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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 217 out of 8,010

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VAERS ID: 1694987 (history)  
Form: Version 2.0  
Age: 52.0  
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 301308A COVID-1 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Headache, Muscle spasms, Nausea, Paraesthesia, Pyrexia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer 1st dose, but not this extensive on August, 20
Other Medications: Prednisone, multi-vitamins, Plaquenil, Symbicort, Omeprazole, folic acid, multivitamins,
Current Illness: Lupus flare
Preexisting Conditions: SLE, migraines, ashthma,
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: fever, nausea, headache, weakness, dizziness, leg cramps, pins, and needles in legs, feet and hands; will follow up with my Dr.


VAERS ID: 1694989 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Missouri  
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 FE3592 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Chills, Dizziness, Fatigue, Headache, Heart rate increased, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: Extreme fatigue started at 6:00 am on Friday. Nausea and light headedness followed as the morning went on. Around 12:00 I started having chills and recorded a 101.7 temperature. All of those symptoms continued throughout the day. At around 3:00pm I started having chest pains and increased heart rate with no physical activity. Around 6:00pm I started having a extreme headache. I took a dose of Tylenol around 9:00 and went to bed. When I woke up on Saturday morning, I felt back to normal.


VAERS ID: 1694994 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Utah  
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 - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Dysuria, Full blood count normal, Haematuria, Metabolic function test normal, Proteinuria, Renal cyst, Ultrasound kidney abnormal, Urine analysis
SMQs:, Acute renal failure (broad), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Proteinuria (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Possible viral symptoms (started after date of vaccination), including sore throat, cough, congestion
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Urinalysis- large blood, packed RBCs, negative leuk esterase, negative nitrites, trace protein (9/11/21) CBC- normal (9/11/21) CMP- normal (9/11/21) Renal ultrasound- simple cyst in right kidney (9/13/21) Complement levels pending Step negative (9/13/21)
CDC Split Type:

Write-up: Gross hematuria, urinary pain


VAERS ID: 1694996 (history)  
Form: Version 2.0  
Age: 38.0  
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 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Expired product administered, Influenza like illness, Product storage error
SMQs:, Medication errors (narrow)

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

Write-up: We gave an expired vaccine to the patient on 9/10/21. The vaccine was punctured and left out at room temperature on accident. After 5.5 hours the patient was given the vaccine. We called her and followed up today and she is doing well. She had minor flu like symptoms on 9/11/21 but those have since resolved. Janssen had no studies to indicate what to do other than follow up with her and her provider. She declined having us do that for her.


VAERS ID: 1695019 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-01
Onset:2021-09-10
   Days after vaccination:193
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 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, Diarrhoea, Hypophagia, Hypoxia, Procalcitonin increased, Renal impairment, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Asthma/bronchospasm (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), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Sepsis (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: acetaminophen,allopurinoL,amLODIPine,aspirin,atorvastatin,dexAMETHasone, doxazosin, enoxaparin,famotidine, gabapentin, isosorbide mononitrate CR, levothyroxine, melatonin, nitroglycerin,sodium bicarbonate,
Current Illness:
Preexisting Conditions:
Allergies: Ace Inhibitors, Codeine, Lyrica [Pregabalin]
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient hospitalized due to COVID-19. tested positive for COVID (previously vaccinated) 8/31, received monoclonal Aby 9/2. Hospitalized here 9/4-9/7/21 due to AKI on CKD4 felt due to side effects of covid (severe diarrhea, poor oral intake) Initially was not on oxygen, so received cautious fluids, but then did develop mild hypoxia so was started on dexamethasone, which he took for 4 days. No remdesivir given CKD. procal was mildly elevated but improved during hospitalization, and was felt more likely due to renal dysfunction; did not receive abx.


