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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 213 out of 4,799

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VAERS ID: 1378763 (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 (JANSSEN)) / JANSSEN 1821288 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site hypoaesthesia, Injection site paraesthesia
SMQs:

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

Write-up: After patient had waited the 15 minutes-upon post vaccine check in patient stated that her are felt funny. I asked her to explain and she said kind of numb and tingly. Told patient to watch make sure no swelling/redness/or spots at injection site or around that area and also to watch and make sure are doesn''t get hot. If so or symptoms worsen patient need to go to ER immediately. I told patient if he symptoms were concerning enough she needed to go to er and patient stated that she did not feel they were that bad at this time.


VAERS ID: 1379005 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
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 - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Oligomenorrhoea
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

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

Write-up: Very heavy bleeding on period. Abnormal amounts of blood. Typically, my period lasts no longer than 5 days, however, I''m on day 6 and I''m still bleeding very heavily.


VAERS ID: 1379018 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-21
Onset:2021-06-02
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Blood lactic acid, C-reactive protein increased, Chest pain, Chills, Dyspnoea, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Fibrin D dimer, Intensive care, International normalised ratio increased, Lymphadenopathy, Oropharyngeal pain, Pericarditis, Prothrombin time prolonged, Pyrexia, Rash, Rash erythematous, SARS-CoV-2 test negative, Tachycardia, Tachypnoea, Troponin
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Arthritis (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: 6/4/2021 (all lab results) Lactate: 3.8; 2nd time-4,6 PT: 13.2 INR:1.2 Troponin: 0.30 CRp: 20 D-Dimer: 3,618 Sars COV2-PCR: negative EKG: sinus tachycardia, ST elevation suggests acute pericarditis
CDC Split Type:

Write-up: Pt was in usual state of health until 6/2/21 and experienced fevers, chills, sore throat, shortness of breath, chest pain, erythematous rash on trunk and limbs, arthralgia inthe ankle. Presented to ED on 6/4-febrile, tachycardic and mildly tachypneic. Pt is still currently admitted in Unit. left axillary adenopathy


VAERS ID: 1379065 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Indiana  
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 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), 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: Ozempic, Synjardy, Glipizide, Lisinopril, probiotic, daily vitamin, OTC allergy medication
Current Illness: None
Preexisting Conditions: Diabetes
Allergies: Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills for 2-3 hours, followed by a headache and aching muscles.


VAERS ID: 1379290 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Washington  
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 048C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Malaise, 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: n/a
CDC Split Type:

Write-up: Pt called stating that starting about 6 hours after her second dose of Moderna vaccine, she began feeling ill with fever, chills, nausea, and aches. As of the time she contacted our pharmacy, 5 days later, she states her symptoms are gradually improving but she felt too sick to even make the phone call on days 2-3 following the vaccine. Advised pt to take OTC pain/fever relievers as needed and contact physician if symptoms worsen within 24 hrs.


VAERS ID: 1379301 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Illinois  
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 1816027 / 1 LA / IM

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

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

Write-up: Patient said that she has experienced pain in her arm since receiving the shot.


VAERS ID: 1379698 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Arizona  
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 030B21A / 2 LA / IM

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

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

Write-up: The patient stated that he needed his second vaccine and at first said the thought he first received the Pfizer injextion. I spoke to him and told him we have all 3 vaccines but the only 2 vaccines that required 2 shots was the Pfizer and then Moderna. I told him he needed to get the same vaccine for both and he then stated Moderna. I asked him if her was sure and he said yes. He didn''t have his card upon the initial visit. We vaccinated him with Moderna and when he returned with his card it indicated he received the Pfizer for the first vaccine. We observed his for the 15 minutes without any adverse reactions.


VAERS ID: 1379734 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / UNK - / IM

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

Write-up: PT REACTED TO 1ST DOSE OF COVID VACCINE W SOB AND DIFFICULTY BREATHING. PT ALSO WENT TO ED FOR TREATMENT WITH 1ST SHOT. PT SAW AN ALLERGIST WHO PRESCRIBED PREDNISONE BEFORE 2ND DOSE + DIPHENHYDRAMINE, WHICH SHE TOOK BOTH. PT GOT 2ND DOSE ON 6/2 AND STILL HAD DIFFICULTY BREATHING AND WENT TO THE ED. PT GOT PREDNISONE 50MG, DIPHENHYDRAMINE 25MG PO, AND PEPCID 20MG. PT DID OK AND WAS DISCHARGED TO HOME.


VAERS ID: 1380633 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Blood test, Chills, Malaise, Pain in extremity, Pallor, Presyncope
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (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: Medical History/Concurrent Conditions: Nose bleed (two incident in past 5 years prior to this report.); Comments: Patient had no other health condition
Allergies:
Diagnostic Lab Data: Test Name: Blood test; Result Unstructured Data: low platelet count
CDC Split Type: USJNJFOC20210603429

Write-up: ALMOST PASSED OUT; SKIN LOOKED WHITE AND PALE; MILD PAIN IN STOMACH; LEG HURTS; CHILLS (FEELING COLD AND SHIVERING); FEELING UNWELL; This spontaneous report received from a parent concerned a 19 year old male. The patient''s height, and weight were not reported. The patient''s past medical history included nose bleed, and other pre-existing medical conditions included patient had no other health condition. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose was not reported, administered on 01-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 almost passed out. On 02-JUN-2021, the subject experienced skin looked and pale. On 02-JUN-2021, the subject experienced mild pain in stomach. On 02-JUN-2021, the subject experienced leg hurts. On 02-JUN-2021, the subject experienced chills (feeling cold and shivering). On 02-JUN-2021, the subject experienced feeling unwell. Laboratory data (dates unspecified) included: Blood test (NR: not provided) low platelet count. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from almost passed out, had not recovered from skin looked white and pale, leg hurts, and chills (feeling cold and shivering), and the outcome of mild pain in stomach and feeling unwell was not reported. This report was non-serious.; Sender''s Comments: V0: Medical Assessment Comment not required as per standard procedure as case assessed as non serious.


VAERS ID: 1380639 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Heart rate, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210602; Test Name: Heart rate; Result Unstructured Data: 99
CDC Split Type: USJNJFOC20210604954

Write-up: FAST HEART RATE; SHORTNESS OF BREATH; This spontaneous report received from a parent concerned a 20 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 02-JUN-2021 09:15 am for prophylactic vaccination. Batch number was not reported and has been requested. No concomitant medications were reported. On 02-JUN-2021, the subject experienced fast heart rate. On 02-JUN-2021, the subject experienced shortness of breath. Laboratory data included: Heart rate (NR: not provided) 99. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from fast heart rate, and shortness of breath. This report was non-serious.


VAERS ID: 1380650 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Chills, Oropharyngeal pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210607421

Write-up: SORE THROAT; JOINT PAIN; CHILLS; FEVER; This spontaneous report received from a patient concerned a 48 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A, expiry: UNKNOWN) dose was not reported, administered on 30-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUN-2021, the subject experienced sore throat. On 02-JUN-2021, the subject experienced joint pain. On 02-JUN-2021, the subject experienced chills. On 02-JUN-2021, the subject experienced fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the sore throat, fever, joint pain and chills was not reported. This report was non-serious.


