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

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



Case Details (Reverse Sorted by Onset Date)

This is page 216 out of 8,010

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VAERS ID: 1693401 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / SYR

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

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

Write-up: Swelling in lymph-nodes in armpit on side that shot was received


VAERS ID: 1693430 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Decreased appetite, Dry throat, Headache, Nasal dryness, Nasopharyngitis
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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: Daily multivitamin Advil Green Tea with Ginger
Current Illness: None
Preexisting Conditions: Epilepsy
Allergies: Shrimp
Diagnostic Lab Data: None, home remedies and advil
CDC Split Type:

Write-up: Cold symptoms, uncontrollable headache, dry nose and throat, no appetite.


VAERS ID: 1693433 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Vaccine positive rechallenge
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Chills, excessive tiredness, 64, March 30 and April 28, covid 19 moderna.
Other Medications: Imuran, Omnaprazole, Atorvastin, Iron, Multivitamin, Calcium + vit. D, Zyrtec, Voltaren gel, Tylenol extra strength.
Current Illness: None
Preexisting Conditions: Crohn''s, anemia, acid reflux, hiatel hernia, newly diagnosed a fib.
Allergies: Lactose, Largon,
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chills, excessive tiredness.


VAERS ID: 1693436 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling cold, Muscle fatigue, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

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

Write-up: muscle fatigue and intense shaking due to a feeling of cold


VAERS ID: 1693450 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-02
Onset:2021-09-10
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash, Rash maculo-papular
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Migraine headaches
Allergies: Suprax, some seafood, caragein
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Maculopapular rash on both the palmar and dorsal surface of bilateral hands started one week after vaccination.


VAERS ID: 1693455 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-08
Onset:2021-09-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939901 / 3 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Anxiety, Atrial fibrillation, Blood glucose normal, Brain natriuretic peptide, Chest X-ray, Electrocardiogram repolarisation abnormality, Fatigue, Ischaemia, Left ventricular dysfunction, Left ventricular failure, Lethargy, Malaise, Nausea, Pain of skin, Rales, SARS-CoV-2 test, Wheezing
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (narrow), Conduction defects (narrow), Supraventricular tachyarrhythmias (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: PARoxetine HCl Tablet 20 MG Give 1 tablet by mouth one time a day for GAD Pharmacy Active 9/4/2021 07:00 9/3/2021 Warning: Controlled Drug There is a black box warning associated with this order. Please click to view details. The Resident
Current Illness: UNSPECIFIED ATRIAL FIBRILLATION (I48.91) 5/4/21 Primary/Principal/Admission (67) Primary/Principal/Admission SHORTNESS OF BREATH (R06.02) 5/4/21 Secondary #1 Admitting Dx (69) CHRONIC COMBINED SYSTOLIC (CONGESTIVE) AND DIASTOLIC (CONGESTIVE) HEART FAILURE (I50.42) 5/4/21 Secondary #2 Admitting Dx (69) MUSCLE WEAKNESS (GENERALIZED) (M62.81) 5/5/21 Secondary #3 Admitting Dx (69) UNSTEADINESS ON FEET (R26.81) 5/5/21 Secondary #4 Admitting Dx (69) NEED FOR ASSISTANCE WITH PERSONAL CARE (Z74.1) 5/5/21 Secondary #5 Admitting Dx (69) HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE WITH HEART FAILURE AND STAGE 1 THROUGH STAGE 4 CHRONIC KIDNEY DISEASE, OR UNSPECIFIED CHRONIC KIDNEY DISEASE (I13.0) 5/4/21 Secondary #6 Admitting Dx (69) TYPE 2 DIABETES MELLITUS WITH HYPERGLYCEMIA (E11.65) 5/4/21 Secondary #7 Admitting Dx (69) DYSPHAGIA, UNSPECIFIED (R13.10) 8/1/21 Secondary 9 Or More During Stay KLEBSIELLA PNEUMONIAE [K. PNEUMONIAE] AS THE CAUSE OF DISEASES CLASSIFIED ELSEWHERE (B96.1) 7/19/21 Secondary 9 Or More During Stay URINARY TRACT INFECTION, SITE NOT SPECIFIED (N39.0) 7/19/21 Secondary 9 Or More During Stay OTHER SYMBOLIC DYSFUNCTIONS (R48.8) 7/16/21 Secondary 9 Or More During Stay ALLERGY STATUS TO UNSPECIFIED DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES (Z88.9) 6/1/21 Secondary 9 Or More CONSTIPATION, UNSPECIFIED (K59.00) 5/5/21 Secondary 9 Or More Admitting Dx (69) HYPOTHYROIDISM, UNSPECIFIED (E03.9) 5/5/21 Secondary 9 Or More Admitting Dx (69) INSOMNIA, UNSPECIFIED (G47.00) 5/5/21 Secondary 9 Or More Admitting Dx (69) MAJOR DEPRESSIVE DISORDER, RECURRENT, UNSPECIFIED (F33.9) 5/5/21 Secondary 9 Or More Admitting Dx (69) ANEMIA, UNSPECIFIED (D64.9) 5/4/21 Secondary 9 Or More Admitting Dx (69) CAROTID ARTERY SYNDROME (HEMISPHERIC) (G45.1) 5/4/21 Secondary 9 Or More Admitting Dx (69) CHRONIC KIDNEY DISEASE, STAGE 3 UNSPECIFIED (N18.30) 5/4/21 Secondary 9 Or More Admitting Dx (69) GENERALIZED ANXIETY DISORDER (F41.1) 5/4/21 Secondary 9 Or More Admitting Dx (69) IRRITABLE BOWEL SYNDROME WITH CONSTIPATION (K58.1) 5/4/21 Secondary 9 Or More Admitting Dx (69) METABOLIC DISORDER, UNSPECIFIED (E88.9) 5/4/21 Secondary 9 Or More Admitting Dx (69) MIXED HYPERLIPIDEMIA (E78.2) 5/4/21 Secondary 9 Or More Admitting Dx (69) MORBID (SEVERE) OBESITY DUE TO EXCESS CALORIES (E66.01) 5/4/21 Secondary 9 Or More Admitting Dx (69) OSTEOPATHY IN DISEASES CLASSIFIED ELSEWHERE, UNSPECIFIED SITE (M90.80) 5/4/21 Secondary 9 Or More Admitting Dx (69) POLYOSTEOARTHRITIS, UNSPECIFIED (M15.9) 5/4/21 Secondary 9 Or More Admitting Dx (69) POSTMENOPAUSAL ATROPHIC VAGINITIS (N95.2) 5/4/21 Secondary 9 Or More Admitting Dx (69) SPINAL STENOSIS, SITE UNSPECIFIED (M48.00) 5/4/21 Secondary 9 Or More Admitting Dx (69) STRESS INCONTINENCE (FEMALE) (MALE) (N39.3) 5/4/21 Se
Preexisting Conditions: UNSPECIFIED ATRIAL FIBRILLATION (I48.91) 5/4/21 Primary/Principal/Admission (67) Primary/Principal/Admission SHORTNESS OF BREATH (R06.02) 5/4/21 Secondary #1 Admitting Dx (69) CHRONIC COMBINED SYSTOLIC (CONGESTIVE) AND DIASTOLIC (CONGESTIVE) HEART FAILURE (I50.42) 5/4/21 Secondary #2 Admitting Dx (69) MUSCLE WEAKNESS (GENERALIZED) (M62.81) 5/5/21 Secondary #3 Admitting Dx (69) UNSTEADINESS ON FEET (R26.81) 5/5/21 Secondary #4 Admitting Dx (69) NEED FOR ASSISTANCE WITH PERSONAL CARE (Z74.1) 5/5/21 Secondary #5 Admitting Dx (69) HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE WITH HEART FAILURE AND STAGE 1 THROUGH STAGE 4 CHRONIC KIDNEY DISEASE, OR UNSPECIFIED CHRONIC KIDNEY DISEASE (I13.0) 5/4/21 Secondary #6 Admitting Dx (69) TYPE 2 DIABETES MELLITUS WITH HYPERGLYCEMIA (E11.65) 5/4/21 Secondary #7 Admitting Dx (69) DYSPHAGIA, UNSPECIFIED (R13.10) 8/1/21 Secondary 9 Or More During Stay KLEBSIELLA PNEUMONIAE [K. PNEUMONIAE] AS THE CAUSE OF DISEASES CLASSIFIED ELSEWHERE (B96.1) 7/19/21 Secondary 9 Or More During Stay URINARY TRACT INFECTION, SITE NOT SPECIFIED (N39.0) 7/19/21 Secondary 9 Or More During Stay OTHER SYMBOLIC DYSFUNCTIONS (R48.8) 7/16/21 Secondary 9 Or More During Stay ALLERGY STATUS TO UNSPECIFIED DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES (Z88.9) 6/1/21 Secondary 9 Or More CONSTIPATION, UNSPECIFIED (K59.00) 5/5/21 Secondary 9 Or More Admitting Dx (69) HYPOTHYROIDISM, UNSPECIFIED (E03.9) 5/5/21 Secondary 9 Or More Admitting Dx (69) INSOMNIA, UNSPECIFIED (G47.00) 5/5/21 Secondary 9 Or More Admitting Dx (69) MAJOR DEPRESSIVE DISORDER, RECURRENT, UNSPECIFIED (F33.9) 5/5/21 Secondary 9 Or More Admitting Dx (69) ANEMIA, UNSPECIFIED (D64.9) 5/4/21 Secondary 9 Or More Admitting Dx (69) CAROTID ARTERY SYNDROME (HEMISPHERIC) (G45.1) 5/4/21 Secondary 9 Or More Admitting Dx (69) CHRONIC KIDNEY DISEASE, STAGE 3 UNSPECIFIED (N18.30) 5/4/21 Secondary 9 Or More Admitting Dx (69) GENERALIZED ANXIETY DISORDER (F41.1) 5/4/21 Secondary 9 Or More Admitting Dx (69) IRRITABLE BOWEL SYNDROME WITH CONSTIPATION (K58.1) 5/4/21 Secondary 9 Or More Admitting Dx (69) METABOLIC DISORDER, UNSPECIFIED (E88.9) 5/4/21 Secondary 9 Or More Admitting Dx (69) MIXED HYPERLIPIDEMIA (E78.2) 5/4/21 Secondary 9 Or More Admitting Dx (69) MORBID (SEVERE) OBESITY DUE TO EXCESS CALORIES (E66.01) 5/4/21 Secondary 9 Or More Admitting Dx (69) OSTEOPATHY IN DISEASES CLASSIFIED ELSEWHERE, UNSPECIFIED SITE (M90.80) 5/4/21 Secondary 9 Or More Admitting Dx (69) POLYOSTEOARTHRITIS, UNSPECIFIED (M15.9) 5/4/21 Secondary 9 Or More Admitting Dx (69) POSTMENOPAUSAL ATROPHIC VAGINITIS (N95.2) 5/4/21 Secondary 9 Or More Admitting Dx (69) SPINAL STENOSIS, SITE UNSPECIFIED (M48.00) 5/4/21 Secondary 9 Or More Admitting Dx (69) STRESS INCONTINENCE (FEMALE) (MALE) (N39.3) 5/4/21 Se
Allergies: Carbidopa, Etodolac, Iodine I 131 Tositumomab, Lovastatin, Metformin, Oxycodone, Cipro, Demerol, Januvia, Levaquin, Nexium, Valium, Vioxx, Sulfa Antibiotics
Diagnostic Lab Data: STAT chest xray, STAT EKG, STAT BNP and to obtain rapid COVID 19 test- 09/10/2021
CDC Split Type:

Write-up: Resident not feeling well, very anxious, wants to go to hospital. All VS stable and WNL, BS 126. Family states resident has behavior like this when she has a UTI. she does have upper airway wheezes and bilateral lower lobe crackles, oxygen increased to 3LPM and is @ 96% whereas when she was on 1LPM she was Sat @ 86%. Residents skin color is very pale, she is lethargic and complaining of nausea and fatigue at this time. EKG done at this time per facility machine. Report reads as follows: atrial fibrillation with rapid mean ventricular response minor high-lateral and lateral repolarization disturbance, consider ischemia, LV overload or aspecific change, abnormal ECG, unconfirmed report. Dr. B returned call, requesting that EKG be uploaded into PCC, EKG was uploaded per request. Dr. B called the center and spoke to this writer, new orders to give additional one time dose of lasix 80mg now and then hold her 60mg dose of lasix in the morning and give her 80mg instead. Then resume normal dosing.


VAERS ID: 1693513 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-07
Onset:2021-09-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC183 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, Dysarthria, Mental status changes
SMQs:, Anticholinergic syndrome (broad), Dementia (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), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: sent to ED for further evaluation, tests and imaging
CDC Split Type:

Write-up: slurred speech, balance disturbance, altered mental status


VAERS ID: 1693516 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 RA / 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: Multivitamin
Current Illness: none
Preexisting Conditions: none
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approx 35 hours post vaccine I broke out in about 7 or so hives on both my right and left legs. I have never in my 35 years prior ever had hives before. I am treating with Benadryl and a topical cream. They have still not gone away.


VAERS ID: 1693517 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amnesia, Fall, 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), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Less than 5 minutes after receiving his vaccination, the patient lost consciousness and fell onto the floor. He was unconscious for less than 3 minutes and suddenly woke up with no memory of the event. The paramedics were called and he was checked out by them. They found no problems and he was able to leave shortly after.


VAERS ID: 1693519 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 RA / IM

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

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

Write-up: Significant dizziness and vomiting for 24hrs.


VAERS ID: 1693540 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Gait disturbance, Headache, Pain, Pyrexia, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine at age of 12 yrs. of age, similar symptoms.
Other Medications: Metoprolol Tylenol, isosorbide mononitrate, Rosuvastatin, montelukast, acyclovir
Current Illness: None
Preexisting Conditions: micro vascular coronary disease recently diagnosed.
Allergies: Flu vaccines, caffeine, penicillin, fish, dust
Diagnostic Lab Data: None made.
CDC Split Type:

Write-up: Within 12 hours had severe chills with body shaking tremors, fever of over 100 degrees, body aches, head ache and difficult to walk. Body shakes lasted two hours until the Tylenol kicked in. Body aches and head ache lasted another 10 hours or so.


