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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 215 out of 4,799

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VAERS ID: 1409729 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-19
Onset:2021-06-02
   Days after vaccination:103
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Muscle strain, Musculoskeletal stiffness, Myalgia, Pain in extremity, Vaccination site discomfort, Vaccination site pain
SMQs:, Rhabdomyolysis/myopathy (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021682886

Write-up: she was working in the garden and she hurt her arm. She pulled a muscle in it. It was her right arm where she had gotten the shot; I got both shot on right arm because I used right arm and I wanna workout the stiffness of the shot right arm.; sore arm/sored and painful arm on the same site where the vaccine was administered; injection site magnetic; sore muscles; sore arm/sored and painful arm on the same site where the vaccine was administered; This is a spontaneous report from a contactable consumer. This 61-year-old female consumer (patient) reported for herself that she received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Lot Number: EM9810, and Expiration date: 30Jun2021), via an unspecified route of administration, administered in right arm on 19Feb2021 (at the age of 61-year-old) as 2nd dose, single dose for COVID-19 immunization. The patient medical history and concomitant medications were not reported. Previously the patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Lot Number: EL9262, and Expiration date: 31May2021), via an unspecified route of administration, administered in right arm on 29Jan2021 as 1st dose, single dose for COVID-19 immunization. The patient was wondering if anyone had complained about their injection site being magnetic. Her girlfriend said that she heard that it was magnetic. Caller could stick a magnet on her arm, and it sticks there. It was weird that her arm was magnetic since the shot and it was not magnetic before. The patient was concerned as the magnet sticks on the same arm where she got the shot. On 02Jun2021, the patient had her injection site magnetic, sore arm/sored and painful arm on the same site where the vaccine was administered, and sore muscles. The patient reported that she got both shot on right arm because she used right arm and she wanted to work out the stiffness of the shot right arm. She got shot just she worked, she got both shot on right arm 3 weeks apart and her right arm got sored and right arm had been magnetic you can stick a magnet on her right arm. A week and half ago (on an unspecified date), she was working in the garden and she hurt her arm. She pulled a muscle in it. It was her right arm where she had gotten the shot. Her arm was so bad that she was not able to use it properly. She went to the doctors and they wanted to make sure her rotator cuff was connected so she could lift her arm up. Her arm was still sore, and they put it in a sling. It had not been recovered. She could lift it up, but it was sore than normal. The patient wondered if they put metal (that could possibly contribute to its magnetic properties) in the shot and it goes on my arm, that''s why it was not recovering. She also wanted to know if this (a probable magnet presence in the vaccine) was the reason why her arm was sore. She was wondering since her arm was not feeling well, she wondered if they connect since her arm had been sore for so long. The patient had been informed that there was no metal on the shot. The patient got both shot on right arm because she used right arm and she wanted to workout the stiffness of the shot right arm. The patient was given with muscle relaxant (as treatment) and she took muscle relaxant but as per patient it was waste of time, it did nothing. The patient stated, "I put give on one minute I better look for cream waste of time. I thought to release that waste of time nothing work, its only things feel good, live things let it rest." Upon addressing Medical Inquiry, she also reported that one of her girlfriends had experience the same side effect where a magnet was sticking on the same arm where they got the vaccine. Unspecified muscle relaxant was given as therapeutic measure as a result of sore arm/sored and painful arm on the same site where the vaccine was administered and sore muscles. The outcome of the events injection site magnetic, sore arm/sored and painful arm on the same site where the vaccine was administered, and sore muscles was reported as not resolved. The outcome of the event "she was working in the garden and she hurt her arm. She pulled a muscle in it. It was her right arm where she had gotten the shot" and "I got both shot on right arm because I used right arm and I wanna workout the stiffness of the shot right arm" was unknown.


VAERS ID: 1409745 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-02
Onset:2021-06-02
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Herpes virus infection, Inflammation, Pruritus, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021690520

Write-up: Herpes Virus associated vesicular rash on top of left foot, with intense, radiating itchiness, inflammation; Herpes Virus associated vesicular rash on top of left foot, with intense, radiating itchiness, inflammation; Herpes Virus associated vesicular rash on top of left foot, with intense, radiating itchiness, inflammation; Herpes Virus associated vesicular rash on top of left foot, with intense, radiating itchiness, inflammation; redness; This is a spontaneous report from a contactable consumer. A 48-year-old female patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, solution for injection, Lot number: EW0187), via an unspecified route of administration in the right arm on 02May2021 as a single dose for COVID-19 vaccination. On an unknown date 03:45 PM the patient received second dose of BNT162B2 (Lot number: EW0176), via an unspecified route of administration in the right arm on 02May2021 as a single dose for COVID-19 vaccination. Medical history included hypothyroidism. Concomitant medications were not provided. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine nor any other medications within 2 weeks of vaccination. The patient was not diagnosed with COVID-19 prior to or since the vaccination. The patient experienced Herpes Virus associated vesicular rash on top of left foot, with intense, radiating itchiness, inflammation. On 02Jun2021 08:30 PM, intensely itchy area on top of left foot, which she thought was a bug bite. Topical Benadryl (Diphenhydramine) was applied. On 03Jun2021, two small scabs emerged (approx. 5-8mm wide) that looked like abrasion/scab from excessive scratching. 03Jun2021 - 04Jun2021 itchiness subsided. On 05Jun2021, there was visible redness, inflammation and small vesicle formation around two scabbed areas in conjunction with intense radiating itchiness extending beyond areas of visible inflammation. 05Jun2021 - 06Jun2021 inflammation, intense radiating itchiness and formation of new and larger vesicles ultimately forming a 3'' rash across top of foot. On 08Jun2021 the patient consulted with primary care physician (PCP): Weeping vesicles and new vesicles formation noted. Antibiotics and topical cream prescribed, and culture performed. On 11Jun2021: second opinion with dermatologist and testing of affected area positive for Herpes virus. Antiviral medication was prescribed. Treatment for the adverse events included Cephalexin, Mupirocin and Valacyclovir. Outcome of the events was not recovered. No follow-up attempts are needed. No further information is expected.


VAERS ID: 1409956 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Drooling, Lethargy
SMQs:, Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

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

Write-up: LETHARGY, DROOLING


VAERS ID: 1410158 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-05-29
Onset:2021-06-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Peripheral swelling, Rash macular
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Patient has cancer and had a reaction after his chemotherapy treatment a few days after receiving his second COVID vaccine.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient got his vaccine on 5/29/21 and then received his normal chemotherapy treatment a few days after receiving the vaccine. He had red blotches all over his body and his left leg swelled. He didn''t have any problems with his first vaccine. He was and is currently taking a prednisone taper. He''s still experiencing these blotches and it doesn''t seem to be getting better so he wanted to make sure the pharmacy was aware.