VAERS ID: 1380666 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-08
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: Comments: The patient was not pregnant at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210607725

Write-up: PATIENT GIVEN DILUTED JNJ COVID VACCINE; WRONG TECHNIQUE IN DRUG USAGE PROCESS; POOR QUALITY VACCINE ADMINISTERED; This spontaneous report received concerned a 42 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included the patient was not pregnant at the time of vaccination. The patient received covid-19 vaccine (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 covid vaccine. On 02-JUN-2021, the subject experienced wrong technique in drug usage process. On 02-JUN-2021, the subject experienced poor quality vaccine administered. The action taken with covid-19 vaccine was not applicable. The outcome of the poor quality vaccine administered, wrong technique in drug usage process and patient given diluted JNJ covid vaccine was not reported. This report was non-serious. This case, from the same reporter is linked to 20210607539 and 20210608711.


VAERS ID: 1380677 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 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: USJNJFOC20210608687

Write-up: CONSUMER GIVEN EXPIRED VACCINE; This spontaneous report received from a pharmacist concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805022, and expiry: 25-MAY-2021) dose was not reported, administered on 02-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUN-2021, the subject experienced consumer given expired vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of consumer given expired vaccine was not reported. This report was non-serious.


VAERS ID: 1380694 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Body temperature, Chills, Cold sweat, Hypoaesthesia, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210602; Test Name: Body temperature; Result Unstructured Data: 103 F
CDC Split Type: USJNJFOC20210612112

Write-up: FEELING NUMB ON RIGHT SIDE INCLUDING ARM AND LEG; WEAKNESS ON RIGHT SIDE INCLUDING ARM AND LEG; NAUSEA; COLD SWEATS; FEVER; CHILLS; This spontaneous report received from a patient concerned a 44 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, batch number: 207A21A expiry: UNKNOWN) dose was not reported, administered on 02-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUN-2021, the subject experienced cold sweats. On 02-JUN-2021, the subject experienced chills. On 02-JUN-2021, the subject experienced fever. Laboratory data included: Body temperature (NR: not provided) 103 F. On 03-JUN-2021, the subject experienced nausea. On 04-JUN-2021, the subject experienced feeling numb on right side including arm and leg. On 04-JUN-2021, the subject experienced weakness on right side including arm and leg. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from cold sweats, chills, and fever on 04-JUN-2021, had not recovered from nausea, and weakness on right side including arm and leg, and the outcome of feeling numb on right side including arm and leg was not reported. This report was non-serious.


VAERS ID: 1381351 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Incorrect dose administered, Off label use, 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: USJNJFOC20210608711

Write-up: WRONG TECHNIQUE IN DRUG USAGE PROCESS; INAPPROPRIATE DOSE OF VACCINE ADMINISTERED; OFF LABEL USE; This spontaneous report received from a pharmacist concerned a 61 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, 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 wrong technique in drug usage process. On 02-JUN-2021, the subject experienced inappropriate dose of vaccine administered. On 02-JUN-2021, the subject experienced off label use. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the wrong technique in drug usage process, inappropriate dose of vaccine administered and off label use was not reported. This report was non-serious. This case, from the same reporter is linked to 20210607539 and 20210607725.


VAERS ID: 1381352 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Eye pain, Influenza like illness
SMQs:, Glaucoma (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 had no known allergies and no history of drug abuse or illicit drug use.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210611631

Write-up: This spontaneous report received from a patient concerned a 47 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included non smoker, and non-alcohol user, and other pre-existing medical conditions included the patient had no known allergies and no history of drug abuse or illicit drug use. The patient received COVID-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808986, expiry: UNKNOWN) dose was not reported, administered on 02-JUNE-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUNE-2021, the subject experienced pain in eyes. On 02-JUNE-2021, the subject experienced flu like symptoms. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from pain in eyes, and flu like symptoms. This report was non-serious.


VAERS ID: 1381386 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021645195

Write-up: Woke up feeling a bit nauseous/ Experiencing nausea "on and off"; This is a spontaneous report received from a contactable consumer. A 14-years-old female patient received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Lot number was not reported) via an unspecified route of administration on 01Jun2021 15:30 as single dose for COVID-19 immunization. The patient medical history and concomitant medications were not reported. The patient woke up feeling a bit nauseous. experiencing nausea "on and off" throughout the morning on 02Jun2021. Event took place after use of product. The outcome of the event was unknown. No follow-up attempts are needed; information about lot/batch number cannot be obtained.


VAERS ID: 1381683 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety
SMQs:, 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: No
Current Illness: No
Preexisting Conditions: Glaucoma in both eyes
Allergies: No
Diagnostic Lab Data: N/A
CDC Split Type: 03052

Write-up: Anxiety


VAERS ID: 1381786 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect product formulation administered, Product storage error
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: vaccine that was drawn up in syringe past the 6 hour window was inadvertently mixed with newly drawn up vaccine. Patient may have rec''d expired vaccine or non-expired vaccine. We contacted Pfizer, CDC and our Facility vaccine experts and the conclusion made was that microbiological contamination was the primary concern and patient was advised to watch for signs of infection at site or fever and report to us if any other symptoms occur. We were advised revaccination is not required.


VAERS ID: 1381790 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-25
Onset:2021-06-02
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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

Write-up: 8 days after the shot, I got a large, red, very hot, itchy rash that still has not gone away after two weeks. Symptoms still include spreading of rash (not nearly as red though), it''s still hot to the touch and itchy.


VAERS ID: 1381821 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine product that was past the 6 hours in the syringe in the fridge was inadvertently mixed up with newly reconstituted and drawn up syringe. Patient may have received product that was $g 6 hours in the syringe after reconstitution. We contacted Pfizer, the CDC, and our Pharmacy vaccine experts. It was determined that microbial contamination was primary concern and no need to revaccinate. Patient was advised to watch for signs of infection, i.e. fever, redness or swelling at site and general illness. This patient reported no symptoms at time of consultation and was advised to follow up if any new symptoms occur.


VAERS ID: 1381875 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-21
Onset:2021-06-02
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1085025 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cough, Respiratory tract congestion
SMQs:, Anaphylactic reaction (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: Albuterol inhaler
Current Illness: none
Preexisting Conditions: COPD
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Could be coincidence, Bad Cough and congestion 8-10 days after vaccine lasting 5 days, just now getting better


VAERS ID: 1381887 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-03-19
Onset:2021-06-02
   Days after vaccination:75
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: Fully Vaccinated with Covid19 Moderna EUA -3/19/21-4/17/21-


VAERS ID: 1381910 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product storage error
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: There was a mix up with expiring product coming out of fridge and new product drawn up. Patient may have received vaccine that was in syringe in fridge longer than the recommended 6 hours. We contact Pfizer, CDC and our vaccine experts. Microbial contamination was primary concern and there was no recommendation for revaccination. Patient was advised of error and to monitor for signs of infection, i.e. redness at injection site and fever. The patient had no reaction at time of contact and was told to follow up if anything changes.


