according to patient size and/or use of iterative reconstruction technique. TOTAL DLP: 1150.84 mGy-cm FINDINGS: The mastoid air cells, middle ears and paranasal sinuses are clear. There is a 2 cm focal area of low-attenuation in the left centrum semiovale secondary to subacute infarct, mass. There is no acute hemorrhage, ventriculomegaly, midline shift. There is no tonsillar ectopia. IMPRESSION: 2 cm focal area of low-attenuation in the left centrum semiovale secondary to subacute infarct or mass. Correlate with clinical findings. MRI recommended for further evaluation. Electronically signed by: MD 6/2/2021 3:24 PM
CDC Split Type:

Write-up: 69 y.o. female that presented to my office with a 5 day history of weakness on her right side. In particular, she states her right arm, right face, and right torso was numb when she woke up on Saturday morning, May 29th. She initially thought she just had some radicular symptoms going down her right arm as she has had before. However, she does admit that the facial numbness did concern her. She had a headache that morning, but no headache after that. She states that some of the sensation has come back a little bit in the right arm and hand. However, she still can not hold anything without up falling out of her hand because she can not feel it. She denies any weakness in the right side of her body. She denies any facial droop. She does think her vision may have gotten a little bit worse, but this is difficult to tell because she does usually have poor vision. Because of her symptoms in the office, I thought it was best that I admit her for observation in order to rule out acute stroke. I sent her for a stat head CT which did come back showing a subacute left-sided CVA. Further workup is underway. Active Hospital Problems Diagnosis Date Noted ? Right sided numbness 06/02/2021 ? Acute cerebrovascular accident (CVA) (HCC) 06/02/2021 ? Essential hypertension 01/27/2021 ? Dyslipidemia 05/22/2017


VAERS ID: 1377969 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-04-23
Onset:2021-06-02
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Deafness unilateral, Sudden hearing loss
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Carboplatin, Taxol, Decadron, Ativan, Zofran, Compazine, DIM, Evening Primrose Oil, Probiotic
Current Illness: Stag 3 Ovarian Cancer - mid chemotherapy treatment when vaccinated
Preexisting Conditions:
Allergies: Sulfa Antibiotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden hearing loss, left ear, onset 6/2/2021. On 60 MG prednisone taper, starting 6/6/2021


VAERS ID: 1378047 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fear, Headache, Injection site pain, Nausea
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Chills, fever, severe headache, nasea. Took ibuprofen, cold compress to head, blanket for chills. Chills and nausea lasted for 6 or 7 hours, Fever lasted for 48 hours. Headache lasted for 60 hours. Very sore arm at injection site which lasted for about 72 hours.


VAERS ID: 1378069 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Arthralgia, Chills, Decreased appetite, Diarrhoea, Fatigue, Influenza like illness, Injection site pain, Injection site swelling, Lymphadenopathy, Myalgia, Pyrexia, Rash, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Asthma
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: pain at injection site with swelling after about one hour. About six hours later followed by flu like symptoms including high fever 102 with chills, fatigue, sleep disturbance, swollen armpit lymph nodes, intestinal discomfort, rash on shoulder and arm, and what I would describe as severe arthritic pain in pretty much all joints of body large and small. Fever subsided in about 24 hours but rash, fatigue, swollen glands and muscle and joint pain lasted at least five days. Diahrrea on days three and four. Little appetite entire time.


VAERS ID: 1378132 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-08
Onset:2021-06-02
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Deafness neurosensory, Deafness unilateral, Ear, nose and throat examination
SMQs:, Hearing impairment (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: ENT administered tuning fork test June 3, 2021. Audiology test conducted June 4, 2021 confirmed 60-80db loss in left ear across all frequencies. Treated with high does prednisone steroid (60mg/day) starting June 3.. Hearing returned gradually over the following 4 days.
CDC Split Type:

Write-up: Sudden Sensorineural Hearing Loss (SSHL) in left ear June 2, 2021. Preceded by intermittent brief hearing loss in same ear, for a few minutes at a time, for up to one week prior to June 2.


VAERS ID: 1378151 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-05-30
Onset:2021-06-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Impaired driving ability, Loss of personal independence in daily activities, Motion sickness, Vertigo, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Both control
Current Illness: NA
Preexisting Conditions: Na
Allergies: Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Day 3 I received severe vertigo which cause vomiting due to the motion and was completely down for two days. Now it is day 6 and I still have dizzy so bad that I can?t drive!


VAERS ID: 1378212 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: pt complained of feeling hot, sweaty and lightheaded approximately 10 minutes after vaccine administration. pt was moved to a cool area and given the opportunity to lie down after drinking a few sips of water. pt very quickly calmed down and stated that he was feeling better, though he was kept for a 30 minute observation. at the end of the period, he was reassessed and found to be ok. pt was released to the care of his mother.


VAERS ID: 1378231 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Anxiety, Dizziness, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: pt complained of feeling sweaty and lightheaded approximately 10 minutes after receiving the vaccination. pt was given water and taken to a cool area to sit. pt stated that she was feeling somewhat anxious (which she has a history of). upon sitting for a few minutes, pt stated that she feeling better. pt was kept for 30 min observation and then left on her own accord.