VAERS ID: 1410194 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: For the duration of a couple weeks after the second Pfizer shot, I sporadically would experience moderate heart palpitations, chest pains, and chest feeling heavy. These symptoms would occur randomly throughout the day (typically when not doing any physical activity - i.e. driving in car or sitting on couch) and would last for several minutes. It never got severe enough to the point where I went to see a doctor. It has been 17 days since the second shot and I feel better and haven''t experienced the pains in a couple days.


VAERS ID: 1410681 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Body temperature increased, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Isibloom OCP, fluoxetine
Current Illness: Issues with abdominal pain and diarrhea for a couple months seen on 5/13/21.
Preexisting Conditions: IBS, endometriosis, anxiety/depression, seasonal allergies
Allergies: shellfish, amoxicillin, cefprozil, environmental allergies
Diagnostic Lab Data: none.
CDC Split Type:

Write-up: June 2nd had second Covid vaccine. Afterward had Vomiting, low grade fever, temp 99.6 when checked in the day but thinks was warmer at night, nausea, arm pain.


VAERS ID: 1410873 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-28
Onset:2021-06-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 LA / SYR

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

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

Write-up: Started with a rash on my face 5 days post vaccine that continued to spread to arms, stomach, back & thighs blistered in some areas


VAERS ID: 1411094 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Oedema peripheral, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Hives and edema on bilateral hands/arms


VAERS ID: 1412441 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Head injury, Nausea, Pyrexia, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: VITAMIN D 2000; VITAMIN C & ROSEHIP
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021655848

Write-up: Fainted; Bumped my head on the tiles in the bathroom; Nauseous; Fever; Chills; Vomiting; This is a spontaneous report from a contactable consumer (patient). A 43-year-old non-pregnant female patient received bnt162b2 (BNT162B2), dose 2 via an unspecified route of administration, administered in Arm Left on 02Jun2021 10:00 (Lot Number: EW0186) as single dose for covid-19 immunisation at the age of 43-year-old. The patient was healthy, no illnesses before vaccination. Concomitant medications included calcium carbonate, colecalciferol (VITAMIN D 2000), ascorbic acid, rosa canina fruit (VITAMIN C & ROSEHIP). The patient didn''t receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient was not diagnosed with COVID-19 prior to vaccination and hasn''t been tested for COVID-19 since the vaccination. The patient previously received the dose 1 administered in Arm Left on 12May2021 11:15 (Lot Number: EW0183) at the age of 43-year-old. On 02Jun2021 22:00, the patient felt nauseous, had fever, chills and vomiting. On 03Jun2021 07:00, the patient fainted and bumped the head on the tiles in the bathroom. The events resulted in visit of Emergency room/department or urgent care. Treatment received for the events. The outcome of the events was recovering. The patient reported, my symptoms began 12 hours after the second dose. I felt nauseous throughout the night and I had fever, chills and vomiting. 21 hours after vaccination I fainted and I bumped my head on the tiles in the bathroom. My husband called 911. Emergency check received from first responders. Follow up attempts are needed. Further information has been requested


VAERS ID: 1413075 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-24
Onset:2021-06-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: School       Purchased by: ?
Symptoms: Pityriasis rosea
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: none
Current Illness: none known
Preexisting Conditions: none
Allergies: none known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diagnosed with a case of Pityriasis rosea by general practitioner, symptoms started roughly 10 days after receiving Jansen vaccine. No possible cause could be identified.


VAERS ID: 1413139 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Arthralgia, Blood test normal, C-reactive protein normal, Chest X-ray normal, Chest discomfort, Chest pain, Chills, Dyspnoea, Electrocardiogram normal, Fibrin D dimer normal, Full blood count normal, Hypoaesthesia, Magnetic resonance imaging normal, Malaise, Metabolic function test normal, Migraine, Myalgia, Pyrexia, SARS-CoV-2 antibody test negative, Scan with contrast normal, Tachycardia, Troponin I normal
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: MRI with and without contrast (done at ER) Chest X-ray (done at ER) Blood labs 2 EKG?s CBC BMP CRP D dimer Troponin 1 All clear. Told it was from the vaccine. serum antibody test testing for any previous infection of covid and it was negative.
CDC Split Type:

Write-up: 1st day fine June 1 2021 Day 2 muscle aches joint pain malaise fever chills Day 3 nighttime/ morning of day 4 anaphylaxis Day 4 morning epi pen at urgent care/ tachycardia Day 5 tachycardia Day 6 tachycardia Day 7 tachycardia and migraine followed by numb right side arm / leg/ face Corticosteroids taken Day 9 visit ER FOR NUMBNESS to rule out stroke Corticosteroids end June 12 (tachycardia and shortness of breath continue since the symptoms first noticed) Night of 13th day anaphylaxis Urgent care june 14: prescribed beta blockers epi pens and corticosteroids Effects continuing today: Tachycardia (baseline prior to shot was 60 resting heart rate and now is in the 100+, going up 10 stairs causes it to hit 160, small movement triggers it- beta blockers help sometimes) Numbness on right side: face arm leg foot etc Chest pain, chest tightness, shortness of breath


VAERS ID: 1413265 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-26
Onset:2021-06-02
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO179 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Pain
SMQs:

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

Write-up: Rash after a week. Burning but not itching. Right after shot dizzy, headaches. I''m allergic to gadolinium and bug bites. Was sick after 2nd shot on 6.16.21 for 2 days- headaches, fatigue, chills, sore


VAERS ID: 1413497 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-28
Onset:2021-06-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / SYR

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

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

Write-up: Rash on back side of hands and knuckles


VAERS ID: 1413580 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-11
Onset:2021-06-02
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Burning sensation, Headache, Herpes zoster, Hypoaesthesia, Nerve injury, Pain, Polymenorrhoea, Rash, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Opportunistic infections (broad)

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

Write-up: Shingles on the left side of the body, same side as vaccine injection. Numbness, systemic rash following C8 and T1 dermatome. pain and burning, require emergency care and medications. Rash lasting for over three weeks and nerve damage and numbness in the carpal tunnel of left hand requiring further medical appointments and further medical attention. Apart from this most serious side effect, also experienced fainting and headaches as well as a discontinuance of my menstrual cycle during the initial injection. Subsequently a much shorter cycle the second one after injection of said vaccine.