VAERS ID: 1381920 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Pt was given a third covid19 vaccination in the Pfizer series.


VAERS ID: 1381921 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 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? 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: There was a mix up of expired product coming out of fridge and newly drawn product. Patient may have received product that was in syringe past the 6 hour recommended timeframe. We contacted Pfizer, CDC and our Facility vaccine experts and it was determined the primary concern seems to be microbial contamination and revaccination was not necessary. Patient was advised of the error and to monitor for signs of infection, i.e. redness at site of injection and fever. Patient reported some nausea, the usual arm pain, and fever around 100 degrees after vaccine. At time of consultation all symptoms had resolved.


VAERS ID: 1381947 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Injection site erythema, Nausea, Pain, Pyrexia, Visual impairment
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Systemic: Body Aches Generalized-Medium, Systemic: Fever-Medium, Systemic: Nausea-Medium, Systemic: Visual Changes/Disturbances-Medium, Systemic: Weakness-Medium


VAERS ID: 1381973 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-31
Onset:2021-06-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Postmenopausal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Systemic: vaginal bleeding/ discharge in post menopause-Mild


VAERS ID: 1382017 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205AZIA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Hyperhidrosis, Myalgia, Pain in extremity, Pyrexia, Ultrasound scan normal, X-ray limb
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabupentin, Bystolic, Rosuvastatin
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Ultra Sound and xray of right let. 6/3
CDC Split Type:

Write-up: Severe chills and fever and sweating started at 7pm and continued until around 6am. Severe pain in right calf muscle started at 3am on 6/3 and lasted for 24 hours. At the direction of my dr, i was seen in the ER at hospital. The hospital checked for blood clot but ultra sound showed no clots.


VAERS ID: 1382298 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Dysgeusia, Fatigue, Headache, Migraine, Nausea, Pain, Pyrexia, Thirst, Vision blurred
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (narrow), Dementia (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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Started off with extreme fatigue the morning after the vaccine, then throbbing intense migraine started around 11 am that lasted until the next morning after which a dull headache lasting till Friday, 102.3 fever, EXTREMELY painful body aches, metallic taste in mouth, thirst that could not be quenched, dizziness, blurred vision, confusing, nausea.


VAERS ID: 1382304 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immunisation, Product storage error
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: vaccine was administered outside of storage recommendations. Notified pt to return for re-vaccination


VAERS ID: 1382308 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole OTC 20mg, Iron OTC 65mg
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: fever/chills and whole body muscle soreness for about 2 days, gone by third day.


VAERS ID: 1382309 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone, Full blood count, Glycosylated haemoglobin, Lymphadenopathy, Metabolic function test, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (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, Ibuprofen
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: Medical evaluation 06-03-2021; CMP, CBC, THS and A1C
CDC Split Type:

Write-up: Lymphadenopathy and localized lower neck swelling


VAERS ID: 1382310 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immunisation, Product storage error
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: vaccine was administered outside of storage recommendations. Notified pt to return for re-vaccination


VAERS ID: 1382312 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Dysgeusia, Fatigue, Headache, Migraine, Nausea, Pain, Pyrexia, Thirst, Vision blurred
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (narrow), Dementia (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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Started off with extreme fatigue the morning after the vaccine, then throbbing intense migraine started around 11 am that lasted until the next morning after which a dull headache lasting till Friday, 102.3 fever, EXTREMELY painful body aches, metallic taste in mouth, thirst that could not be quenched, dizziness, blurred vision, confusing, nausea.


VAERS ID: 1382318 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

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

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

Write-up: vaccine was administered outside of storage recommendations. Notified pt to return for re-vaccination


VAERS ID: 1382324 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

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

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

Write-up: vaccine was administered outside of storage recommendations. Notified pt to return for re-vaccination


VAERS ID: 1382328 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

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

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

Write-up: vaccine was administered outside of storage recommendations. Notified pt to return for re-vaccination


VAERS ID: 1382333 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

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

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

Write-up: vaccine was administered outside of storage recommendations. Notified pt to return for re-vaccination


VAERS ID: 1382399 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Pain in extremity, Rash, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: My first shot only made my arm sore. The second shot my arm was sore, but the following day a red rash the size of my hand came up on my arm and lasted 5 days. The injection site itched still a week later even after the redness went away.


VAERS ID: 1382416 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, Dizziness, Electrocardiogram, Hyperhidrosis, Pain, Palpitations, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Onset of dizziness, sweating, heart racing, body aches, fever to 102.3


VAERS ID: 1382495 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event, Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Pfizer vaccine vial was not diluted prior to administration. Patient received 0.3 mL of undiluted vaccine. Patient and physician were notified of error and monitored for adverse events/flu-like symptoms per CDC recommendations. Patient remained hospitalized for reasons unrelated to COVID-19 vaccine administration (M1 hold). No adverse events documented by nursing or providers, no fevers or other adverse reactions noted.


VAERS ID: 1382592 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-29
Onset:2021-06-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Had a cold and sinus infection 3 weeks before vaccine
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sore lymph node under left armpit and left collar bone. Rash on left arm. Fatigue lasting a week. Lymph nodes better after 6 days. Rash appeared 7 days after shot and has not gone away.


VAERS ID: 1382597 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-09
Onset:2021-06-02
   Days after vaccination:113
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac monitoring, Full blood count, Metabolic function test, Nausea, Palpitations
SMQs:, Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: cardiac monitor, CBC, BMP on 6/2/21
CDC Split Type:

Write-up: heart palpitations, nausea


VAERS ID: 1382617 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-26
Onset:2021-06-02
   Days after vaccination:96
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Compression fracture, Computerised tomogram, Echocardiogram, Fall, Full blood count, Metabolic function test, Pleural effusion, Rib fracture
SMQs:, Systemic lupus erythematosus (broad), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Osteoporosis/osteopenia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CT with contrast, CMP, Echocardiogram, CBC on 6/2/21
CDC Split Type:

Write-up: fall, rib fractures, pleural effusion, compression fracture


VAERS ID: 1382704 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-04-09
Onset:2021-06-02
   Days after vaccination:54
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / UNK LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Asthma
Allergies: None
Diagnostic Lab Data: Wife has an appointment with her primary care doctor on 11 June
CDC Split Type:

Write-up: Continued off and on heavy periods/heavy bleeding...this started on 2 June....about two months after receiving the J&J COVID shot (4 Apr)


VAERS ID: 1383381 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO191 / 1 RA / IM

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

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

Write-up: Vasovagal syncope - While seated in chair, patient became dizzy and glass-eyed approx 10 minutes after vaccination. Before he could fall, he was lowered to the ground and positioned with legs raised. Cool, wet cloth applied to patient''s forehead and ice pack applied to back of patient''s neck. He was also give cold water and orange juice to sip on. Remained supine for 15 minutes, then sat in chair for another 10 to 15 minutes before going home with Mom (a nurse). Followed up with patient''s mother @ 7:45 pm - patient was fine.