VAERS ID: 1693553 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Diarrhoea, Headache, Pain
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: na
Current Illness: na
Preexisting Conditions: na
Allergies: na
Diagnostic Lab Data: na
CDC Split Type:

Write-up: servere diareeha , headake , chills, pain. since have the runs on and off.


VAERS ID: 1693559 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939893 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dyskinesia, Feeling cold, Rash, Rash pruritic, Seizure like phenomena, Skin discolouration
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Convulsions (narrow), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: fluoxetine 20 tablet, myrbetriq er 50 mg tab, ibuprofen 600 mg tab, estradiol 0.01% cream, rosuvastatin 5 mg tab, levothyroxine 100 mcg tab, ezetimibe 10 mg tab, fluoxetine 10 tab
Current Illness: n/a
Preexisting Conditions: osteoporosis, high cholesterol, hypothyroidism, heart disease
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient called pharmacy 09/12/2021 in the afternoon stating that she wanted to report an adverse event. She stated that on Friday night she experienced chills so cold it felt like she was in a freezer. She also stated that she felt she had seizure-like contractions, arms were jerking, and has pink plaque on both arms and they are itchy. She did not go to the hospital. She had been taking benadryl and using a heating pad to soothe herself. She said that she will reach out to her doctor tomorrow.


VAERS ID: 1693562 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Intermenstrual bleeding, Menstruation irregular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

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

Write-up: Breakthru menstruation 12 days early


VAERS ID: 1693563 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-02
Onset:2021-09-10
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Amnesia, Fall, Generalised tonic-clonic seizure, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Sexual dysfunction (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3 minute diagnosed Grand Mal seizure, never had a seizure before. No signs beforehand other than legs went numb immediately before falling to the ground. After the seizure witnesses confirmed I spoke with emts and answered questions but I do not remember anything for 20 minutes after the seizure began. It took about 45 minutes for my memory of the rest of the day and moments prior to the seizure to return.


VAERS ID: 1693630 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Feeling abnormal, Hyperhidrosis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: close contact with person positive for COVID-19, she was tested within past week and had negative result
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood pressure was checked at pharmacy and was 116/65 mmHg. Patient stated she has no history of low blood pressure.
CDC Split Type:

Write-up: Patient left pharmacy after vaccination and reports she had to pull her vehicle over because she "was feeling weird" and stated she then had a syncopal episode. When she regained consciousness, she was not completely alert to surrounding for about a minute and was "drenched in sweat" and felt "clammy." Reported no other symptoms.


VAERS ID: 1693636 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / N/A LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Chills, Decreased activity, Dizziness, Dyspnoea exertional, Fatigue, Headache, Impaired work ability, Night sweats, Pain, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: 12:20 pm - vaccination 2:20pm - Most severe headache i''ve ever experienced, Rash on both arms and legs. 8:30pm - severe fever(101.7) with chills and body ache Tylenol 975 mg taken 9/11/21, 3:30am . Woke with severe night sweats, chills and fever tylenol taken again. 10am - rash still visible on arms and leg. fatigue and weak persistent headache 12 noon - tylenol taken for headache 9pm went to sleep woke up at 12:30 am 9/12/21. severe chills night sweats and fever. tylonol975mg taken 9/12/21 continue tylenol every 6-8 hours as needed. weak dizzy activity intolerance SOB upon activity. Unable to go to work called out sick. reported adverse reaction to VAERS.


VAERS ID: 1693643 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA D17E21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, 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: None
Current Illness: None
Preexisting Conditions: Obesity
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bell''s Palsy


VAERS ID: 1693667 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-08-26
Onset:2021-09-10
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site pain, Myalgia, Neuralgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient came to the pharmacy expressing some concerns about muscle and nerve pain after receiving vaccine on 08/26/2021. Patient explains that he had the normal injection site pain and soreness but after that he started to experience nerve pain in this arms and back.


VAERS ID: 1693690 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Condition aggravated, Erythema, Fatigue, Flushing, Hyperhidrosis, Injected limb mobility decreased, Injection site erythema, Injection site pain, Injection site reaction, Injection site warmth, Migraine, Muscle spasms, Nausea, Pain, Pain in extremity, Paraesthesia, Peripheral coldness, Pyrexia, Sensory disturbance, Skin odour abnormal, Skin warm
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: See first Vaers completed 8/31/2021- Covid 19 Vaccine admin. on 8/18/21
Other Medications: Metformin ER 500mg 1 tab po qd Multivitamin daily
Current Illness: N/A
Preexisting Conditions: PCOS, arthritis (unk if RA), hx of migraines since 12 yrs old
Allergies: Keflex, Femara, latex (sensitivity)
Diagnostic Lab Data: None at this time. I have messages out to my Dr. I don''t believe there is anything that can necessarily be done but ride out the symptoms at this point.
CDC Split Type:

Write-up: Immediate bilat legs tingling, 20 mins later face/head tingling, face red hot/flushed with lips ice cold -lasted 2hrs, day one to day three currently intermittent bilat top and bottom of feet sharp/stabbing pains, injection site muscle spasms constantly for 48+hrs, multiple episodes of nausea from day 1-3, woke up day after inj with head to toe aches/chills and fever x24+ hours, migraine started day two and current, fatigue- many naps, day 3- woke up with hot, redness from top of shoulder to elbow on inj site arm, also have a hx of pea sized scar tissue on inside of arm today skin is indented, painful and no scar tissue felt, difficulty raising L arm on day 3. Day 3- profuse sweating when still- had to change clothes as they were drenched. Spouse stated I smell different- like chemicals. When I bend down crown of head feels like it will explode. I am completing this on day three unk if will have more issues. I am still currently having a migraine and body aches, redness /hotness on L arm still present. Also filled out report for first vaccine-issues as well. Pls do note same vaccine lot #. After 1st vaccine did have 1 menses that was longer than usual by 4 days, heavier bleeding and increased clots.


VAERS ID: 1693732 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-05
Onset:2021-09-10
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Pfizer 3/15 and 4/5. Positive on 9/10


VAERS ID: 1693735 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-26
Onset:2021-09-10
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Inappropriate schedule of product administration, SARS-CoV-2 test positive
SMQs:, Medication errors (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Moderna 2/24 and 3/26. Positive on 9/10


VAERS ID: 1693737 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-30
Onset:2021-09-10
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / SC

Administered by: Other       Purchased by: ?
Symptoms: Rash, Rash pruritic
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: Amlodipine
Current Illness: None
Preexisting Conditions: hypertension
Allergies: None known
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Painful itchy rash on chest arms


VAERS ID: 1693739 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Freezing phenomenon, Pain, Pain in extremity, Sleep disorder
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (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: protonix
Current Illness: none
Preexisting Conditions: none
Allergies: hydrocodone
Diagnostic Lab Data:
CDC Split Type:

Write-up: achy all over started about 7pm, woke up in the middle of the night freezing and achy all over, unable to sleep and felt worse than when I actually had covid. unable to get warm and shivering without having a fever for hours. severe left arm pain and aches lasted until the evening of 9/12


VAERS ID: 1693747 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-30
Onset:2021-09-10
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Burning sensation, Depression, Disturbance in attention, Epistaxis, Headache, Night sweats, Peripheral coldness, Poor peripheral circulation, Thrombosis
SMQs:, Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (narrow), Hypoglycaemia (broad)

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

Write-up: Bad Headaches, nose bleeds with heavy blood clots, burning heat sensation going down left lower leg. Night sweats, cold hands from bad circulation, hard to concentrate at times, depression .