VAERS ID: 1414187 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-27
Onset:2021-06-02
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Burning sensation, Fatigue, Hypoaesthesia, Muscle spasms, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: topomaz methotrextate folic acid sumatriptan
Current Illness: CIDP UCTD
Preexisting Conditions: CIDP
Allergies: penicillin propranolol buspurone
Diagnostic Lab Data: none, had IV steriod treatment for 3 days to treat
CDC Split Type:

Write-up: Right side numbness, tingling, weakness, felt like icy hot all of right side of my body, fatigue. Slight burning, numbness tingling left foot. Muscle spasms under both rib cages/diaphram.


VAERS ID: 1414414 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-02-01
Onset:2021-06-02
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Nasal congestion, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test positive, Secretion discharge, Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 mg tablet amLODIPine (NORVASC) 2.5 mg tablet atorvastatin (LIPITOR) 40 mg tablet brimonidine (ALPHAGAN) 0.2 % ophthalmic solution cholecalciferol, vitamin D3, (VITAMIN D3 ORAL) cyanocobalamin, vitamin B-12, (VITA
Current Illness:
Preexisting Conditions: Nervous Glaucoma Neuropathy, lumbosacral plexus Meibomian gland dysfunction (MGD) of both eyes Respiratory Allergic rhinitis Circulatory Hypertension Digestive Diverticulosis Fatty liver GERD without esophagitis Genitourinary CKD (chronic kidney disease) stage 2, GFR 60-89 ml/min Musculoskeletal Lipoma of left thigh Lipoma of right thigh Hirsutism Endocrine/Metabolic Familial hyperlipidemia Hypothyroidism Controlled type 2 diabetes mellitus, without long-term current use of insulin (CMS/HCC) Multinodular goiter Other Anxiety Depression Lactose intolerance Leukoplakia Overweight(278.02) History of repair of retinal tear by laser photocoagulation
Allergies: CinnamonSwelling PromethazineHallucinations CodeineAnxiety, Nausea and Vomiting Milk Containing ProductsNausea Only
Diagnostic Lab Data: 06/03/21 0036 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 06/02/21 1256 | Final result | Specimen: Swab from Nares COVID-19 SARS-CoV-2 Overall Result DetectedCritical 06/03/21 0036 COVID-19 PCR Collected: 06/02/21 1256 | Final result | Specimen: Swab from Nares
CDC Split Type:

Write-up: Topic: Acute Illness $g$g Jun 2, 2021 9:18 AM: Pt states she has a sinus infection. Pt sxs include, sore throat, burning in throat, coughing, head congestion, nose drainage, yellow mucus. Pt states provider has prescribed her medication in the past that has helped alleviate her sinus symptoms.


VAERS ID: 1414642 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-01
Onset:2021-06-02
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Pneumonia, Pneumonia streptococcal
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad)

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

Write-up: Acute respiratory failure; pneumonia; Strep pneumonia


VAERS ID: 1414648 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-01
Onset:2021-06-02
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow)

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

Write-up: Acute respiratory failure


VAERS ID: 1414652 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-01
Onset:2021-06-02
   Days after vaccination:93
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Atrial fibrillation
SMQs:, Anaphylactic reaction (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow)

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

Write-up: Acute respiratory failure; atrial fibrillation


VAERS ID: 1414662 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-01
Onset:2021-06-02
   Days after vaccination:93
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Atrioventricular block, Bradycardia, Respiratory failure
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypokalaemia (broad)

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

Write-up: Respiratory failure; bradycardia with heart block


VAERS ID: 1414975 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Diarrhoea, Fatigue, Headache, Pain in extremity
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), 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: none
Current Illness:
Preexisting Conditions: mainly diabetes
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: On the next day, 06/02/2021 and lasting 4 days, I experienced the following: painful left shoulder/arm, headache, extremely tired, uncontrollable diarrhea. Note: Daughter living in another city also had trouble over 4 days with the second shot. My Mother had Guillen-Barre Syndrome over 40 years ago and was incapacitated for a year.


VAERS ID: 1415005 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1415226 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-05-03
Onset:2021-06-02
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal pain, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood alkaline phosphatase increased, Blood lactic acid, C-reactive protein, Chest X-ray abnormal, Computerised tomogram abdomen, Drug screen, Electrocardiogram QT prolonged, Electrocardiogram abnormal, Laboratory test, Lung infiltration, Lung opacity, Lymphadenopathy, Motor dysfunction, Muscular weakness, Neutrophil percentage increased, Pneumonia, Procalcitonin, Protein total decreased, Pyrexia, Sepsis, Sinus tachycardia, Supraventricular extrasystoles, Tachycardia, Urine analysis normal, White blood cell count normal
SMQs:, Torsade de pointes/QT prolongation (narrow), Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Torsade de pointes, shock-associated conditions (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Drug abuse and dependence (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Biliary system related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lyrica, Estroven Complete Menopause, Cymbalta, Suboxone, Wellbutrin
Current Illness: Uncertain
Preexisting Conditions: Pt. vague with history when seen in ED, reports having "7 surgeries in 7 months" but not able to recall reason for surgeries.
Allergies: NKA, unaware if allergic to foods or other products
Diagnostic Lab Data: EKG - Sinus Tach, with PAC, borderline prolonged QT interval; CXR - bibasilar pneumonia - a single portable AP semierect view of the chest was obtained showing patchy hazy/ground glass infiltrates in the lung bases representing multifocal pneumonia; CT of ABD and pelvis - infiltrates in the lower lobe, lingula and right middle lobe, significant stool indicating constipation, common bile duct 1.4 cm in diameter may relate to prior cholecystectomy, prominent right external iliac and right inguinal lymph nodes - possibly reactive. WBC - 7.2, Neutrophil % - 85.2%, MDW - 22.5, Lactic acid 1.3, AST 55, ALT 50, Alkaline Phosphate 228, CRP 2.20, Total Protein 5.8, Procalcitonin 8.59. UA was WNL/negative. Rapid drug screen per urine was obtained.
CDC Split Type:

Write-up: Pt. presents to ER on 06/02/2021 stating "has not felt right for a long time". Pt. is not sure how long of time that she has not felt right. Pt. reports this am going to the refrigerator and was not able to grasp a pop. Pt. reports having right hand weakness that started this am. Pt. reports not being able to grasp her phone either due to the right hand weakness. Pt. was found to have an initial temp of 100.4 which spiked to 103.1, HR tachy at 126, BP 108/71, O2 sat on RA 98% and respirations 18. Pt. received and IV lock, fluids, CXR, EKG and CT of ABD and pelvis for c/o abd pain/discomfort and Lab were obtained. Pt. received Rocephin 1 gm IV and Zosyn 3.375 gm IV times 1 dose of each in ED. Pt. was transferred to Hospital in another area for diagnosis of sepsis and fever of unknown origin for higher level of care.