VAERS ID: 1378236 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

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

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

Write-up: The day after my shot I noticed some hives, but I thought they were bug bites at first. But everyday I?m getting more and more bumps, and when I looked at a picture of hives, these bumps look very similar. The first ones look like big mosquito bites or spider bites. But the next day I got small bumps that looked more like hives. The big bumps are on my right arm, but not next to where I got my shot. The hives are on my right ankle, and now are popping up on my right arm. They are every itchy, and a bit disconcerting because they are growing in size and spreading more each day.


VAERS ID: 1378250 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-03
Onset:2021-06-02
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Cough, Eye disorder, Neurological symptom
SMQs:, Anaphylactic reaction (broad), Corneal disorders (broad), Retinal disorders (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: coronary artery disease-ongoing but function just fine-just hereditary
Allergies: hydralazine & statins
Diagnostic Lab Data: went to my urgent care on 6/4 and they diagnosed the bells palsey, gave me prednazone and an antibiotics
CDC Split Type:

Write-up: bells palsey - severe issue in left eye and left side; minor chest cough I didn''t have before


VAERS ID: 1378265 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Chills, Fatigue, Headache, Injection site pain, Injection site swelling, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Pain and swelling at the injection location. Extreme tiredness, headache, muscle pain/soreness, chills and intermittent (minimal) nausea. Felt like my body was working harder than normal, with slight tightness in my chest.


VAERS ID: 1378315 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Syncope. Felt very light headed, then said he was ''dreaming'' but lost consciousness for a few seconds. Gave water, and orange juice when pt said he hadn''t eaten. We moved him to the floor, where he laid down for a few minutes. He continued to sip water and OJ, and within a few minutes regained color and strength. Gradually felt better and back to baseline in about 15-20 minutes


VAERS ID: 1378345 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Injection site pain, Injection site warmth, Rash, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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: probiotics, women''s multi
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Large red area, covering arm (side to side) 3 inches by 6inches, below the injection site. The red area was hot to the touch. Feels sore/ bruised. Began fading after 4 days. Used topical Triamcinolone 0.5% ointment, and took allergy medication. 3 days after injection, began getting blister type rash on lower opposite arm from vaccination site. Today 07 June, 6 days after vaccine, large red area almost gone, no longer tender, but more blister type bumps appearing on lower right arm, and a few are now beginning to show on lower left arm (injection arm).


VAERS ID: 1378364 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Washington  
Vaccinated:1980-06-15
Onset:2021-06-02
   Days after vaccination:14962
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

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

Write-up: mom states that pt had to go to the er due to serious adverse reaction, high fever, feeling badly


VAERS ID: 1378447 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 547334 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: went to the emergency and I preserved CEPHALEXIN 500MG CAPSULES
Current Illness: NO
Preexisting Conditions: NO
Allergies: NO
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: the first one a huge big black brush, the second one gave me a huge pink rush.


VAERS ID: 1378484 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Neurological examination normal, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Not reported
Current Illness: Patient had an esophagogastroduodenoscopy on 6/1/2021, one day prior to vaccination. He had open heart surgery on 3/22/2021, and had a pacemaker implanted on 3/29/2021.
Preexisting Conditions: AV BLOCK, COMPLETE PRESENCE OF IMPLANTABLE CARDIAC PACEMAKER CAD W HX OF CABG ATRIAL FLUTTER, PAROXYSMAL HX OF ASCENDING AORTA REPAIR SCREENING FOR COLORECTAL CANCER, HIGH RISK OBESITY, BMI 35-39.9, ADULT ADULT OBSTRUCTIVE SLEEP APNEA FHX OF COLORECTAL CANCER ANEMIA INSOMNIA HX OF AORTIC ROOT REPLACEMENT UPPER GI HEMORRHAGE HX OF PEPTIC ULCER
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient felt fine during observation period after receiving Janssen. On his drive home he experienced blurred vision in his right eye that lasted for about 3 minutes. He returned to vaccine site. Doctor on site was called and patient was transferred to the doctor''s office for further evaluation. No symptoms of anaphylaxis. Neurological exam normal. No other symptoms of stroke. Vital signs stable. Patient feels fine. Due to patient''s cardiac history, doctor was concerned about a possible transient ischemic attack. Therefore, he was transferred to the emergency department for further evaluation. Patient declined additional tests in the ED. Patient admitted to the ED, pt with normal exam. Sx only lasted 2-3 minutes. Consulted with neurologist. Does not sound like stroke. Also not suggestive of known J & J vaccine reaction. Suggest ophth eval.


VAERS ID: 1378542 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Fall, Fear of injection, Head injury, Hyperhidrosis, Pallor, Syncope, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: 14:08 While washing hands I heard commotion in the other section of the observation area. Noticed pt. on the floor, next to his chair. He was having "shaky" movements, unresponsive, diaphoretic and very pale. Also noticed he was hitting head twice on wall. After protecting his head, he regained consciousness in approx. 15 sec. Staff had been called and 911 was activated. My oximeter read pulse of 40 to 45 and saturation between 96 to 98%. Pt. claimed it wasn''t his first time after "needles" passing out. Said he had a good breakfast and lunch. He declined having his parents called.


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