VAERS ID: 1693752 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Visual field defect
SMQs:, Noninfectious encephalitis (broad), Optic nerve disorders (broad), Retinal 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: Pre natal vitamin, probiotic, fiber
Current Illness: None
Preexisting Conditions: Psoriasis
Allergies: Cefdinir and Bactrim
Diagnostic Lab Data:
CDC Split Type:

Write-up: Temporary loss of peripheral vision in right eye. Started in the center of right eye vision as large white spot and slowly moved to the peripheral before disappearing. Lasted approximately 1 hour.


VAERS ID: 1693765 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Decreased appetite, Fatigue, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Keppra ER Multivitamin
Current Illness: None
Preexisting Conditions: Epilepsy
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever of ranging from 100-100.7 from Friday evening and still continuing. Not responsive to ibuprofen. Other symptoms include chills, aches, loss of appetite, nausea, weakness and fatigue


VAERS ID: 1693770 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Immediate post-injection reaction, Paraesthesia, Peripheral coldness, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

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

Write-up: Immediately after vaccine administration w/in <10mins. pt noted tingling and cold sensation in her left 4th and 5th digit with mild swelling, that extended laterally up to her left shoulder. Pt also noted cold sensation and tingling that started from her left hip that extended laterally down to her mid thigh. + bilateral hand shaking. Denied pain. Treatment: 45 mins of observation Outcome: Released w/o any interventions, reassurance provided and f/u with her Primary Care Provider the next business day.


VAERS ID: 1693782 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Dizziness, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Arthritis (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: Zyrtec 20mg, Symbicort Inhaler 160/4.5, Ventolin Inhaler PRN, Tylenol 1000mg, Protonix 80mg
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Walnut, Cashew
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chills, joint pain, body aches, fever of 102 degrees, headache, dizziness


VAERS ID: 1693797 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-01
Onset:2021-09-10
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020FZ1A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chest pain, Fatigue, Headache, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, body aches, fatigue, headache, chest pain, lower back pain


VAERS ID: 1693817 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-05
Onset:2021-09-10
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Dyspnoea, Lymphadenopathy, Malaise, Pain, Pain in extremity, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 1-3 days after vaccination: Fever, malaise, lightheadedness, chills, and arm pain. Also slightly winded 5-7 days after vaccination: Fever returns ~99.2, axillary lymphadenopathy and pain, and malaise


VAERS ID: 1693855 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Oxygen saturation abnormal
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Thyroid medication and hormone replacement therapy cream
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: None
Diagnostic Lab Data: I was too tired and exhausted to go to the doctor but did keep a constant eye on O2 level and would have called an ambulance had it dropped below 85.
CDC Split Type:

Write-up: The next day was extremely tired. Took EKG with apple Iwatch 6. It was fine. Took O2 sat level and it was 89. Performed several deep breathing exercises then took it again, but it was only 91. Continued taking O2 readings throughout the day but was always between 88-92. The next morning I was back to normal with readings between 98-100. Even when I had Covid-19 in Nov 2020, my 02 levels stayed between 97-99. So it being down to high 80s and low 90s is unheard of for me. It was most definitely from this vaccine.


VAERS ID: 1694078 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine phosphokinase, Dysphagia, Dyspnoea, Full blood count, Metabolic function test, Musculoskeletal stiffness, Pain, Pain in extremity, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamisil,Farxiga,enalapril-hctz,Trental,atorvastatin,Insulin
Current Illness: None
Preexisting Conditions: CLL, Diabetes, Hypertension
Allergies: NKDA
Diagnostic Lab Data: CPK, CMP and CBC were ordered on 9/13/2021 with results pending
CDC Split Type:

Write-up: Approximately 11 hours after the injection, patient developed pain and stiffness throughout his whole body particularly in his left arm. He had an episode in which he felt his throat was closing off and he had difficulty swallowing and catching his breath. He states that the difficulty swallowing lasted approximately 2 minutes and his whole body was stiff ("like a huge cramp and it was hurting.") He still has pain in his left arm


VAERS ID: 1694092 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 3 LA / IM

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

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

Write-up: Patient complained of tremors, nausea, vomiting, sweats late evening the day of vaccine administration and continued for about 36 hours following vaccination.


VAERS ID: 1694123 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: There was no reaction. patients mom scheduled him for a first dose vaccine for pfizer. She filled out the forms and marked no to ever receiving a covid vaccine. brought them back and went over the Q and A and asked if this was the first dose. She replied yes its his first dose. When putting in the patients info into system and the end of day I discovered that she lied to me and he was given a Pfizer dose at the pharmacy on 9/6/2021. I did report it and added Alerts to the patient chart to not give another vaccine if they come back in again.


VAERS ID: 1694156 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Headache, Injection site pain, Myalgia, Pyrexia, Somnolence
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxin and Triiodothyronine Thyroid Support multivitamin vitamin d3
Current Illness: none
Preexisting Conditions: autoimmune hashimotos thyroiditis
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: pain at injection site same day of jab. The next day I had a low grade fever all day, all of my joints and muscles ached to the point it hurt to walk. I had a horrendous headache. Fatigue was really bad, I slept all day. Although I don''t feel as bad as I did this weekend, I am still very fatigued with joint paint and a slight headache ongoing.


VAERS ID: 1694157 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-21
Onset:2021-09-10
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: Coronary Artery Disease; Hypertension; Mitral valve regurgitation
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Covid postive; admitted to hospital; treated with remdesivir, oxygen and dexamethasone


VAERS ID: 1694176 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: Numbness (feeling of pins and needles) on the right side of the face. Started about 12 hrs after receiving the vaccine and is still continuing today 3 days later. No loss of motion is occurring with the first vaccine. I am concerned about the second vaccine.


VAERS ID: 1694191 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-08
Onset:2021-09-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / UNK - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone normal, Full blood count, Metabolic function test, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: neurontin, ditropan xl
Current Illness:
Preexisting Conditions: asthma, T2DM, obesity
Allergies: none
Diagnostic Lab Data: CBC, BMP, TSH normal on 09/13/2021
CDC Split Type:

Write-up: Generalized, intensely pruritic urticaria


VAERS ID: 1694197 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-11
Onset:2021-09-10
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS 300138A / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR T1E142M / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, Critical illness, Diabetes mellitus, Diabetic ketoacidosis, Intensive care, SARS-CoV-2 test positive, Wisdom teeth removal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hyperglycaemia/new onset diabetes mellitus (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), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None
Preexisting Conditions: Undiagnosed diabetes - discovered 10Sept2021 when patient was found down in room and taken to ED in critical condition. He was also immediate post op wisdom tooth extraction at time of incident
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approx one month after vaccination, member found down in room. He was couple days post op from wisdom teeth extraction surgery. He was taken to local hospital and found to be in DKA (no prior dx of diabetes), Acute renal failure, COVID-19 positive. He remains in ICU in critical condition.