VAERS ID: 1415279 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1415280 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-05-05
Onset:2021-06-02
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

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

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

Write-up: Medication error. 1st dose was Moderna. 2nd dose should have been Moderna, but was given Pfizer.


VAERS ID: 1415340 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-21
Onset:2021-06-02
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Bell's palsy, Facial paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AllerClear (Loratadine)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: went to urgent care for diagnosis on June 2nd, date of onset of symptoms
CDC Split Type:

Write-up: Bell''s Palsy - right side facial paralysis, on day 20, still no improvements


VAERS ID: 1415515 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Pain, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Not taken at time of vaccine but taken morning and evening on the day of vaccine. One a day vitamin over 50+ age Gabapentin Hydrocodone Mucinix DM Vitamin D3 Vitamin B12 Extra strength Tylenol
Current Illness: None
Preexisting Conditions: Symptoms of Neuropathy but not 100% diagnosed
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain in right foot. Pain between ankle all the way up to knee. Waking up in night with tingling and sharp pain.


VAERS ID: 1416347 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

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

Write-up: Headache, blurred vision, fatigue, freezing chills with no fever. Symptoms lasted about 36 hours


VAERS ID: 1416747 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1416828 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-19
Onset:2021-06-02
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Fish Oil, Thera-m (multivitamin-iron-calcium), Psyllium, Rizatriptan 5mg
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE.
Diagnostic Lab Data: Went to follow up with cardiologist on 06/22/2021.
CDC Split Type:

Write-up: Patient has been having chest pain, shortness of breathe after 2 weeks of getting vaccine and was diagnosed with pericarditis on 06/22/2021.


VAERS ID: 1416975 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-28
Onset:2021-06-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Alligen, Vitamin D, B-12 shots (April).
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin, Antihistamines, epinephrine, novocaine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Rash on arm that went over complete body next day. Extreme itching which could not be calmed. Exhaustion. Swelling in hands and feet. Treatments: 6 day steroid, hydrocortisone cream 2.5%, acetaminophen, Xanax, Benedryl spray,


VAERS ID: 1417276 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 RA / IM

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

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

Write-up: Mom lied about the child''s age during a mass vaccination clinic.


VAERS ID: 1417585 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1417748 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1417789 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1417969 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Unknown  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1417987 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-27
Onset:2021-06-02
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

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

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

Write-up: Hive like rashes


VAERS ID: 1418008 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1418070 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B214 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Decreased appetite, Dizziness, Fatigue, Headache, Injection site pain, Malaise, Pain, Pyrexia, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: flu shots make me very ill for up to a week
Other Medications: Zegrid, Focus Factor, 5 HTP
Current Illness:
Preexisting Conditions: Ulcerative colitis, Heart murmur, asthma, fibromyalgia
Allergies: Iodine, Keflex, penicillian
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever of 103 for 4 days, severe chills, headaches, body aches, blurry vision, dizzy even laying down. no appetite, soreness at injection site, malais, exhaustion lasted for 2 weeks


VAERS ID: 1418097 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Unknown  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1418158 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1418173 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1418346 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1418613 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-04
Onset:2021-06-02
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Chills, Fatigue, Myalgia, Productive cough
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, ezetimibe, baby aspirin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: high temperature up to 103 degrees, chills, muscle aches, fatigue / tired started next day and continued for 3 days. then they subsided, then developed lingering cough and coughing up white flehm.


VAERS ID: 1420185 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Oropharyngeal pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Prozac, vitamin D
Current Illness: None
Preexisting Conditions: None
Allergies: Keflex
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Moderate unilateral throat pain on side vaccinations recieved. Appeared with 24 hours of injection, resolved within 7 days. Treated with ibuprofen with minimal relief


VAERS ID: 1420244 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1420271 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1420280 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1420512 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Joint lock, Menstrual disorder, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: i had the shakes and a fever, my joints were locked, and i started getting my period every other week


VAERS ID: 1421080 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1421091 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 2 RA / IM

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

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

Write-up: Pt received 2nd dose of Moderna vaccine from a vial that had reached it''s beyond use date 10 days prior. Pt did not experience any adverse effects or side effects from this vaccine.


VAERS ID: 1421106 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Unknown  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1421109 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 2 RA / IM

Administered by: Private       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: Unknown, vaccine given at a community outreach event.
Current Illness: Unknown, vaccine given at a community outreach event.
Preexisting Conditions: Unknown , vaccine given at a community outreach event.
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Recipient was inadvertently was given 2nd dose of Moderna vaccine from a vial that had reached its beyond use date 10 days prior.


VAERS ID: 1421152 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Blood pressure medication
Current Illness: Unknown, vaccine given at a community outreach event.
Preexisting Conditions: Hypertension
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: She was inadvertently given 2nd dose of Moderna vaccine from a vial that had reached its beyond use date 10 days prior. She denied any adverse effects or side effects from the vaccine administered.


VAERS ID: 1421165 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1421172 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 LA / IM

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

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

Write-up: Mother brought her son to get his second dose of Pfizer vaccine and it was discovered that he was only 11 years old. She wanted me to give him the 2nd dose, but I told her that he needed to be 12 years old and we would need to wait until 6/30/21 before administering the 2nd dose due to his age. Mom filled out son''s date of birth wrong and age: 12 on the administration form that was filled out on 6/2/21. No adverse events occurred after 1st dose was administered and mother wanted to get son a second dose as quickly as possible. This form required that I fill in a date and time of adverse event but no adverse event was reported.


VAERS ID: 1421173 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1421176 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1421181 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1421303 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-05-28
Onset:2021-06-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Epistaxis
SMQs:, Haemorrhage terms (excl laboratory terms) (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: Sesame Seeds
Diagnostic Lab Data:
CDC Split Type:

Write-up: I''ve been getting bloody noses a lot (at least every three days, and sometimes 3 or 4 times a day). The bleeding also lasts much longer than I''ve had before, and will sometimes soak entirely through a tissue or two before stopping.