VAERS ID: 1695023 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-13
Onset:2021-09-10
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Injection site pain, Magnetic resonance imaging abnormal, Oedema peripheral, Tremor, White blood cell count increased
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: no known allergies
Diagnostic Lab Data: 9/13/2021-MRI of left humerus/arm reviewed and shows myofascial edema throughout the medial arm. There are no fluid collections or lesions. No bony abnormalities 9/12/2021-WBC-13.93 9/13/2021-WBC-14.37
CDC Split Type:

Write-up: Left arm interstitial edema. Pain at injection site since vaccine administered. Experienced severe pain in left shoulder , chills, and shaking since Friday night, 9/10/2021. Pain in biceps and deltoid region


VAERS ID: 1695046 (history)  
Form: Version 2.0  
Age: 81.0  
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 (MODERNA)) / MODERNA 058E21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Calcitonin 200IU nasal spray, ciprofloxacin 250mg
Current Illness: UTI
Preexisting Conditions: chronic recurring uti and genitourinary disease
Allergies: macrolides and ketolides
Diagnostic Lab Data: na
CDC Split Type:

Write-up: The patient was mistakenly administered the covid (Moderna) vaccine. She had 2 doses of covid (Pfizer) vaccine, previously. She got both FluzoneHD and the covid (Moderna) vaccine on 9/10/21.


VAERS ID: 1695068 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-25
Onset:2021-09-10
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Brain natriuretic peptide increased, Chest pain, Decreased appetite, Diarrhoea, Dyspnoea, Hyperhidrosis, Pallor, Pyrexia, Rash, Troponin
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: obesity
Allergies: NKA
Diagnostic Lab Data: 9/10/21 Troponin 0.35 at outside hospital. repeat=0.19 on admission. 9/10/21 BNP= 304 9/11/21 Troponin=0.17 @0050; 0.11 @ 0624; 0.08 @1734 9/11/21 BNP= 361.1 9/12/21 Troponin=0.06 @0631; 0.03 @1803 9/12/21 BNP=319
CDC Split Type:

Write-up: concerns of vaccine induced myocarditis. Noted to be less energetic, poor appetite, pale and sweaty appearing starting 3 days PTA. SOB and chest pain started 1 day PTA. For the last two days he has had fevers (~100F) with generalized abdominal pain and diarrhea. A rash developed on his hands, chest, and legs, about 24 hours ago while he was febrile. The rash has persisted especially while febrile. ROS was otherwise negative; no vomiting, cough, loss of smell, etc. He has noticed improvement of symptoms with Ibuprofen. He received his first COVID-19 vaccine on 08/25/2021 (Pfizer). A classmate tested positive this week for COVID-19.


VAERS ID: 1695242 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Virginia  
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 048F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Similar red swelling on arm just not as severe.
Other Medications: Patient used Claritin, Advil, Hydrocortisone 1% cream and applied ice on and off the affected area. 2 days after receiving 2nd moderna vaccine patient''s entire left arm (4 x 7") was entirely inflamed and red for 2 days
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received severe swelling in her left arm 2 days after second dose. She treated the adverse reaction with Claritin, Advil, Hydrocortisone for 2 days and it finally went away. She also received a similar reaction with the first vaccine but not as severe and wide-spread.


VAERS ID: 1695270 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Washington  
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 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Impaired work ability, Influenza like illness, Malaise, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Venlafaxine ER 37.5mg , Levothyroxine 0.075mg Vitamin D Flax Seed Oil
Current Illness: None
Preexisting Conditions: Hypothyroidism, Anxiety
Allergies: Sulfa Antibiotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: I woke up the next morning after receiving the injection with body muscle aches, headache, and fatigue. I felt like I had influenza. I did not have a fever. I was unable to go to work as I felt very ill. The RN that gave me the shot thought that I would most likely have a very sore arm the next day. My arm was not sore.