VAERS ID: 1383415 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: None


VAERS ID: 1383622 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: None


VAERS ID: 1383631 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: None


VAERS ID: 1383635 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: None


VAERS ID: 1383648 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: None


VAERS ID: 1383782 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: None


VAERS ID: 1384285 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Delaware  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Adverse reaction, Incorrect route of product administration, Off label use
SMQs:, Drug abuse and dependence (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Anxiety; Blood pressure high
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210607696

Write-up: SEVERE BAD ADVERSE REACTION AFTER THE INJECTION; WRONG ROUTE OF ADMINISTRATION; OFF LABEL USE; This spontaneous report received from a pharmacist concerned a 60 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included high blood pressure and anxiety. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intravenous, batch number: Unknown, expiry: Unknown) (Incorrect route of product administration and off label use) dose was not reported, 1 total, 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, post vaccination the patient experienced severe bad adverse reactions (unspecified) and was admitted to the hospital. The patient was kept overnight (one day) at the hospital and discharged on 03-JUN-2021. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from off label use, wrong route of administration, and severe bad adverse reaction after the injection. This report was serious (Hospitalization Caused / Prolonged).; Sender''s Comments: V0;20210607696-COVID-19 VACCINE AD26.COV2.S-severe bad adverse reactions . This event is considered unassessable. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event . V0 20210607696-COVID-19 VACCINE AD26.COV2.S-Wrong route of administration , off label use. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1384304 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Back pain, Gait disturbance, Headache, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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:
Current Illness: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: Patient had no known allergies and drug abuse or illicit drug usage
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210611958

Write-up: CAN BARELY WALK; WEAKNESS; FELT LIKE THROWING UP; HEADACHE; BACK STARTED TO HURT (TERRIBLE PAIN IN LOWER BACK); SORE ARM; This spontaneous report received from a patient concerned a 19 year old male. The patient''s weight was 175 pounds, and height was 66 inches. The patient''s concurrent conditions included non-smoker, and non-alcohol user, and other pre-existing medical conditions included patient had no known allergies and drug abuse or illicit drug usage. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1820095 expiry: UNKNOWN) dose was not reported, administered on 02-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUN-2021, the subject experienced sore arm. On 03-JUN-2021, the subject experienced back started to hurt (terrible pain in lower back). On 03-JUN-2021, the subject experienced weakness. On 03-JUN-2021, the subject experienced felt like throwing up. On 03-JUN-2021, the subject experienced headache. On 04-JUN-2021, the subject experienced can barely walk. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from sore arm, and headache, had not recovered from felt like throwing up, weakness, and back started to hurt (terrible pain in lower back), and the outcome of can barely walk was not reported. This report was non-serious.


VAERS ID: 1384725 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Florida  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Hyperhidrosis, Illness, Sensory disturbance, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021645361

Write-up: doesn''t feel right leg or left arm; cramps in her stomach; Shaking; Sweating; throwing up; feeling really sick; This is a spontaneous report from a contactable consumer (patients sister). A 14-years-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Lot number, expiry date: unknown), dose 1 via an unspecified route of administration, administered in Arm Left on 01Jun2021 at like around 12:30 or 1:00 pm (as reported) as single dose for covid-19 immunisation. History of all previous immunization with the Pfizer vaccine considered as suspect was reported as none. No additional vaccines were administered on the same date of COVID-19 vaccine. The patient medical history and concomitant medications were not reported. Family medical history relevant to AEs was none. Patient was not taking any other products. Patient did not had prior vaccination within 4 weeks. On 02Jun2021 reporter stated that her 14 year old sister got vaccinated yesterday and when she woke up she felt really sick. On 02Jun2021, at 09:00 the patient experienced cramps in her stomach, shaking, sweating, throwing up and has gotten worse. On 02Jun2021, patient reported she felt like she did not feel one of her legs and one of her arms. Clarified that it is the right leg and the left arm. Started about an hour and a half later than the other symptoms, so was around 10:30 this morning and had gotten worse. Patient did not visit emergency room or physician office. No treatment was received for the events cramps in her stomach, shaking, sweating, throwing up, felt like she did not feel one of her legs and one of her arms. When they passed through the place to get the vaccine, they said to get it just in case, for the next school year. Investigation assessment and relevant tests was reported as no. The outcome of events cramps in her stomach, shaking, sweating, throwing up, doesn''t feel right leg or left arm was not recovered and the outcome of other event was unknown. Information related to batch/Lot no. was requested.


VAERS ID: 1384763 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal discomfort, Condition aggravated, Headache, Illness, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021654840

Write-up: She already took Tylenol yesterday because of headache and high hernia and high hernia is swelling; I got headache; I have a higher hernia and after the Tylenol it made my high hernia to swell, it made my stomach open up and I got sick; stomach open up; I got sick; high hernia is swelling; This is a spontaneous report from a Pfizer sponsored program via contactable consumer (patient, self-reported). A 59-year-old female patient (age at vaccination: 59 year) received second dose of BNT162B2 (PFIZER-BIONTEC COVID-19 mRNA VACCINE, Solution for injection, lot number and expiry date were not reported), via an unspecified route of administration, on 02Jun2021 at 13:05 PM, as a single dose for COVID-19 immunization; paracetamol (TYLENOL), route of administration, start and stop date, batch/lot number and dose were not reported for an unspecified indication; ibuprofen (IBUPROFEN), route of administration, start and stop date, batch/lot number and dose were not reported for an unspecified indication. Historical vaccine included first dose of BNT162B2 (PFIZER-BIONTEC COVID-19 mRNA VACCINE, Solution for injection, lot number and expiry date were not reported), via an unspecified route of administration, on an unknown date, as a single dose for COVID-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient reported that she already took Tylenol (Captured as suspect) yesterday because of headache and high hernia and high hernia was swelling; she got headache. She had a higher hernia and after the Tylenol it made her high hernia to swell, it made her stomach open up and she got sick on 02Jun2021. The patient stated, she wanted to find out if it was okay for her to take the Ibuprofen (captured as suspect) because she was told that we are taking the shot, she already had her second shot, this was her second, she had it was second, but they told her to take Tylenol and she had a higher hernia and after the Tylenol it made her high hernia to swell, it made her stomach open up and she got sick. She got headache like so and all and she mean she just, she was for bed off. So, she wanted to find out if it was okay to take as Ibuprofen and two doses of the Tylenol. The action taken in response to the events for Tylenol and Ibuprofen was unknown. Outcome of the events was unknown. No follow-up attempts are needed. No further information is expected.