VAERS ID: 1421372 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Unknown  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1421436 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Unknown  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1421772 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hyperhidrosis, Irritability, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Generalised convulsive seizures following immunisation (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Your Current Medications Are albuterol HFA 90 mcg/actuation inhaler (Taking) INHALE 2 PUFFS INTO LUNGS EVERY 6 HOURS AS NEEDED FOR WHEEZING atropine (ISOPTO ATROPINE) 1 % ophthalmic solution (Taking) INSTILL ONE DROP IN TO THE RIGHT EYE EV
Current Illness: Respiratory Acute allergic rhinitis Asthma Moderate persistent asthma without complication Digestive Chronic constipation Chronic gastritis without bleeding Dental caries Gastroesophageal reflux disease without esophagitis Nervous and Auditory Cerebral palsy, quadriplegic (HCC) Intractable generalized idiopathic epilepsy without status epilepticus (HCC) Neuronal ceroid lipofuscinosis (HCC) Spastic quadriplegic cerebral palsy (HCC) Musculoskeletal and Integument Decubitus ulcer of back, stage 1 Decubitus ulcer of sacral region, stage 1 Flexion contracture of wrist joint, left Flexion contracture of wrist joint, right Other osteoporosis with current pathological fracture Scoliosis Skin infection at gastrostomy tube site (HCC) Genitourinary Recurrent scrotal infection Testicular torsion Other Annual physical exam Cataract of right eye Central corneal opacity of right eye Contracture, joint, multiple sites Fecal incontinence Fever, low grade Flexion contracture of elbow, left Flexion contracture of right elbow Right retinal detachment S/P percutaneous endoscopic gastrostomy (PEG) tube placement (HCC) Seizure (HCC) Severe intellectual disability Testicular swelling Urinary incontinence Vaccination reaction
Preexisting Conditions: Asthma Chronic constipation Chronic gastritis without bleeding Gastroesophageal reflux disease without esophagitis Cerebral palsy, quadriplegic (HCC) Intractable generalized idiopathic epilepsy without status epilepticus (HCC) Neuronal ceroid lipofuscinosis (HCC) Spastic quadriplegic cerebral palsy (HCC) Flexion contracture of wrist joint, left Flexion contracture of wrist joint, right Other osteoporosis with current pathological fracture Scoliosis Skin infection at gastrostomy tube site (HCC) Testicular torsion Cataract of right eye Central corneal opacity of right eye Contracture, joint, multiple sites Fecal incontinence Flexion contracture of elbow, left Flexion contracture of right elbow Right retinal detachment Seizure (HCC) Severe intellectual disability Urinary incontinence
Allergies: Allergies as of 6/23/2021 Pediasure [food Supplemt, Lactose-reduced] Valproic Acid
Diagnostic Lab Data:
CDC Split Type:

Write-up: INCREASED DIAPHORESIS, INCREASED IRRITATION, NEW SEIZURE ACTIVITY AFTER 2 WEEKS OF VACCINE


VAERS ID: 1421774 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-24
Onset:2021-06-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest pain, Computerised tomogram, Dyspnoea, Electrocardiogram, Mobility decreased, Myocarditis, Pain, Palpitations, Pericarditis, Ultrasound scan, X-ray
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Testosterone Cypionate Celexa
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Ekg, CT scan, bloodwork, ultrasound - hospital 6/11/2021 Ekg, X-ray, bloodwork, ultrasound - BI 6/17/2020
CDC Split Type:

Write-up: Heart inflammation (diagnosis myocarditis from one hospital & pericarditis by the other) Chest pains, trouble breathing, cannot move easily without pain., heart palpitations (those ended). Started off being told to take Advil every 6 hours. That didn?t help, went to a new ER, they gave me colchicine. It?s helping but I still am pretty much bedridden.


VAERS ID: 1421803 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1421805 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-26
Onset:2021-06-02
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect route of product administration, Muscle strain, Musculoskeletal stiffness, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Dystonia (broad), Parkinson-like events (broad), Drug abuse and dependence (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (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: Patient reports approximately 1 week after receiving Moderna COVID vaccine she started to have tingling in her left arm down to her left hand. The tingling also went back up her arm to her neck causing muscle strain in the area and causing her to crack her neck. Patient''s primary care provider told her this tingling is a result of the vaccine being given too low on the arm. Patient also reports she has gone to physical therapy as a result of this adverse event she associates with the Moderna vaccine.


VAERS ID: 1422077 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1422513 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1422526 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1422557 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Unknown  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1422744 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1423321 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Confusional state, Disorientation, Dysarthria, Fatigue, Hypertension, Incontinence, Lethargy
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: multi vitamins Levothyroxine Blood Pressure medication eye vitamins
Current Illness: none
Preexisting Conditions: Heart Disease Smoker
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient became disoriented incontinent extremely high blood pressure lethargic exhausted confused jumbled speech


VAERS ID: 1423346 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1423354 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 1 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1423532 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole, Zoloft, zertec,gilpezide,
Current Illness:
Preexisting Conditions: Fibromyalgia, diabetes, asthma, PTSD, bpd
Allergies: Toradol, walnuts
Diagnostic Lab Data: 2 EKGS, 1 on 6/4 and the other on 6/11, showing possible enlargement of left atrial valve. Blood tests on 6/4 normal. ECG on 6/24, waiting for results.
CDC Split Type:

Write-up: Severe chest pains found to not be myocarditis or pericarditis. However, the vaccine may have inflamed a previously unknown heart condition.


VAERS ID: 1423794 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041CZ1A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Feeding disorder, Feeling abnormal, Migraine, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin 300mg 2xdaily Verapamil 40mg 2xdaily Tizanidine 40mg 2xdaily
Current Illness:
Preexisting Conditions: Migraines Pinched Nerve in neck
Allergies: Shellfish Contrast
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: He woke up with a severe migraine, was kind of foggy. He felt like he had been poisoned. He was nauseous, spinning, and couldn''t eat. He rode it out. It took 1 day to get back to normal.


VAERS ID: 1423855 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal discomfort, Ageusia, Anosmia, Decreased appetite, Dizziness, Fatigue, Gait disturbance, Headache, Lethargy, Muscle spasms, Nausea, Respiratory tract congestion, Sinusitis, Stomatitis, Vomiting
SMQs:, Severe cutaneous adverse reactions (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), 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: Budesonide 3mg/once daily
Current Illness:
Preexisting Conditions: Crohns, celiac, IBS, COPD, asthma, GIST tumor
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Full body cramping. Stomach feel like it?s in knots. Headache. Nausea. Vomiting. Stumbling. Dizziness. Sinuses and mouth scratchy. Congestion. Severe fatigue and lethargic. Loss of appetite, taste and smell.