VAERS ID: 1695332 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Unknown  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2021-09-10
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A20A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Body temperature, Chills, Fatigue, Injection site reaction, 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: OMEPRAZOLE
Current Illness: Irritable bowel syndrome (Patient is on Omeprazole.); Non-smoker; Social alcohol drinker (Patient consume alcohol sometimes but not today or yesterday.)
Preexisting Conditions: Medical History/Concurrent Conditions: Hernia; Comments: Patient have no known allergies.
Allergies:
Diagnostic Lab Data: Test Date: 20210910; Test Name: Body temperature; Result Unstructured Data: 101 F
CDC Split Type: USJNJFOC20210921355

Write-up: BODY ACHE; INJECTION SITE LITTLE HARD (ON RIGHT ARM); CHILLS; NAUSEA; 101 F FEVER; FATIGUE; NO ENERGY; This spontaneous report received from a patient concerned a 36 year old of unspecified sex. The patient''s height, and weight were not reported. The patient''s past medical history included: hernia, and concurrent conditions included: irritable bowel syndrome, alcohol user, and non smoker, and other pre-existing medical conditions included: Patient have no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 207A20A, expiry: UNKNOWN) dose was not reported, administered on 10-SEP-2021 for prophylactic vaccination. Concomitant medications included omeprazole for irritable bowel syndrome. On 10-SEP-2021, the patient experienced body ache. On 10-SEP-2021, the patient experienced injection site little hard (on right arm). On 10-SEP-2021, the patient experienced chills. On 10-SEP-2021, the patient experienced nausea. On 10-SEP-2021, the patient experienced 101 f fever. On 10-SEP-2021, the patient experienced fatigue. On 10-SEP-2021, the patient experienced no energy. Laboratory data included: Body temperature (NR: not provided) 101 F. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from body ache, nausea, 101 f fever, chills, fatigue, no energy, and injection site little hard (on right arm). This report was non-serious.


VAERS ID: 1695462 (history)  
Form: Version 2.0  
Age: 30.0  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Dysuria, Pain, Penile pain, Testicular pain, Testicular swelling
SMQs:, Haemodynamic oedema, effusions and fluid overload (narrow), 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe testicular pain and swelling, sensitive during urination and during sedentary moments (Sitting, in bed) The pain began approximately 5 hours after the Pfizer Biotech 1st injection, three full days later and the pain has not let up - The pain has moved from the testicles and now includes the shaft of the penis itself, primarily across the top - Initially the area was iced down and that did not help - It is not an STI - No insurance to get medical opinions.


VAERS ID: 1695472 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-07
Onset:2021-09-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Lisinopril and synthryoid
Current Illness: No
Preexisting Conditions: Thyroid-hashimotos disease
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Throat burning like it?s on fire. Hard to swallow.


VAERS ID: 1695515 (history)  
Form: Version 2.0  
Age: 32.0  
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 FD 0809 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Condition aggravated, Presyncope
SMQs:, Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: 32 year old female attendee with preexisting condition of vasovagal response to needles, reacted within 4 minutes of receipt of vaccination. She was assisted to gurney, exhibited a lower muscle tone which initiated EMS. EMS arrived 5 minutes and monitored until event self resolved to point Attendee was able to stand and ambulate without assistance 55 minutes later. Discharged self to home with brother driving, declined EMS.


VAERS ID: 1695516 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-07
Onset:2021-09-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: -multi vitamin -zinc -vitamin d3
Current Illness: None
Preexisting Conditions: None
Allergies: Cats
Diagnostic Lab Data: Na
CDC Split Type:

Write-up: On the first day of symptoms, experienced pins and needles in right wrist and hand. In the following days, the sensation moved to full right arm and right leg. The symptoms are still persistent at the time of this submission.


VAERS ID: 1695524 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-06
Onset:2021-09-10
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Blood electrolytes, Facial paresis, Full blood count, Magnetic resonance imaging head, Skin wrinkling
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Influenza
Other Medications: Flexeril, Sprintec, Vyvanse, Lasix
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: MRI brain, CBC, metabolic electrolyte panel
CDC Split Type:

Write-up: Had facial parenthesis and weakness on right side with mouth and eye. Diagnosed as Bells Palsy. Given steroids and anti viral.