VAERS ID: 1384791 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Bedridden, Bone pain, Chest pain, Dizziness, Headache, Musculoskeletal stiffness, Nausea, Nuchal rigidity, Pain, Vision blurred
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Osteonecrosis (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Peanut allergy (Peanut); Shellfish allergy (shellfish)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021659000

Write-up: bedridden; extreme nausea; headache; bodyache; stiffness; chest pain; dizzy whenever I try and stand/ light headed; can''t focus on screen very long without feeling like throwing up; can barely turn neck; bones/joints hurt; bones/joints hurt; no energy; This is a spontaneous report from a contactable consumer (patient). A 32-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Lot number: EW0191) via unspecified route of administration, administered in arm left on 01Jun2021 at 06:15 (at the age of 32-year-old) as 2nd dose, single dose for COVID-19 immunization. Medical history included allergy to peanuts and shellfish. Concomitant medication was not reported. The patient previously took bnt162b2 (lot number: EW0185) in arm left on 07May2021 at 07:15 as 1st dose, single dose for COVID-19 immunization and experienced bed ridden and fatigue. No other vaccines within 4 weeks prior to the COVID vaccine. On 02Jun2021 at 10:00 (AM), the patient experienced lightheaded, extreme nausea, physical weakness, headache and body ache. It was reported that the patient also experienced stiffness, chest pain, dizzy on same day. Whenever the patient was trying and stand, could not focus on screen very long without feeling like throwing up, always lightheaded, could barely turn neck, bones and joints hurt and no energy. The patient stated he received full-time care while bedridden first day and a half from his partner and continue to receive care daily as he was not able to accomplish much on his own at this point. The patient also stated he did not know if this was a permanent condition caused by the vaccine nor did he know what the extent of any permanent damage was. This was the worst body he had ever felt. The patient was not diagnosed with COVID-19 prior to vaccination and since the vaccination. Patient was not tested COVID post vaccination. The outcome of events was not recovered. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1384810 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-24
Onset:2021-06-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Bell's palsy, Blood test normal, Muscle twitching, Musculoskeletal stiffness
SMQs:, Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Citalopram, Delzicol, Mercaptopurine, Multi Vitamin, Calcium, Vitamin D
Current Illness: None
Preexisting Conditions: Colitis, Hashimoto Thyroiditis
Allergies: N/A
Diagnostic Lab Data: Lyme''s Disease Test which came out negative. Going within the next day or so for an MRI of the Brain to rule out anything else.
CDC Split Type:

Write-up: Bell''s Palsy. Prednisone, Antiviral medication and artificial tear eye drops. Left Ear Pain on 6/1/2021 in the evening. Twitching on the left side of my mouth. Woke up on 6/2/2021 with the left side of my face very stiff. Went to ER. They said it was the early stages of Bell''s Palsy. Followed up with my Primary Care Physician on 6/8/2021 and confirmed Bell''s Palsy.


VAERS ID: 1384901 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dysphagia, Dyspnoea, Extra dose administered, Fatigue, Headache, Inappropriate schedule of product administration, Injection site pain, Lethargy, Oropharyngeal discomfort, Respiratory symptom, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (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: Site: Pain at Injection Site-Mild, Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Medium, Systemic: Chills-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Headache-Medium, Error: Booster Given Too Early, Additional Details: GIVEN 3RD DOSE IN ERROR. INITIAL SX: FATIGUE, HA, CHILLS, THROAT DISCOMFORT. DELAYED RESPIRATORY SYMPTOMS DEVELOPED OVER WEEKEND


VAERS ID: 1384909 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206H21H / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SYNTHROID, ESTROGEN, PROGESTERONE
Current Illness: N/A
Preexisting Conditions: HASHIMOTOS
Allergies: ORANGE PEEL, BIAXIN, METHOCARBOMAL, LEVAQUIN,
Diagnostic Lab Data:
CDC Split Type:

Write-up: Ringing in ears within the first 10 minutes post injection. (tinnitus) Has not subsided, within first week. Have never experienced tinnitus previously. Predominantly in left ear, same side as injection.


VAERS ID: 1384910 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event
SMQs:

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

Write-up: No Adverse outcome, no treatment needed


VAERS ID: 1384934 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-05-05
Onset:2021-06-02
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 0424A1A / UNK RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test normal, Computerised tomogram normal, Electrocardiogram normal, Fatigue, Feeling abnormal, Magnetic resonance imaging normal, Urine analysis normal, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Clariton
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CT, EKG, bloodwork 6/5/21 MRI, blood, urine 6/6/21 ENT visit 6/7/21 All test negative
CDC Split Type:

Write-up: Brain fog, vision issues, fatigue/still ongoing. Began 6/2/21


VAERS ID: 1384940 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 - / IM

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: 2nd dose given to soon


VAERS ID: 1384947 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 - / IM

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: 2nd dose given to soon


VAERS ID: 1384950 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event
SMQs:

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

Write-up: No adverse reaction no treatment required


VAERS ID: 1385013 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

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: 2nd dose given to soon, no treatment required


VAERS ID: 1385019 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: no adverse reaction, no treatment required


VAERS ID: 1385052 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-26
Onset:2021-06-02
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Injection site mass, Injection site pain, Injection site pruritus, Injection site rash, Injection site swelling, Joint range of motion decreased, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D2, Allegra.
Current Illness: None.
Preexisting Conditions: Chronic hives, vitamin D deficiency.
Allergies: NSAIDs (anaphylaxis), Penicillin (Anaphylaxis), Latex, Sulfa (Hives), Ciprofloxacin (dizziness), Macrobid (hives).
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: She got her vaccine, she did well. She had chronic hives that were presenting at first, but was very nervous and her arm hurt a little. Later that evening she could not lift her arm at all, just midway, but no rash or anything else at that time, just the pain. She felt real achy, her knees hurt, felt like she had a fever but did not. Then on 6/2/21 she had a rash that started on her lower left arm 6" from her shoulder, just underneath the injection site, and it has continued to spread. It is a wide band now and has normal skin tone in the middle, and the outskirts is gravitating, angry and rashy and looks like it wants to wrap around the entire arm, and it''s itchy and burns. She called her allergist and to take her Allegra and cool compresses. The swelling has gone down, but the burning and itching are still there and not improving. She originally had a lump near the biceps that has gone down some, but not as profound as it was at the beginning. She is going to go to the ER as what she is taking now is not resolving it, and needs medical attention. She has called her allergist to ask for some sort of steroid ointment but they refused to give it to her, and would not schedule her an appointment to be seen as it was a common side effect with Moderna and that it should go away. She wishes that they would do more research and have a place in the hospital for people with autoimmune diseases to be closely monitored after getting the vaccine.


VAERS ID: 1385202 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-04-03
Onset:2021-06-02
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: SARS-CV-2 RAPID JUNE 2, 2021
CDC Split Type:

Write-up: TESTED POSITIVE WHEN FULLY VACCINATED


VAERS ID: 1385261 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-04-05
Onset:2021-06-02
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cerebrovascular accident, Disorientation, Fall, Fatigue
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), 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: Unknown
Preexisting Conditions: Heart Disease, Double By-pass 01/18/2021
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Case developed extreme fatigue and disorientation resulting in a fall. Case was taken by ambulance to Hospital. Case suffered a stroke, admitted to hospital 06/02, then into ICU 06/07/2021.