VAERS ID: 1424072 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-03
Onset:2021-06-02
   Days after vaccination:119
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029K20A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Crestor 5 mg every day Ecotrin - 1 p.o. every day
Current Illness: None
Preexisting Conditions: High cholesterol
Allergies: Allergic to tomatoes Allergic to IV Iodine
Diagnostic Lab Data: Tested positive for COVID-19 (PCR) on 6/2/2021.
CDC Split Type:

Write-up: Breakthrough vaccine.


VAERS ID: 1424129 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-07
Onset:2021-06-02
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Joint range of motion decreased
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Joint pain started about 3 weeks after vaccine. First affected joints in both hands and finger, has progressed to knee pain since first noticed. Range of motion in hands is limited due to pain and loss of flexibility. Range of motion in knees is currently unaffected but pain is moderate during daily activities and work. No prior history of injuries to hands or knees.


VAERS ID: 1424284 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-11
Onset:2021-06-02
   Days after vaccination:83
Submitted: 0000-00-00
Entered: 2021-06-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Activated partial thromboplastin time normal, Angiogram pulmonary abnormal, Anti factor X activity increased, Anticoagulant therapy, Antiphospholipid antibodies negative, Arteriogram carotid normal, Asthma exercise induced, Atrial septal defect, Blood folate normal, Blood homocysteine increased, Cardiolipin antibody negative, Cerebral artery occlusion, Cerebral artery thrombosis, Cerebral infarction, Chest discomfort, Computerised tomogram head abnormal, Deep vein thrombosis, Dysarthria, Dyspnoea, Dyspnoea exertional, Echocardiogram, Echocardiogram abnormal, Facial paralysis, Factor II mutation, Gene mutation identification test negative, Headache, Intensive care, International normalised ratio normal, Muscular weakness, Paradoxical embolism, Protein C increased, Protein S increased, Prothrombin time prolonged, Pulmonary embolism, Thrombectomy, Thrombolysis, Upper motor neurone lesion, Vitamin B12 normal
SMQs:, Rhabdomyolysis/myopathy (broad), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Ischaemic central nervous system vascular conditions (narrow), 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), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hearing impairment (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: norgestimate-ethinyl estradiol (Tri-Sprintec, 28,) 0.18/0.215/0.25 mg-35 mcg (28) Oral Tab Sig: Take 1 tablet by mouth daily Cyclobenzaprine (FLEXERIL) 10 mg Oral Tab Sig: Take 1 tablet by mouth 3 times a day as needed for muscle spasms
Current Illness: Thoracic Spine Pain
Preexisting Conditions:
Allergies: nkda
Diagnostic Lab Data: Ref. Range 6/14/2021 16:24 6/16/2021 18:22 FOLATE Latest Ref Range: $g=4.0 ng/mL 12.0 HOMOCYSTEINE Latest Ref Range: 0.0 - 13.9 umol/L 14.4 (H) VIT B12 Latest Ref Range: $g=200 pg/mL 357 Results as of 6/24/2021 13:13 Ref. Range 6/14/2021 11:32 6/14/2021 16:24 6/15/2021 15:00 6/15/2021 21:12 6/16/2021 03:10 6/16/2021 07:01 6/16/2021 16:10 6/21/2021 13:33 APTT Latest Ref Range: 23.8 - 36.1 second(s) 24.1 28.9 PT Latest Ref Range: 11.7 - 14.3 second(s) 13.6 INR Latest Units: Ratio 1.1 PROT C Latest Ref Range: 70 - 130 % TND 87 193 (H) PROT S Latest Ref Range: 65 - 140 % TND 90 196 (H) ANTICOAG Unknown NOT IND NOT IND CARDIOLIPIN AB, SER Latest Ref Range: NEGATIVE NEGATIVE LEIDEN FACTOR ANAL Unknown NEGATIVE LUPUS ANTICOAG Latest Ref Range: NEGATIVE TND NEGATIVE NEGATIVE ANTI XA, HEP UNFR Latest Units: U/mL <0.10 0.15 0.27 0.16 COMMENT, COAGULATION Unknown SEE NOTE F2 GENE P. G20210A MUTATION Unknown NEGATIVE
CDC Split Type:

Write-up: 35 Y female no signif PMH but with OCP (TriSprintec) since at least 2018, family hx of strokes in family members'' 40s, daily marijuana use, and recently (10 days ago) seen in clinic for shortness of breath who per chart review was in her usual state of health until 10:30 am today shen she developed R sided headache, slurred speech, and L arm weakness while she was working out at the gym. At the time she was doing light cardio exercise including jumping jacks and lunges. On arrival stroke scale - 3 for facial palsy, left arm drift, and mild dysarthria. CT H demonstrated hyperdense R MCA which corresponded with a filling defect in the R MCA (M2/M3 segment) c/w thrombosis; her CTa neck was normal and there were no e/o hemorrhage. Furthermore, this same CTa showed extensive bilateral PE. An extended stroke alert was called and she was given IV tenecteplase at 1250pm and underwent thrombectomy. 2 weeks ago (6/2) she was seen in clinic for sudden onset shortness of breath, thought at that time by that clinician to be most likely exercise-induced asthma vs less likely ACS. She was advised to use her already written albuterol and had follow up in 2 days (6/4). At that time it was noted she had more SOB with exercises and increased chest tightness that were both relieved with inhaler use. She has a family history of strokes: Maternal uncle and maternal aunt strokes in their 40s Recent surgeries/immobility/travel: No surgeries, no more than a 2 hour car ride Smoking history: Dialy cannabis smoking but no tobacco smoking Age appropriate cancer screen: Yes Family history of cancer: breast cancer in grandmother Baseline functional status Full IADL''s and A&O x4. At time of ICU consult, temp 98, BP 140/89, HR 88, RR 18. Patient received: intraop NS, Versed, fentanyl, tenecteplase for thrombectomy Labs notable for All labs wnl 35 y.o female with no significant PMH on OCP presented with shortness of breath and slurred speech and LUE weakness found to have acute right M1 occlusion. She underwent thrombolysis with successful recanalization. Deficits resolved. She was also found bilateral PE and non occlusive DVT. Repeat imaging stable. TTE with evidence of small PFO. Today, she is feeling well, denies shortness of breath or new neurological complaints/deficits. 1. R MCA infarct s/p TNK and thrombectomy 6/14 with no residual deficits - secondary to paradoxical embolism. Appreciate neurology recommendations. Small PFO found on TTE, appreciate cardiology evaluation for closure. 2. Bilateral PE/non occlusive DVT - mildly elevated homocysteine level. Rest of hypercoagulable workup pending. Continue heparin gtt, transition to Pradaxa with Lovenox bridging.