VAERS ID: 1695731 (history)  
Form: Version 2.0  
Age: 23.0  
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 EW0196 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Dizziness, Erythema, Fatigue, Gingival erythema, Gingival swelling, Headache, Inflammation, Lymphadenopathy, Malaise, Myalgia, Oral pain, Oropharyngeal pain, Pyrexia, Stomatitis
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Gingival disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Ehlers-Danlos Syndrome Type 3, Postural Orthostatic Tachycardia Syndrome
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Friday evening (9/10): fatigue, muscle aches, joint pain, fever all began Saturday (9/11): major fatigue, malaise, muscle aches, joint pain, bad headaches, fever and chills, dizziness, sore throat, terrible mouth pain with swollen and red gums and splotchiness on roof of mouth Sunday (9/12): fatigue, malaise aches, headaches, fever and chills, dizziness, sore throat, mouth pain, swollen lymphnodes under armpits Monday (9/13): mouth and throat pain, inflammation, redness, headaches, fatigue


VAERS ID: 1695740 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Michigan  
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 - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest pain, Echocardiogram, Electrocardiogram abnormal, Pain, Sleep disorder, Troponin increased
SMQs:, Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Claritin Non-Drowsy 24 Hour
Current Illness: None
Preexisting Conditions: None
Allergies: Mold; No other known allergies.
Diagnostic Lab Data: EKG at Urgent Care on 09/11 - came back slightly abnormal EKG in ER on 09/11 - came back normal Ultrasound of Heart on 09/11 - came back normal Bloodwork, 3-4 times, on 09/11 - Troponin levels were elevated Echocardiogram on 09/11 - came back normal Bloodwork, 3 times on 09/12 - Troponin levels were elevated
CDC Split Type:

Write-up: I started feeling chest pain around 9:00pm on Friday, 09/10. I could not sleep through the night, and was in extreme pain (8 out of 10). I went to an urgent care after speaking with the pharmacy that administered the second dose of the Moderna vaccine on 09/09 at 5:00pm. The Urgent Care did an EKG that came back slightly abnormal but stated it not uncommon for my age (24). They recommended I go to the ER to get blood work done. After speaking with family members, I decided to go to the ER. I was seen immediately and many tests were done. I stayed over night (arrived Sat, 09/11 at 12:30pm and stayed until Sunday, 09/12 at 11am).


VAERS ID: 1695757 (history)  
Form: Version 2.0  
Age: 32.0  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest pain, Dyspnoea, Electrocardiogram, Fibrin D dimer increased, Injection site pain, Pain, Pain in extremity, Presyncope, Swelling, Syncope, Tachycardia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Arthritic Condition after FLU vaccine in 2015
Other Medications: Multi-vitamin
Current Illness: N/A
Preexisting Conditions: Asthma and Eczema
Allergies: Nightsides, Gluten, and Kiwi
Diagnostic Lab Data: EKG - 9/11/21 Cardiac Panel- 9/11/21 Ct w/ Contrast- 9/11/21 D-Dimer - Elevated.- 9/11/21
CDC Split Type:

Write-up: Unexplained Tachycardia, Radiating chest pain, Presyncope episodes, unexplained syncope, elevated d-Dimer, Shortness of breath, Leg pain, swelling, pain at the injection site.


VAERS ID: 1695762 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Michigan  
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: Other       Purchased by: ?
Symptoms: Axillary pain, Hypoaesthesia, Nodule, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: B12,
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa, Macrodantin
Diagnostic Lab Data: Awaiting to see my physician
CDC Split Type:

Write-up: I started to have axillary swelling and pain on the same side as the injection site. I had axillary tissue removed back in 2015 and never had any issues with this arm since. There is a lump after receiving the vaccine and it''s tender to touch. There was also some numbness at times.