VAERS ID: 1385265 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN EW0187 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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

Write-up: Miscommunication b/w prescriber, patient, and/or pharmacy regarding the vaccine that was intended to be administered


VAERS ID: 1385339 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product storage error
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: vaccine was administered outside of storage recommendations. Notified pt to return for re-vaccination


VAERS ID: 1385348 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Poor quality product administered, Product storage error
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: vaccine was administered outside of storage recommendations. Notified pt to return for re-vaccination


VAERS ID: 1385526 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

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

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

Write-up: Severe headache , Fever , Chills , Muscle aches , Left arm hurt at injection site warm to the touch as well


VAERS ID: 1385835 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-05-14
Onset:2021-06-02
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Muscle twitching
SMQs:, Dyskinesia (broad), Dystonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vit D , B12 ,C , Zinc
Current Illness: N/A
Preexisting Conditions:
Allergies: N/A. Minor Sensitivity to Shrimp
Diagnostic Lab Data:
CDC Split Type:

Write-up: -Head ache lasting almost all day. No particular region of the head -Started 06/01~ 06/02 . Persistent upto now 06/09. - Taking ~ 75 mg Aspirin 1 X day, since 05/06. Pain intensity is lower now. -Patient has minor history of muscle twitching , no particular history of head ache - Will consider visiting primary care physician , if pain doesn''t subside in the next few days


VAERS ID: 1385890 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Chills, Fatigue, Pain
SMQs:

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

Write-up: Very fatigue, body aches and chills for 2 days


VAERS ID: 1386023 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-17
Onset:2021-06-02
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 RA / SYR

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

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

Write-up: The patient received the first dose on 5/17 and on 6/2 had a severe headache and vomiting. The vomiting has since subsided but the patient has had a mild headache ever since


VAERS ID: 1386030 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Hypoaesthesia, Inflammation, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: L4 compression fracture, intermittently symptomatic
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Acute exacerbation of back pain with radiation in L4 L5 dermatomes to knee. Numbness a large part of the symptomatology at times. Saw pain Physician suggested it was inflammation related to vaccine, Advil and steroids Improving but was debilitating and remain numb in that area with paraesthesia


VAERS ID: 1386178 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UJ371AB / 1 RA / SC

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, Hypersensitivity, Nausea, Pharyngeal swelling, Respiratory tract congestion, Urticaria
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 11:08 Text from client''s mom: allergic reaction, throat swelling and hives all over. Client took Benadryl. Instructed to go to ER and ask them to complete a VAERS form. The mom texted back,: he took some Benadryl and it was about 30 minutes and he could feel things staring to go down and he feels a ton better, so I think we are OK. At 1:02 PM I texted her "How is he doing?" Her reply: "Much Better." At 5:11 PM Client''s mom called and said patient was having chest congestion, swelling in his throat and sick to his stomach and nausea. I instructed her once again to get him to the ER . Client took Benadryl once again and also went to the ER. At 6:36 PM Client''s mom let me know they were giving him an epinephrine shot and a steroid shot. she also texted: Dr. has never seen this kind of reaction. 6/3/2021 9:30 AM Client "so much better, thank goodness. 6/8/2021 Client himself stated he was fine. No additional problems


VAERS ID: 1386298 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-19
Onset:2021-06-02
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None. Healthy
Preexisting Conditions: None
Allergies: reported allergic to a medication but it was a long time ago and she does not remember specifically
Diagnostic Lab Data:
CDC Split Type:

Write-up: After about 15 to 16 days, patient reported hives/rash that are round in shape with sharp clear borders. Initially light red in color, turned red then dark red, then faded with border becoming more diffuse. Rash occurs on right thigh and back of right arm. The rash feels hot, a feeling of heat, like she was touching a hot burner. Vaccine was administered on right deltoid. Severe insomnia, could not sleep at all. Headaches. Today 6/9/2021 the rash appears to have subsided, became more diffuse and lighter but still there.


VAERS ID: 1386313 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: NONE
CDC Split Type:

Write-up: PHARMACY LEFT PFIZER VIALS IN THE FREEZER FOR LONGER THAN 2 WEEKS AT THE TEMPERATURE (-25 AND -15 DEGREES C). WE GAVE DOSES OUT OF THESE VIALS, RENDERING THEM POSSIBLY LESS EFFECTIVE.


VAERS ID: 1386346 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye movement disorder, Syncope, Tension headache
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Vasovagal syncope after roughly 13 minutes post-injection. Syncope lasted a few seconds (roughly 10 seconds) according to family that helped me. Head went backwards and eyes rolled back in head and then head/body slowly moved forward/sideways. Treatment or follow-up was not provided by anyone at pharmacy location even though family asked for assistance. I left after the 15 minute mark that I was required to stay for. My head felt very tight for the rest of the day, like a rubber band was squeezing my head around both temples.


VAERS ID: 1386392 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / UNK - / -

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

Write-up: The patient was adminstered the Moderna vaccine outside of the EUA, as she is 14 years and 9 months old. Pt has a pediatric nephrologist who will administer dose 2. Her mother has a note form her daughters doctor. The crew that gave her the vaccine did not know to check the age of the patient and she slipped through our screening tools. Patient had no adverse affects


VAERS ID: 1386824 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 03721 / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Ageusia, Anosmia, Diarrhoea, Dyspnoea, Fatigue, Hyperhidrosis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Biktarvy 50mg-200 mg-25 tab, lisinopril 100 mg tab
Current Illness: HiV. hypertension, COPD Borderline diabetes, male erectile dysfunction, GERD with esophagitis,
Preexisting Conditions: HiV and as above
Allergies: none
Diagnostic Lab Data: none, as pt refused to seek care per pt he is improved but continues to have lessened smell and taste, and diarrhea, and some fatigue. He speaks in full sentences and is able to easily verbalize 7-9 word sentences from recall of beginning of conversation at this time, as he was during earlier report.
CDC Split Type:

Write-up: Pt initially contacted clinic describing shortness of breath present the night before, and no other symptoms. Pt advised to go to ED or call 911. Pt contacted today and he described his symptoms differently, specifically as: aprox 5 hours after COVID immunization, developed fever 102, sweating, loss of small and taste, diarrhea, fatigue beginning noc of immunization and gradually fading over ~3.5 days. Only residual Sx pt endorses at this time are diarrhea and fatigue. Pt given advice directly from Provider to go to emergency dept/call 911. Pt cont. to decline to attend emergency dept /urgent care of get COVID test, saying "I''ll ride it out."


VAERS ID: 1386844 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-28
Onset:2021-06-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Activated protein C resistance, Anticoagulant therapy, Antinuclear antibody, Antiphospholipid antibodies positive, Antithrombin III decreased, Beta-2 glycoprotein antibody negative, Blood creatinine normal, Cardiolipin antibody negative, Coagulation factor IX level normal, Coagulation factor VIII level normal, Coagulation factor X level normal, Coagulation factor XI level normal, Coagulation test, Computerised tomogram abdomen, Computerised tomogram kidney abnormal, Computerised tomogram normal, Computerised tomogram pelvis, Computerised tomogram thorax, Factor VII deficiency, Flank pain, Immediate post-injection reaction, International normalised ratio increased, Leukocytosis, Pain, Pain in extremity, Positron emission tomogram normal, Protein C, Prothrombin level normal, Pyrexia, Renal artery thrombosis, Renal infarct, Thrombosis, Ultrasound kidney, White blood cell count increased
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Congenital, familial and genetic disorders (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Renovascular disorders (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: History of typhoid infection; class 4 LTBI (s/p RIPE in 2017)
Allergies: Hives with eggs
Diagnostic Lab Data: PET/CT skull base to thigh without evidence of occult malignancy. Coagulation workup guided by Hematology notable for: - No evidence of factor V Leiden based on a ACP of 2.5. - Slightly decreased Antithrombin III at 73% and protein C at 63% -- but could be explained by acute thrombosis. - Prothrombin gene mutation pending - LAC positive; cardiolipin neg; b2gp neg - PT-INR was noted to be elevated up to 2.0. PT mixing study (15.9 -$g 12.9) -- Factor VII activity low at 21%; inhibitor study not done -- Factor II, IX, X activities were normal - PTT nml -- Factor VIII, XI activities were normal ANA pending.
CDC Split Type:

Write-up: Patient has no clotting history. He developed body aches, left arm pain, and fevers immediately after immunization, but improved. Two days later on 6/2, he developed left flank pain and fevers. On 6/4, he was evaluated in the ED, with CT scan showing partially occlusive thrombosis of left renal artery with areas of renal infarction. Cr remained stably at baseline. Initial workup was otherwise notable for WBC 17 and negative infectious workup. He was initiated on therapeutic Lovenox. On 6/5, CTA chest/abdomen/pelvis was performed to evaluate for other clots. Left renal artery was complete thromboses with evolving foci of renal infarction. No other clots were detected. He continued to have fevers. By 6/8, his leukocytosis, fever, and flank pain resolved. Renal ultrasound with doppler showed restoration of some flow in the left renal artery. He is to be discharged 6/9 on Lovenox 1mg/kg BID without patient Hematology follow-up. His coagulability workup was notable for positive LAC, FVII deficiency, and PET/CT without evidence of occult malignancy.


VAERS ID: 1386860 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO191 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Tinnitus
SMQs:, Hearing impairment (narrow)

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

Write-up: Tinnitus (persistent ringing in both ears)


VAERS ID: 1387472 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 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: Comments: The patient had no known allergies, no chronic health condition, no infusion and biologics and no history of thrombocytopenia.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210604758

Write-up: EXPIRED VACCINE USED; This spontaneous report received from a pharmacist concerned a 51 year old female of an unspecified race and ethnic origin. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included that the patient had no history of known allergies, no chronic health condition, no history of thrombocytopenia, and no infusion and biologics. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 206A21A, and expiry: 23-JUN-2021) dose was not reported, 1 total administered on 02-JUN-2021 09:15 for prophylactic vaccination on left deltoid. No concomitant medications were reported. It was reported that on 01-JUN-2021 (reported as yesterday) at 14:00, pharmacist opened a vial of Janssen COVID-19 vaccine and then they stored it in the fridge with the recommended temperature. On 02-JUN-2021, the patient was administered expired vaccine which passed recommended time limit for the punctured/opened vial. The pharmacist stated that no reported side effects from the patient at the time of call. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the expired vaccine administered was not reported. This report was serious (Other Medically Important Condition)..; Sender''s Comments: 20210604758-Covid-19 vaccine ad26.cov2.s- expired vaccine used. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1387484 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Indiana  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Cough, Dizziness, Fatigue, Injection site pain, Nausea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Long COVID
Preexisting Conditions: Medical History/Concurrent Conditions: Cholecystectomy; COVID-19
Allergies:
Diagnostic Lab Data: Test Date: 20210603; Test Name: Body temperature; Result Unstructured Data: 101 F
CDC Split Type: USJNJFOC20210611909

Write-up: COUGHING ALL DAY WITH DRY COUGH; FEELING DIZZY; FATIGUE; FEVER; NAUSEAOUS; SHARP PAIN IN THE UPPER RIGHT SHOULDER NEAR INJECTION SITE PAIN; This spontaneous report received from a patient concerned a 64 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included covid-19, and gall bladder taken out, and concurrent conditions included long covid hauler.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 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 sharp pain in the upper right shoulder near injection site pain. On 03-JUN-2021, the subject experienced coughing all day with dry cough. On 03-JUN-2021, the subject experienced feeling dizzy. On 03-JUN-2021, the subject experienced fatigue. On 03-JUN-2021, the subject experienced fever. On 03-JUN-2021, the subject experienced nauseaous. Laboratory data included: Body temperature (NR: not provided) 101 F. Treatment medications (dates unspecified) included: ibuprofen. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from fever, was recovering from coughing all day with dry cough, and had not recovered from fatigue, nauseaous, feeling dizzy, and sharp pain in the upper right shoulder near injection site pain. This report was non-serious.


VAERS ID: 1387495 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Maryland  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Non-smoker; Social alcohol drinker (Occasionally use of alcohol)
Preexisting Conditions: Comments: No known allergies and no drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210614171

Write-up: BONE PAIN IN RIGHT SOLE OF FEET AND BOTH ARMS, FINGERS AS WELL AS WRISTS ON BOTH HANDS; INTERMITTENT FEVER; This spontaneous report received from a patient concerned a 45 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included non-smoker, and alcohol user, and other pre-existing medical conditions included no known allergies and no drug abuse or illicit drug usage.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808986, expiry: UNKNOWN) dose was not reported, administered on 21-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUN-2021, the subject experienced bone pain in right sole of feet and both arms, fingers as well as wrists on both hands. On 02-JUN-2021, the subject experienced intermittent fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from intermittent fever on 05-JUN-2021, and had not recovered from bone pain in right sole of feet and both arms, fingers as well as wrists on both hands. This report was non-serious.


VAERS ID: 1387706 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aphasia, Chills, Flushing, Muscle spasms, Muscle twitching, Writer's cramp
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Dyskinesia (broad), Dystonia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (broad)

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

Write-up: Approximately 12 hours post vaccine, she started experiencing intense muscle spasms/twitching and chills. This lasted approximately 3 hours. She stated she was unable to control her hands to work her phone to text or call for help. She stated she could not talk. After approximately 3 hours, she stated she got very flushed and then regained muscle control. She fell asleep amd felt fine when she awoke.


VAERS ID: 1387802 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination site reaction, Vaccination site warmth
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021641627

Write-up: A bubble of clear liquid came up at the injection site on her right arm; bubble the size of a Q-tip and it is really hot outside; This is a spontaneous report received via Pfizer sponsored program. A contactable consumer (patient) reported a 44-year-old female patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection), via an unspecified route of administration on 02Jun2021 (at an age of 44-years-old) on arm right as 1st dose, single dose for covid-19 immunization. The patient''s medical history and concomitant medications were not reported. On 02Jun2021, the patient experienced a bubble of clear liquid came up at the injection site on her right arm, bubble the size of a q-tip and it is really hot outside. Caller states she got the vaccine, what they did was put the band aid on first the right arm, it was round white circle with clear middle and gave the shot through the band-aid on her arm, the patient saw a big bubble of liquid on her arm and wanted to know if all of this was going to be fine. Patient stated that band-aid started to come up and a bubble of clear liquid came up at the injection site on her right arm 2 hours after the administration. The bubble was the size of a Q-tip and it is really hot outside. Patient also stated that the person who administered did not get her temperature first and asked if this process is correct. Patient also enquired if placing a band aid on prior to administration is appropriate. The clinical outcome of the a bubble of clear liquid came up at the injection site on her right arm, bubble the size of a q-tip and it is really hot outside were not recovered. Information related to batch/Lot no. was requested.