VAERS ID: 1694199 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Interchange of vaccine products, Wrong product administered
SMQs:, Medication errors (narrow)

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

Write-up: Pt was inadvertently given Pfizer Covid 19 vaccine for a second dose instead of Moderna Covid 19 Vaccine.


VAERS ID: 1694208 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PremPro, Vitamin D3, BHT, Vitamin C, Potassium, Vitamin D, Biotin, Zyrtec, Losartan
Current Illness:
Preexisting Conditions:
Allergies: Sulfur and codeine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tinnitus hissing in both ears. Stronger hiss in left ear. Never stops


VAERS ID: 1694212 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-05
Onset:2021-09-10
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

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

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

Write-up: None stated.


VAERS ID: 1694213 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-02
Onset:2021-09-10
   Days after vaccination:220
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

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

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

Write-up: Pt testing positive for COVID-19 and being hospitalized


VAERS ID: 1694234 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site pruritus, Injection site vesicles
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
Preexisting Conditions: None
Allergies: NKDA or other allergies
Diagnostic Lab Data: None, continued monitoring.
CDC Split Type:

Write-up: Itching of left arm after administration of 2nd Pfizer vaccine. Unclear if from Band-Aid adhesive on upper arm however with single blister with itching developed morning of 9/13/2021 after continued itching post vaccine administration.


VAERS ID: 1694239 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Blood urine present, Chills, Headache, Pain, Urine analysis abnormal
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow)

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

Write-up: blood in urine, chills, body ache, headache


VAERS ID: 1694269 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Back pain, Chest pain, Neuralgia, Pleuritic pain
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Infective pneumonia (broad)

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

Write-up: Pleurisy type pain on week 2 after first dose, then back pain, and new event of nerve pain that began all over and now has localized to the trunk (back, chest and abdomen) Feels like a bad sunburn- nerve pain began on 9/10 after my second dose was given on 9/9 and has been worsening.


VAERS ID: 1694272 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro 20mg, Bupropion 75mg, Quetiapine 100mg, Vistaril 25mg, Lipitor 40mg, Losartan 100mg, HCTZ 25MG
Current Illness:
Preexisting Conditions:
Allergies: No known drug allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient called stating she experienced severe back pain after receiving the Moderna COVID-19 vaccine. She went to the hospital and was prescribed Flexeril and Prednisone. She was told at the hospital it was most likely related to arthritis.


VAERS ID: 1694329 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Autoscopy, Dizziness, Dysuria, Fatigue, Feeling abnormal, Headache, Injection site erythema, Injection site mass, Nasal congestion, Pain, Pain in extremity, Pyrexia, Rhinorrhoea
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Esomeprazole 40mg once daily Famotidine 40mg once at bedtime Quetiapine 25mg once at bedtime Pregabalin 200mg twice daily Montelukast 10mg at bedtime Vyvanse 60mg once daily Cetirizine 10mg once daily Ethynodiol diacetate and ethinyl estr
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Most started around 11am 9/10/21. Headache, severe fatigue, painful urination (this only lasted a couple hours on 9/10), dizzy/not feeling like I''m "in my body" floating maybe?, runny/stuffy nose, severe body aches (previous injuries hurting as if they were healing all over again), arm is sore of course but as of 9/13, there is now a red lump approximately one inch lower than injection site. Had low grade fever on 9/11/21 Currently have not seen or spoken to a HCP about symptoms. Taking 200mg ibuprofen every 6 hours as needed. It has only slightly relieved symptoms.


VAERS ID: 1694337 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-01-28
Onset:2021-09-10
   Days after vaccination:225
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 2 LA / IM

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

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

Write-up: Patient vaccinated and then tested positive for COVID-19


VAERS ID: 1694356 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Immunodeficiency, Influenza like illness, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient, who is an OB/GYN, reported severe "flu-like" symptoms over the next 48 hours after receiving booster (3rd) dose of the vaccine. Patient had fever/chills, muscle and joint pain, extreme fatigue to where she could not walk with her family for more than 15 minutes without requiring a 4 hour nap. Patient also alternated ibuprofen and acetaminophen doses every 4 hours to combat symptoms. Patient reports today at 10:00am EST she is still fatigued, but other symptoms have gone.


VAERS ID: 1694381 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3184 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Chills, Injection site erythema, Injection site induration, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: The injection site, the day after the 2nd dose, started getting very red, hot, swollen, and sore. The red spot was dime-sized, but in subsequent days, the injection site spot has quadrupled in size. I received the 2nd dose on 9/9/21 and as of today, 4 days later, the area is still swollen, hard, and warmer in temperature than the rest of my arm and body. I also experienced some chills and slightly elevated body temperature on 9/10/21, but that went away. I have applied ice to the swollen injection site area and have taken benadryl at the advice of the pharmacist where I received the 2nd dose. So far, the area is increasing in size, but is lighter pink in color than when it started.


VAERS ID: 1694387 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / IM

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

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

Write-up: severe fever, malaise, weakness, arm pain, dizziness lasting 3 days, still recovering. limited responsiveness to motrin/tylenol/aspirin


VAERS ID: 1694413 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-08
Onset:2021-09-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vancomycin PO
Current Illness: Not Assessed
Preexisting Conditions: Not Assessed
Allergies: PCN, Morphine, Erythromycin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient presented to the clinic with complaints of itching, soreness and swelling at the injection site. Symptoms appeared localized and patient was instructed to use benadryl cream and ice packs through resolution of symptoms. Contacted patient 9/13 for follow-up: Soreness has resolved. Itching still remains - placing benadryl three times daily to site. Patient has an appointment with NP on wednesday. If not resolved by then, patient will review with NP


VAERS ID: 1694418 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-26
Onset:2021-09-10
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Loss of consciousness, Menstrual disorder, Pain, Thrombosis
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), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamin.
Current Illness: N/A
Preexisting Conditions: Endometriosis, PCOS.
Allergies: Augmentin, Lorazepam, Vantin, Vicodin, Bentley, Elavil
Diagnostic Lab Data:
CDC Split Type:

Write-up: I have suffered with Endometriosis and PCOS for nearly my entire reproductive life. Two weeks after my first Pfizer vaccine, I had doubling over intense pain that made me pass out. I have had a hx of this due to Endometriosis but have not experienced these symptoms in years. The following day I began an out of cycle period which was full of major clots. I am typically on a 28 day cycle so for it to be off is unusual. The most telling is the amount of bleeding and clots I have never experienced in my entire life. Clots have been continuing for 3 days now and the size of a small orange or plum. I have not been sexually active in over a year so there is no risk of pregnancy or anything that would warrant clots of this nature.