VAERS ID: 1426761 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-19
Onset:2021-06-02
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Bursitis, X-ray
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Lupus Glaucoma Poly Kendistris Livedo Reticularis Vaculitis Tachycardia fibromyalgia Immune Deficiency
Allergies: Penicillin Erythromycin Sulfa Spiro Drugs
Diagnostic Lab Data: x-ray
CDC Split Type: vsafe

Write-up: I went to hospital on 06/04/2021. They x-rayed it and wrapped it. I followed up with my rheumatologist. She put a drain in it but it came back that night. They diagnosed it as olecranon bursitis. All I have on now is a compression wrap.


VAERS ID: 1426763 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

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

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

Write-up: Systemic: Numbness (specify: facial area, extremities)-Mild, Additional Details: patient said she had numbness occure 2 hours after first shot. numbness in left neck,left chest,left arm,left shoulder


VAERS ID: 1427413 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-26
Onset:2021-06-02
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

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

Write-up: Urticaria and rash 7 days after first dose.


VAERS ID: 1427695 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-25
Onset:2021-06-02
   Days after vaccination:97
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 LA / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 RA / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Dizziness, Dyspnoea, Respiratory syncytial virus test positive, SARS-CoV-2 test negative, Sputum discoloured
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Venlafaxine
Current Illness: none
Preexisting Conditions: Asthma
Allergies: none
Diagnostic Lab Data: Covid Negative 6/10 RSV positive 6/10
CDC Split Type:

Write-up: Around the 2nd I was coughing up green phlegm and had a severe cough. After getting antibiotic, the symptoms were not better after the dosage was over. I started getting more of a wet, heavy cough. Most of the phlegm I was coughing up was coming from my lungs. I was getting light headed and breathing was getting very struggled. On the evening of 6/10/2021, my mom advised that I go to the ER as my breathing was getting very taxed. During this visit I was diagnosed with RSV and tested COVID negative.


VAERS ID: 1427760 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / N/A LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Chest discomfort, Chills, Dizziness, Fatigue, Hemiparesis, Muscle tightness, Musculoskeletal stiffness, Sinusitis, Visual impairment
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Vestibular disorders (broad), Arthritis (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: None
Current Illness: No
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Immediately after receiving vaccine, patient felt dizzy but waited 15 minutes and felt ok to drive home. Upon arriving home, she felt sensation of weakness on her left side. She stated that her vision was somewhat impaired and that she felt weak, although able to move her arms and legs. This lasted for around one hour. She also started to have symptoms of fatigue, stiffness of neck and shoulders(bilaterally), chills, tightness of the upper back and chest but no shortness of breath noted. These symptoms continue. She went to an urgent care office on 6/11/21 and was diagnosed with a sinus infection. No lab work or medical tests were performed. She was prescribed Augmentin and finished full regimen of medication. The symptoms of fatigue, stiffness of neck and shoulders(bilaterally), chills, tightness of the upper back and chest continue today.


VAERS ID: 1427867 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Flushing
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad)

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

Write-up: Patient describes flushing and face, neck and upper chest, dizziness and lightheadedness that started 45 minutes after the vaccine was administered. She had already left the clinic at this time. She did not take any medications or seek any medical attention. The symptoms resolved 45 minutes after they started. She subsequently consulted with her primary care provider, who advised her not to get her second vaccine dose and referred her to an allergist for further evaluation and advice.


VAERS ID: 1427884 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-26
Onset:2021-06-02
   Days after vaccination:68
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: PRN Tylenol, Ventolin inhaler, Dulcolax PRN, multivitamin, miralax
Current Illness: No acute conditions noted.
Preexisting Conditions: Type 2 Diabetes, anemia, hypercholesteremia, vitamin d deficiency, CKD, hypertension, goiter
Allergies: Niacin preparations, actos
Diagnostic Lab Data: PCR on 05/28/2021 confirming COVID diagnosis.
CDC Split Type:

Write-up: Patient fully vaccinated, admitted to hospital on 05/28/2021 for COVID pneumonia, after being diagnosed per PCR on 05/28/2021. Patient discharged home on 06/02/2021 and then readmitted 06/08/21 to 06/10/21 for failure to thrive. Discharge home with homecare on 06/10/21.


VAERS ID: 1427983 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWNWILLCALL / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Blister, Diarrhoea, Headache, Pain in extremity, Rash, Rash erythematous, Rash papular, Rash pruritic
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, ibuprofen
Current Illness: none
Preexisting Conditions: arthritits
Allergies: Keflex-rash Hydrocodone-rash Codeine-rash
Diagnostic Lab Data: none
CDC Split Type: vsafe

Write-up: Starting on the day of the vaccine, 6 hours afterwards I had left arm pain and notice a blister appeared. I also had upset stomach, headache, and diarrhea. By the next morning, most symptoms resolved but the rash remaining and diarrhea. The rash is raised, blister-like, measles looking, itchy and painful and now all over my body from head to toe. I did not take any medication. I went to see the doctor and was prescribed 2 topical creams which not help. The rash continue to spread. I let it run its course and now it''s slowly improving. I am still having daily diarrhea.


VAERS ID: 1428099 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Injection site swelling, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: pollen and dust
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: patient reported increased swelling and pain at injection site day after receiving the second dose of moderna vaccine followed by admission to hospital for 2 days with reported oxygen support.