VAERS ID: 1695773 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Virginia  
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 - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Cardiac flutter, Chest discomfort, Headache, Heart rate increased, Heart rate irregular, Injection site induration, Injection site pruritus, Injection site swelling, Nausea, Pain in extremity, Pain in jaw, Palpitations, Paraesthesia oral, Pruritus, Rash, Sensory disturbance, Tenderness
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Tachyarrhythmia terms, nonspecific (narrow), Osteonecrosis (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 20, Fluticason Propinate, Vitamin D, Vitamin B, Ibuprofen
Current Illness: none
Preexisting Conditions: no
Allergies: I am allergic to novacaine, lidocaine, and naproxen sodium. I have gluten allergies. I am allergic to scents, perfumes, colognes, and cleaning products with scents
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 35 minutes following the innoculation, I felt my heart beat speed up and could also feel my heartbeat in my lower mouth and jaw line, my jaws clenched and were not exactly itchy or tingly but some mixed sensation thereof. My heart would seem to race and then slow down (off an on). I had onset of localized intense headaches. For the course of 24 to 48 hours (varied depending on which event), I experienced heart palpatations, fluttering, sensations of something swelling and filling my chest cavity - to where I felt I could not expand my chest and sit upright, I had to cave in to breathe; headaches from mild to migraine level in different spots - it would come and go and move around my cranium; my face cheeks broke out and I was itchy on cheeks, across jaw line, back of throat, neck, chest, and left arm; my lips and tongue were midly tingly (like a food allergy, but not intense) - this occurred the least amount of time. The worst event was between 6 and 7 PM on Friday night: my left arm hurt from my left ear, down my neck, all the way down the arm (at bone), and to the fingertips - the only way to describe the sensation is a combination of a cold burn and what I think it would feel like in the nerves to be electrocuted - the hair folicules ached - that only lasted for about 15 minutes but was intense - so intense that my jaws were still tense and slightly sore for a while following. On Sunday, 09/12/2021, I experinced mild abdominal cramping and on this morning (09/13/2021), I had two instances of severe abdonimal cramping which felt worse than any menstrual cramps experienced. I felt nauseous (mildly) off an on from Friday to Sunday - I did not get sick and vomit or have diarrhea at any time. I did not experience any events which seemed to be an immune system response, so I was able to eat - I drank water and gaterade. My arm was terribly sore so I took 2 200 mg ibuprofen every 4 to 6 hours for the first 48 hours. The injection site did swell and get a knot on it, but I could not get a good picture. Yesterday, the injection site began to be itchy. My arm is still tender and sore today, but not like over the weekend - on Saturday, my arm was about a 5 in pain.


VAERS ID: 1695777 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Kentucky  
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 (JANSSEN)) / JANSSEN 207A21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Pain of skin
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Florinef, hydrocortisone , gabapentin,robaxin, zanaflex
Current Illness:
Preexisting Conditions: Addison?s Disease, benign brain tumor
Allergies: Vimpat, morphine, depakote,Dilantin
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2 weeks after vaccine, bilateral bruises noted to lower extremities without trauma. Skin hurts


VAERS ID: 1695789 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anosmia, Chills, Oropharyngeal pain, Pain, Pyrexia, Rhinorrhoea, SARS-CoV-2 test, Sinus disorder, Sleep disorder
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Yellow Fever Vaccine 32 years old at the time. Cannot be certain, but one month after vaccine I had a river of snot coming out o
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: I got a Covid test today to see if I am showing positive somehow for the virus. There are other viruses around, but want to know what I am showing for C19.
CDC Split Type:

Write-up: About 12 hours after shot, began to have chills and a 102.5 fever which lasted all night. Body aches as well. Next day was okay then 100 fever at night. The next day I had a very sore throat and very runny nose. All very similar to my prior Covid infection from January 2021, but actually worse than the actual virus. I know ?flu like symptoms? are possible, but on day and night four now I have no smell and my sinus is exactly that of the Covid I experienced, and my throat is very sore still, making it difficult to fall asleep. Generally feel better during the day, then fairly poor at night.