VAERS ID: 1694419 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Feeling abnormal, Headache, Injection site pain, Pain
SMQs:, Dementia (broad), Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Around 2 hours after receiving the Janssen Covid-19 treatment. Symptoms of headache, body soreness, pain at injection site, fatigue, and "mental fogginess" (as if I were concussed) occurred. On the following morning, 9/11, I awoke with a slighter headache, with the same pain at injection site and continued body soreness. These persisted through the day but once the evening came again around 6 pm - the body soreness increased, and fatigue as well as the mental fog came back. This subsided after a good nights rest and since 9/12 no problems have arisen.


VAERS ID: 1694440 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD 8448 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Decreased appetite, Disturbance in attention, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prestige 50mg daily Estradiol 1mg daily Multi vitamin daily
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Starting the evening of the 2nd injection, I became extremely weak with general muscle and overall joint pain?inability to concentrate . Nausea and poor appetite all lasting from onset until 9/13/2021.


VAERS ID: 1694448 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Exposure via breast milk, Night sweats, Pyrexia, Suppressed lactation
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Functional lactation disorders (narrow), Neonatal exposures via breast milk (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: cold like symptoms 2 weeks prior (1 week after first dose of Pfizer)
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Loss of lactation in breastfeeding mom. Took the vaccine on Friday at 10:30 am. Had fever, chills, night sweats beginning at 11:00 pm, lasting through the night. Breast fed baby around 4 am per routine. Attempted to breastfeed baby per routine at 6 am. Less milk was available during this feed as indicated by short feed time and upset baby. Breastfeeding routine was kept through the weekend which includes feedings at 4 am, 6 am, 5 pm, and bed time (approximately 9pm). This has been routine for 10 months. Less milk was available through the weekend and today as indicated by frustrated baby and short feed times with no active feeding observed. Monday there is only a drop of milk available with manual stimulation. Breasts feel lighter and "empty", nursing bra is now baggy and does not fit (too large).


VAERS ID: 1694453 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-08
Onset:2021-09-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Blood creatinine increased, Condition aggravated, Dehydration, Electrolyte imbalance, Extra dose administered, Hyperkalaemia, Hyponatraemia, Laboratory test abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (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), Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aloe vera, alprazolam, B complex with vitamin C, denosumab, everolimus, exemestane, ondansetron, pantoprazole, prochlorperazine
Current Illness:
Preexisting Conditions: Metastatic breast cancer, hypertension, hyperlipidemia, asthma, depression, anxiety, diabetes mellitus
Allergies: Codeine (nausea), epinephrine (nausea)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received 3rd booster vaccine on 9/8, on 9/10 she was seen in the outpatient breast clinic setting and directed to report to MD for admission given abnormal labs which included elevated serum creatinine, dehydration, hyperkalemia, and hyponatremia. The AKI and electrolyte imbalances were primarily thought to be due to her receiving paracentesis on 9/7 for malignant ascites and poor hydration status.


VAERS ID: 1694466 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Condition aggravated, Cough, Fatigue, Headache, Heart rate increased, Injection site pain, Malaise, Oropharyngeal pain, Pain, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test negative, Tremor, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), COVID-19 (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: 105 mg Armour Thyroid; daily vitamin; magnesium malate/glycinate/citrate; vitamin B complex, Thyroid support vitamin; 5HTP, St. John Wort; curcumin; NAC; Cod liver oil; Vitamin C with Quercitin; Iron
Current Illness: I had Covid starting August 20. My symptoms were better about 6 days later but my resting heart rate (64 bpm) was still elevated anywhere from 6 to 9 bpm.
Preexisting Conditions: None. Recently diagnosed with hypothyroidism due to symptoms and an elevated reverse t3 level likely caused by prolonged stress and extremely low ferritin levels.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: My 1st shot was at the Walmart on 8/12/21. The minor side effects I experienced were soreness at the injection site for a couple days as well as exhaustion for a couple days. On August 20th I came down with Covid symptoms. Dry cough, congestion, head ache, sore throat, exhaustion, wheezing, I drove out and took a rapid test and was negative. I would have gone for a PCR test but they are pretty hard to come by in our area. Pharmacy was booked 5 days out at the time. 4 days later, while I was on the mend, my 16 year old daughter came down with symptoms and we were able to borrow a Binax test from a friend and test very and she was positive, so I am quite certain what I had was Covid and I had given it to her. My symptoms gradually improved and I was able to resume normal activity but my resting heart rate stayed elevated by 6-10 beats per mintute, started on a downward tend 8 days out from onset of symptoms, and then began to rise back to an elevation of 8 bpm. I researched Fitbit data at this time and found out that this is a common heart trend for health activity tracker wearers. I got my second shot on 9/10. I went home and began to work on a Spanish course I am taken and had to take a nap. 8 hours later I was stuck in bed with a fever of 102.5, shakes, chills, body aches, and a heart rate that was stuck at 125. Ibuprofren and Tylenol helped some, We were able to get the fever to break, and my resting heart rate over night was 90 bpm. Heart rate is still elevated in the 90s.


VAERS ID: 1694477 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Injection site pain, Lymphadenopathy, Myalgia, Nausea, Pruritus, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid/ Pfizer/ Lot # Ej1685 01/07/2021
Other Medications: Pepcid, Lexapro, Calcium/Vitamin D, Claritin
Current Illness:
Preexisting Conditions: Asthma
Allergies: PCN
Diagnostic Lab Data: 9/10 - intervention with Phenergan and Demerol 9/11 - Benadryl / NSAID 9/12 - NSAID
CDC Split Type:

Write-up: Nausea/Vomitting/Rigors = 1343 9/10 duration aprox 2 hrs Fever/Chills/Itchy/Myalgia/Pain at injection site = 9/11 Swollen Lymph Node = 9/12


VAERS ID: 1694518 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-08
Onset:2021-09-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chapped lips, Lip swelling, Mouth swelling, Mouth ulceration, Pain, Pyrexia, Swollen tongue, Tongue ulceration
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Magnesium, Vitamin D, Milk Thistle, Cinnamon, fish oil
Current Illness: None
Preexisting Conditions: High blood pressure, elevated blood sugar
Allergies: None
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: Swelling of the lips, mouth and tounge. Lesions on the interior of the top and bottom lip. Ulcers on the top and bottom of the tongue. Chapped lips. Joint pain, body aches, low-grade temp.


VAERS ID: 1694528 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Heart meds, thyroid meds, cholesterol, and Vitamin D
Current Illness: None
Preexisting Conditions: Chronic heart condition
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Client stated she stated a day after the vaccination that she had an enlarged lymph node in her right arm pit. It was swollen, painful, and very tender. Stated on 9/13/2021 that the pain is much better and swelling is going down. No treatment was needed.


VAERS ID: 1694564 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Undiluted, a whole vial of Covid vaccine (Pfizer) was given to a patient. No adverse drug reaction. Absence of death or significant disability.