VAERS ID: 1428243 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-02-25
Onset:2021-06-02
   Days after vaccination:97
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood urine present, Culture negative, Haematuria
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: simvastatin, olanzapine, lisinoplil, allopurinol, levothyroxin
Current Illness:
Preexisting Conditions: schizophenia, hypothyroidism, hypertension
Allergies: none
Diagnostic Lab Data: hematuria, culture negative
CDC Split Type:

Write-up: blood in urine


VAERS ID: 1429319 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-01
Onset:2021-06-02
   Days after vaccination:93
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, COVID-19, Chills, Cough, Dizziness, Fatigue, Illness, Productive cough, Pulmonary congestion, Sinus congestion
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Arthritis (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ESTRADIOL; PROGESTERONE; BABY ASPIRIN; ESCITALOPRAM; CRESTOR; CLARITIN [LORATADINE]; FLONASE [FLUTICASONE PROPIONATE]; MAGNESIUM; VITAMIN C [ASCORBIC ACID]
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Joint pain; Chills; Congested chest; So bad COVID-19 infection after the 2nd dose; Very sick; A lot of phlegm; Lots of coughing; Congested head/ Sinus infection; Dizziness; Fatigue; This spontaneous case was reported by a patient and describes the occurrence of PULMONARY CONGESTION (Congested chest) in a 63-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 020B21A and 029A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concomitant products included ESTRADIOL, PROGESTERONE, ACETYLSALICYLIC ACID (BABY ASPIRIN), ESCITALOPRAM, ROSUVASTATIN CALCIUM (CRESTOR), LORATADINE (CLARITIN [LORATADINE]), FLUTICASONE PROPIONATE (FLONASE [FLUTICASONE PROPIONATE]), MAGNESIUM and VITAMIN C [ASCORBIC ACID] for an unknown indication. On 01-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 31-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 02-Jun-2021, the patient experienced PULMONARY CONGESTION (Congested chest) (seriousness criterion medically significant), COVID-19 (So bad COVID-19 infection after the 2nd dose), ILLNESS (Very sick), PRODUCTIVE COUGH (A lot of phlegm), COUGH (Lots of coughing), SINUS CONGESTION (Congested head/ Sinus infection), DIZZINESS (Dizziness), FATIGUE (Fatigue) and CHILLS (Chills). On an unknown date, the patient experienced ARTHRALGIA (Joint pain). At the time of the report, PULMONARY CONGESTION (Congested chest), COVID-19 (So bad COVID-19 infection after the 2nd dose), ILLNESS (Very sick), PRODUCTIVE COUGH (A lot of phlegm), COUGH (Lots of coughing), SINUS CONGESTION (Congested head/ Sinus infection), DIZZINESS (Dizziness), FATIGUE (Fatigue), ARTHRALGIA (Joint pain) and CHILLS (Chills) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Patient took Aleve, Mucinex DM to breakup the phlegm, Tylenol, and Pain pill as a treatment medications. Company Comment : For the event of COVID-19:Based on mechanism of action of mRNA -1273 vaccine, the event is assessed as unlikely related to mRNA-1273.(Moderna COVID-19 Vaccine) For other events:Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Reporter did not allow further contact; Sender''s Comments: For the event of COVID-19:Based on mechanism of action of mRNA -1273 vaccine, the event is assessed as unlikely related to mRNA-1273.(Moderna COVID-19 Vaccine) For other events:Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1429599 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Blood test, Dyspnoea, Electrocardiogram, 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), Hypertension (narrow), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pepcid, Zyrtec, escitalopram, synthtoid, ambien, trazodone
Current Illness: None
Preexisting Conditions: Hypothyroid, asthma, insomnia, sleep apnea
Allergies: Seasonal, dairy, cross reactive to grains
Diagnostic Lab Data: EKG, epi pen, steroids, blood work, increased blood pressure
CDC Split Type:

Write-up: Shortness of breath, increased heart rate beginning after 2 weeks


VAERS ID: 1429705 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-28
Onset:2021-06-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure increased, Fatigue, Vertigo, Vestibular neuronitis, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Vestibular disorders (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: Benazapril, atorvastatin, levothyrozine, hydrochlorothiazide, calcium, mutli vits, magnesium, vit D
Current Illness: none
Preexisting Conditions: hypertension, hypothyroid, hyperlipidemia
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Sudden onset severe vestibular neuritis with vertigo, vomiting, extreme prostration - extremely symptomatic with significantly elevated BP - severely symptomatic x 36 hrs - mildly symptomatic for another 3 days


VAERS ID: 1429732 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Texas  
Vaccinated:1991-12-07
Onset:2021-06-02
   Days after vaccination:10770
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 LA / IM

Administered by: Pharmacy       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:

Write-up: pt feeling extreme nauseous from 6/2 after her 2nd dose of covid vaccine.


VAERS ID: 1429757 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspepsia
SMQs:, Gastrointestinal nonspecific dysfunction (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: Oxcarbazepime 600mg x2 daily
Current Illness: None
Preexisting Conditions: Seizures
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Heartburn


VAERS ID: 1429764 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-24
Onset:2021-06-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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

Write-up: "Covid arm" , oval shaped red patch around injection site. Lasted 3 weeks plus, still mildly present at time of second dose, then more pronounced.


VAERS ID: 1429798 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-29
Onset:2021-06-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebrovascular accident, Fall, Speech disorder
SMQs:, 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), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow)

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

Write-up: Systemic: Stroke-Severe, Additional Details: Spouse of patient states that wife fell on 6/2/21 and went to the emergency room. States that MD said patient no histoy of blood disorder and believes patient got a stroke due to COVID vaccine. Currently taking blood thinners for incident. Now has trouble speeking due to blood clot/stroke.


VAERS ID: 1429949 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

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

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

Write-up: No reported adverse event- 2nd dose given out of CDC guidelines. 2nd dose was administered at 21 days, instead of 28. The patient reports having no issues with either vaccination.


VAERS ID: 1430057 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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

Write-up: fever of 102, chills, pain in arm, weakness, fatigue, headache


VAERS ID: 1430158 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-05-28
Onset:2021-06-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine phosphokinase, Blood creatine phosphokinase MB, Burning sensation, C-reactive protein, Cardiac discomfort, Catheterisation cardiac, Chest X-ray, Echocardiogram, Electrocardiogram, Fibrin D dimer, Glomerular filtration rate, Lipids, Myocardial necrosis marker, Myocarditis, Red blood cell sedimentation rate, Respiratory viral panel, Troponin
SMQs:, Peripheral neuropathy (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Rosuvastatin, Estarylla, vitafusion probiotic for digestive health
Current Illness: None
Preexisting Conditions: High cholesterol (hereditary)
Allergies: Alcohol (beer, cider, liquor, etc)
Diagnostic Lab Data: EKGs (x5), SARS antigen test, cardiac stat panel, glomerular filtration rate, CK total and CKMB, c reactive protein, sedimentation rate, d-dimer test, lipid panel, troponin tests (x4) chest X-ray, echocardiogram, heart cath procedure, all performed from June 2nd to June 4th.
CDC Split Type:

Write-up: Woke up with burning sensation and pressure in my heart, felt like a heart attack and was treated with Myocarditis, treated with metoprolol succinate to help heal the inflammation of my heart.


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