VAERS ID: 1387828 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-28
Onset:2021-06-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Pruritus
SMQs:, Anaphylactic reaction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Itching - generalised (sometimes get this same itch back in the past.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021654932

Write-up: itching; shortness of breath; This is a spontaneous report from a contactable consumer or other non hcp. A 72-years-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Batch/Lot number was not reported) via an unspecified route of administration, administered in Arm on 28May2021 (Batch/Lot number was not reported) as 1st Dose, Single Dose for covid-19 immunization. The patient''s medical history was reported as itch in her back (sometimes get this same itch back in the past). The patient''s concomitant medications were not reported. On Wednesday, 02Jun2021,the patient experienced itching, no rash, shortness of breath. The case was assessed as non-serious by the reporter. The outcome for the events was Unknown. Information on the lot/batch number has been requested


VAERS ID: 1387938 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Site: Itching at Injection Site-Severe, Site: Pain at Injection Site-Severe, Site: Redness at Injection Site-Severe, Site: Swelling at Injection Site-Severe


VAERS ID: 1387948 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site pain, Injection site swelling
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), 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? 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: Site: Pain at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Systemic: Numbness (specify: facial area, extremities)-Severe, Additional Details: numbness on left side from neck to toes. did not go away for days


VAERS ID: 1388008 (history)  
Form: Version 2.0  
Age: 100.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin Calcium Tablet 40 MG Give 40 mg by mouth at bedtime for HLD Furosemide Tablet 20 MG Give 1 tablet by mouth one time a day for htn Allopurinol Tablet Give 200 mg by mouth one time a day for gout Clopidogrel Bisulfate Tablet 7
Current Illness: none
Preexisting Conditions: CEREBRAL INFARCTION,, DIASTOLIC (CONGESTIVE) HEART FAILURE, HYPERLIPIDEMIA, VASCULAR DEMENTIA, HYPOTHYROIDISM,, CEREBROVASCULAR DISEASE, GOUT
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient received J&J vaccine and should have received 2nd dose of Pfizer. monitored patient and without adverse reaction.


VAERS ID: 1388181 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-02-20
Onset:2021-06-02
   Days after vaccination:102
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Buproprion SR 100mg tab, Escitalopram 20 mg tab, Centrum Silver multi-vitamin, Caltrate, Folic Acid
Current Illness: None
Preexisting Conditions: Depression, anxiety
Allergies: Lactose intolerant
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Diagnosed with Shingles on 6/9/21 by Dr. Treatment with valACYclovir (VALTREX) begun 6/10/21 for 7 days


VAERS ID: 1388206 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood albumin decreased, Blood alkaline phosphatase increased, Blood bilirubin, Blood calcium normal, Blood chloride normal, Blood creatinine increased, Blood culture negative, Blood glucose normal, Blood potassium normal, Blood sodium normal, Blood urea normal, C-reactive protein increased, Carbon dioxide normal, Chest X-ray abnormal, Computerised tomogram abdomen, Computerised tomogram abnormal, Echocardiogram abnormal, Ejection fraction decreased, Full blood count, Gallbladder disorder, Haematocrit increased, Haemoglobin normal, Immunoglobulin therapy, Inflammatory marker increased, Influenza A virus test negative, Influenza B virus test, Laboratory test, Liver function test, Lymphocyte count normal, Metabolic function test, Monocyte count normal, Mononucleosis heterophile test negative, Multisystem inflammatory syndrome in children, Myalgia, Neutrophil count increased, Nitrite urine absent, Platelet count normal, Procalcitonin, Protein total normal, Protein urine absent, Pyrexia, Red blood cell sedimentation rate increased, Red blood cells urine, SARS-CoV-2 test negative, Urine leukocyte esterase, Urobilinogen urine, Vomiting, White blood cell count increased, White blood cells urine
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Toxic-septic shock conditions (broad), Biliary system related investigations, signs and symptoms (broad), Gallbladder related disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Symbicort, Claritin, albuterol
Current Illness:
Preexisting Conditions: Asthma
Allergies: None
Diagnostic Lab Data: 6/6: CBC: WBC 10.8, H/H 14.6/44.9, Plt 158 diff: 84 neut, 4 lymph, 3 mono; BMP: Na 138, K 4.6, Cl 102, CO2 22, CUN 13, CReat 0.8, glc 110, Ca 9.4; ESR 20; LFT: TP 6.7, alb 3.9, Tbili 2.2, AP 492, AST 51, ALT 68; CRP 136.2; Procalcitonin: 1.300; COVID 19 PCR: negative; Flu A/B RNA: negative; Monotest: negative; UA: 1.015, neg protein, neg nitrite,negative LE 1+ bili, urobili $g 8, 0-5 RBC, 0-5 WBC; Blood culture: negative to date; 6/7: CBC: WBC 8.8, H/H 12.9/39.3, Plt 173 diff: 78 seg, 4 band, 6 lymph, 12 eos); ESR 25; BMP: Na 134, K 4.6, Cl 101, CO2 23, BUN 15, Creat 0.7, glc 95, Ca 8.8; LFT: TP 5.4, Alb 2.9, AST 31, ALT 44, Tbili 1.10, AP 341; CRP 166.40; CPK 39; Procalcitonin 3.880; Echocardiogram with reported depressed EF to upper 40s per report; CXR without focal opacifications, but concerns of possible air trapping/hyperinflation; Abdominal CT: showed some possible gall bladder wall thickening. 6/8: Multiple additional labs done upon transfer, evaluation on going.
CDC Split Type:

Write-up: Morning after vaccine the patient developed fever, myalgias and then developed abdominal pain and vomiting. Presented to emergency department where he was noted to have elevated inflammatory markers, gallbladder thickening, and decreased EF in the 40s. Patient met criteria for MIS-C and was treated with IVIG and steroids. Case was reported to a federal agency.


VAERS ID: 1388207 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / SYR

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

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

Write-up: Headace


VAERS ID: 1388460 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Cough, Electrocardiogram normal, Pyrexia
SMQs:, Anaphylactic reaction (broad), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: amoxicillin and cephalosporin antibiotics
Diagnostic Lab Data: EKG on 6/9/21 - normal
CDC Split Type:

Write-up: My daughter presented with a fever of 101.9 and complaints of chest tightness about 24 hours after her 2nd Pfizer vaccine. She also was coughing a very shallow, tight cough that was triggered by trying to take a deep breath. She rated the chest tightness a 7/10. By bedtime, fever down to 100.1 without any medication. Gave one ibuprofen for chest tightness. The next morning she was feeling much better and said she could barely feel chest tightness. As day progressed and over next several days, the symptom would come back, but was mild. Pediatrician saw her on 6/4 - no abnormal findings. Due to lingering , though mild symptoms over weekend, pediatrician made referral for cardiologist. Cardiologist performed EKG on 6/9 and results normal.


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