VAERS ID: 1694574 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-04-12
Onset:2021-09-10
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Dizziness, Headache, Paranasal sinus discomfort, SARS-CoV-2 test positive
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: GERD
Allergies: AMOXICILLIN
Diagnostic Lab Data: 09/10/21: POSITIVE POC SARS COVID RAPID ANTIGEN
CDC Split Type:

Write-up: HEADACHE, SINUS PRESSURE, DIZZINESS


VAERS ID: 1694595 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-03-24
Onset:2021-09-10
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Fatigue, Headache, Malaise, SARS-CoV-2 test positive, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LISINOPRIL, CETRIZINE, SERTRALINE, GABAPENTIN, ASPIRIN
Current Illness: NONE
Preexisting Conditions: HTN, DM TYPE 2, OSTEOARTHRITIS, DIVERTICULOSIS, DEPRESSION, ALCOHOLISM IN REMISSION
Allergies: NKA
Diagnostic Lab Data: 09/10/21: POSITIVE POC SARS COVID RAPID ANTIGEN
CDC Split Type:

Write-up: VOMITING, HEADACHE, FATIGUE, MALISE


VAERS ID: 1694601 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-16
Onset:2021-09-10
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FWO198 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstrual disorder
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: effexor 112.5mg, Larissa Birth Control
Current Illness: Sinus issues
Preexisting Conditions: major depressive disorder
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Heavy menstrual bleeding for the second time in a menstrual cycle. Very uncommon for me personally. Initial mensuration cycle began on Tuesday August 22 and ended on August 29 which consisted of a much heavier and brighter flow, and the current mensuration began Thursday, September 10. This is a very heavy and dark flow. Both times are inconsistent with my "normal" cycles in which are about 5 days long with maybe one heavy day of bleeding.


VAERS ID: 1694604 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-15
Onset:2021-09-10
   Days after vaccination:87
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Breakthrough COVID case. Development of symptoms 9/10/21. Tested positive for COVID on 9/12/21.


VAERS ID: 1694623 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Pain, 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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness:
Preexisting Conditions:
Allergies: NKDA.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain, rash, bulla.


VAERS ID: 1694630 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Chills, Fatigue, Feeling abnormal, Hot flush, Night sweats, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: A little over 24 hours after the shot suddenly I felt weak, brain foggy, my face was hot and extreme exhaustion. I am not a napper but took a 1 1/2 nap. Went back to bed and had chills and sweats all night. I took Advil but it did not help. The next morning my joints were achy but the fever symptoms were gone. Took more Advil and this time it seemed to help a bit. Was excessively tired the whole weekend. Had the shot on a Thursday.


VAERS ID: 1694675 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Breast pain, Breast tenderness, Lymphadenopathy
SMQs:, Lipodystrophy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Effexor, Atorvastatin, Vitamin D, Vyvanse, Topax, Imitrex prn, Clonazepam prn
Current Illness: None
Preexisting Conditions: High Cholesterol, Depression, ADD, Migraines, Situational Anxiety
Allergies: None
Diagnostic Lab Data: none.
CDC Split Type:

Write-up: swelling in Left axilla (entire length, approximately 3 inches), next to Left Breast (area of lymph nodes); both L axilla and L breast tender and sore; symptoms began within 18-19 hours after vaccination; as of today, day 4, swelling and tenderness is decreasing. No fever, no redness; no other reactions or symptoms.


VAERS ID: 1694685 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC 3182 / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of control of legs, Mobility decreased, Muscular weakness, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: After the vaccine shot I felt fine except for minor arm soreness. I woke up at 2 AM to use the bathroom. Lost muscular control in my legs and body, sank down to the floor (didn''t fall), and was unable to get up from commode. Had to drag myself back to bed due to complete loss of muscle control. Woke up in the morning and was fine after that.


VAERS ID: 1694691 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Exposure during pregnancy, Paraesthesia, Pharyngeal swelling, Sensory loss, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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: Prenatal vitamins
Current Illness: Positive Covid-19 infection 8/13/2021
Preexisting Conditions:
Allergies: Pt stated having the following allergies and reactions: Bee Venom- swollen throat; Miralax-SOB; hydrocodone-hives; doxycycline-hives
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt stated being in first trimester of pregnancy, she was recommended to speak to her primary care provider or OB, Pt stated that she had spoken to a few providers, was asked if she was consenting and sure to receive it 9/10/2021 she stated she wanted to proceed with receiving the vaccine. Pt. c/o tightness in the throat and tingling present throughout her body. Pt assessed, vitals read BP-122/74, HR- 80, RR-18, O2 sat-99%. Pt laid down and provided ice pack to throat as pt. stated feeling tightness as if throat was swelling. Pt A/O to place and time and able to speak without problems. Was provided a cup of water and able to swallow without difficulty. No audible wheezing present. Vitals assessed at 5:03pm BP-122/72, HR-76, RR-20, O2 sat-99%. Pt stated feeling a bit better stated regaining sensation in some parts of her face. Pt had stated she had an allergic reaction before to Benadryl and we were unable to administer Benadryl. She was continuously monitored and pt. was able to speak without difficulty. She was provided with few more ice packs placed on her neck and throat. Pt was monitored for 1 hr., she stated feeling better and ice packs were helping, she stated still feeling tingling just in her arms and stated she was regaining sensation to her face. She stated feeling better to go home. Pt assessed again at 5:30pm and vitals read BP-122/74, HR-76, RR-20, O2 Sat-99%. Provider assessed pt. and pt. was counselled of monitoring symptoms and to report to ER if symptoms were any concern or worsened. Was recommended to call someone and be picked up as to not drive self. Was released to an acquaintance.


VAERS ID: 1694692 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: vaccine expired on 8/31/2021.


VAERS ID: 1694697 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: vaccine expired on 8/31/2021.


VAERS ID: 1694699 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: vaccine expired on 8/31/2021.


VAERS ID: 1694702 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 3 LA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER 939906 / 4 LA / IM
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER 039B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, 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: NONE
Current Illness: COLD (GOT FROM CHILD)
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PATIENT TOOK THE SAME VACCINE 4 TIMES. WE DIDN;T KNOW AT THE TIME OF VACCINATION, BUT THE PATIENT HAS BEEN FINE WITH NO REACTIONS. HE DID NOT REALIZE THAT HE DIDN''T NEED TO GET IT. HE IS A HEALTHY 32 YEAR OLD MALE, WITH NO ISSUES.


VAERS ID: 1694704 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: vaccine expired on 8/31/2021.


VAERS ID: 1694711 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: vaccine expired on 8/31/2021


VAERS ID: 1694718 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-02-03
Onset:2021-09-10
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Chills, Hypotension, Hypoxia, Lethargy, Lung infiltration, Pneumonia, Pyrexia, SARS-CoV-2 test positive, Tachycardia, Tremor, Urinary tract infection, Urine analysis
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH of anxiety, Down Syndrome (lives in a group home), and hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received both doses of Pfizer COVID vaccine (on 1/12/21 and 2/3/21). Despite this, patient tested positive for COVID in the ED on 9/10/21. On the morning of his ED visit, patient was noted to be lethargic and had an episode of rigors and shaking. Patient did receive his flu shot on 9/9/21 (specific vaccine unknown). In the ED, patient was found to be febrile, hypotensive, tachycardic, and hypoxic (SpO2 92%). A chest X-ray was done and showed infiltrates in both lungs, and a urinalysis showed possible UTI. Patient was admitted to the hospital on 9/10/21 for COVID treatment (remdesivir and dexamethasone) and antibiotics for UTI vs. PNA. Patient is currently on day 3 of hospitalization and is requiring 2L of oxygen.


VAERS ID: 1694719 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Swelling of right arm and hand. Swelling on right side of face.


VAERS ID: 1694722 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: Vaccine expired on 8/31/2021.


VAERS ID: 1694731 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: vaccine expired 8/31/2021


VAERS ID: 1694743 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-18
Onset:2021-09-10
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 LA / IM

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

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

Write-up: Hospitalization due to COVID-19.


VAERS ID: 1694778 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling cold, Injection site erythema, Injection site induration, Injection site swelling, Injection site warmth, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Previous flu shots as an adult. Swollen area at injection site but not to this degree.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: 1. Severely swollen, very hard, warm to touch injection site. Within 24 hours of my injection the injection site became severely swollen, extremely hard, red and warm to the touch. The affected area is approximately 3-1/2" in diameter top to bottom and side to side. This continues to the present time which is 9/13/21 at 2pm. 2. Experienced being extremely cold with chills, very fatigued with body aches all over....within 24 hours of injection lasting 72 hours.


VAERS ID: 1694792 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Electrocardiogram abnormal, Extrasystoles, Ventricular extrasystoles
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Hypokalaemia (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: Cymbalta; Wellbutrin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EKG
CDC Split Type:

Write-up: Bigeminy PVC?s within 1 hour of administration, followed by chest pain and shortness of breath within 90 min. Continues 3 days later


VAERS ID: 1694808 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-15
Onset:2021-09-10
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Pain, Pyrexia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PMH BREAST CANCER ON CHEMO, DM
Allergies:
Diagnostic Lab Data: POSITIVE SARS-COV-2 BY PCR
CDC Split Type:

Write-up: This case meets vaccine breakthrough criteria . SXS INCLUDE COUGH, GENERALIZED WEAKNESS, BODY ACHES, FEVER


VAERS ID: 1694812 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)

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

Write-up: Administered outside of normal time frame after dilution, passed beyond use time of 6 hours


VAERS ID: 1694825 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-20
Onset:2021-09-10
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiopathy, Cardiac failure, Cardiomegaly, Chest X-ray abnormal, Dyspnoea, Hypoxia, Intensive care, Positive airway pressure therapy, Pulmonary oedema
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: DM,HTN, ESRD on dialysis
Allergies: Glyburide, Amoxicillin, Metformin, Glimepiride,Pioglitazone
Diagnostic Lab Data: 9/10/2021 chest x ray cardiomegaly with vascular congestion an interstitial edema/heart failure
CDC Split Type:

Write-up: Ongoing Hospitalization, currently day 4 in ICU. Shortness of breath during dialysis treatment, given supplemental oxygen and admitted to intensive care unit. Placed on BiPAP for hypoxia, then Vapotherm 25L and 75% FiO2. 5 ays of remdesivir, dexamethason


VAERS ID: 1694850 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-15
Onset:2021-09-10
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NA / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Dyspnoea, Pain, Respiratory tract congestion, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: This case meets vaccine breakthrough criteria . SXS INCLUDE RIGORS, BODY ACHES, CONGESTION, SOB


VAERS ID: 1694866 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache, Nausea, Pruritus
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MOVANTIK; OXYCONTIN; oxycodone; CYMBALTA
Current Illness:
Preexisting Conditions: Chronic pain
Allergies: Tomatoes; aspirin
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: I experienced nausea, headaches, itchiness and tiredness.


VAERS ID: 1694886 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Cough, Full blood count, Hyperhidrosis, Metabolic function test
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: influenza vaccine, tongue and lip swelling, reported 2/3/19
Other Medications: losartan, furosemide, Advair
Current Illness:
Preexisting Conditions: asthma, hypertension, history of pulmonary embolus
Allergies: nuts, shellfish
Diagnostic Lab Data: CBC, BMP, chest radiograph
CDC Split Type:

Write-up: coughing, diaphoresis


VAERS ID: 1694912 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Feeling abnormal, Heart rate increased, Inflammation, Influenza like illness, Oedema peripheral, Pain, Panic attack
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Dehydration (broad)

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

Write-up: Severe brain fog panic attacks elevated BPM flu like systems also inflamed right foot with shooting pains


VAERS ID: 1694918 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Tinnitus, Vertigo
SMQs:, Hearing impairment (narrow), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Slight vertigo with first does recovered with in 2 days
Other Medications: propranolol levothyroxine Effexor Zyrtec
Current Illness: none
Preexisting Conditions: Hypertension Hypothyroid menopause
Allergies: Vomiting form pain medications
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe Vertigo. 3 days later still having it. Mornings are fine for first couple hours. Then on/off rest of day. Even with laying down and resting most of the time. Slight ringing in ears.


VAERS ID: 1694921 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Military       Purchased by: ?
Symptoms: Arthralgia, Headache, Neck pain
SMQs:, Arthritis (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: Sore shoulders and neck along with headache


VAERS ID: 1694931 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 LA / IM

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

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

Write-up: PT FELT DIZZY AND NOT GOOD FOR A FEW MINUTES


VAERS ID: 1694937 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain, shortness of breath, uncomfortable pressure in chest


VAERS ID: 1694961 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Burning sensation, Injection site erythema, Injection site induration, Injection site pruritus, Injection site warmth
SMQs:, Peripheral neuropathy (broad), 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: Not aware of
Current Illness: None noted
Preexisting Conditions: None noted
Allergies: None noted
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Burning sensation right after the injection and into the next day. Really hard raised knot and warm at site of injection, itchy and reddish. No fever, No numbness, No tingling. No S.O.B. or other Breathing issues. has soreness but good R.O.M. Feels tired. Patient states using Ibuprofen which helps. Advised to use cold packs to site but no ice packs. 30 minutes on the off and rotate.. She did state today she noticed what appears to be puss pockets. Advised to watch for infection. if condition worsens seek her PCP for advised or examination or call local ER if after hours. She states understanding.


VAERS ID: 1694976 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-01
Onset:2021-09-10
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 - / -

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

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

Write-up: Hospitalized for COVID.


VAERS ID: 1694977 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site erythema, Injection site warmth, Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (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: none disclosed
Current Illness: none disclosed
Preexisting Conditions: none disclosed
Allergies: sulfa (moderte, dealyed), keflex (moderate, delayed)
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient c/o feeling tired and ill starting 6 hours after the dose was administered, she also developed a fever to 101.5F that responded to antipyretics and lasted approx 48 hours (AF in the last 12 hours). She also developed a local reaction on her left upper arm that appears red and feels warm to touch and extends 6.5" down from the shoulder and 3.5" from side to side. She has not treated the area in any way. There is a darker red area at the injection site, not raised. Recommended that patient applies cool compresses to the area and uses a nonsedating histamine. If reaction getting worse or not improving, she should also seek MD evaluation.


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