VAERS ID: 1695792 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-03
Onset:2021-09-10
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Cardiac flutter, Chest pain, Electrocardiogram
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (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: Symbicort Inhaler 160/4.5 (2puffs in the morning and 2 puffs in the evening), Mometasone nasal spray 50mcg (2 sprays in each nostril each morning), and Montelukast 5 mg chewable tablets (2 chewable tablets each evening)
Current Illness: Asthmatic
Preexisting Conditions: Asthmatic
Allergies: Allergic to Amoxicillin
Diagnostic Lab Data: EKG on September 10, 2021 Will have blood work done on September 20, 2021
CDC Split Type:

Write-up: One 1 week after getting 2nd dose of Pfizer vaccination, September 10, 2021, at around 2:50 p.m. Patient got a sharp pain in chest and started having what felt like flutters in heart area. The pain in chest would come and go, so we took her to see cardiologist the same day. She got an EKG and the doctor prescribed medication for 30 days. She will follow up with blood work in 10 days and then follow up with an office visit with cardiologist in three weeks or earlier, if anything else should arise before then.


VAERS ID: 1695813 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Fatigue, Hyperhidrosis, Influenza like illness, Nasopharyngitis, Pain, Sleep disorder
SMQs:, Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Basic supplements
Current Illness: None
Preexisting Conditions: None
Allergies: None to my knowledge
Diagnostic Lab Data: I didn''t go to Urgent Care or seek medical treatment as I expected some adverse results.
CDC Split Type:

Write-up: Woke up middle of the night thinking I was having a heart attack; lasted 30-40 minutes Left side so painful couldn''t lay on that side Often thru the night and next day felt as if I had the flu; cold and shivering one minute, sweating the next. Didn''t sleep well at all that night and could not get myself out to take on the day as I usually do. Felt really tired and weak most of the day.


VAERS ID: 1695829 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-08
Onset:2021-09-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Electrocardiogram normal, Head discomfort, Hypertension, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypertension (narrow), 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: Lisinopril, hydrochlorothiazide, alprazolam
Current Illness: None
Preexisting Conditions: Hypertension
Allergies: Benzonatate
Diagnostic Lab Data: EKG 09/13/2021 resulted as normal. Blood pressure of 141/90 resulted in ?high-normal? Echocardiogram scheduled for 09/22/2021
CDC Split Type:

Write-up: 2 days after shot, my arm was sore. I started feeling a ?pinch-type? feeling in my upper left chest. My blood pressure, which is controlled by medicine, has been rising since. I also have had a pressure in the back left portion of my head.


VAERS ID: 1696063 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

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

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

Write-up: severe calf pain, aching , non responsive to nsaids


VAERS ID: 1696090 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 3 RA / IM

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

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

Write-up: Severe pain in arm and shoulder starting the day after vaccination. This occurred after the "booster" dose was administered. Hot pads, OTC lidocaine, ice packs, massage therapy, and OTC Tylenol have been given to relieve the pain but nothing seems to work. Wakes patient up at night due to severity of pain.


VAERS ID: 1696175 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-08
Onset:2021-09-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

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

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

Write-up: Hives


VAERS ID: 1696188 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-08
Onset:2021-09-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort
SMQs:, Anaphylactic reaction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Niacin. Vegan protein. Vitamin d3. Vitamin c. Multi vitamin. Psllium husk
Current Illness: None
Preexisting Conditions: Mild sleep apnea.
Allergies: Penicillin
Diagnostic Lab Data: None yet. Will see my doctor soon
CDC Split Type:

Write-up: After a day or two my heart started to feel tight. I?ve experience anxiety and panic in the past but never in my chest. My breathing is normal. Heart rate normal. But i can?t shake this tight chest. I?m gonna see a doctor if it doesn?t get better.


VAERS ID: 1696237 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-04
Onset:2021-09-10
   Days after vaccination:129
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CAD, DM, HTN
Allergies: no known allergies
Diagnostic Lab Data: COVID PCR + 9/13/21
CDC Split Type:

Write-up: SOB, chest pain


VAERS ID: 1696240 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-16
Onset:2021-09-10
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001B21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, cefaDROXIL, cetirizine, cinacalcet,dextrose, gapentin, glucagon, glucose, insulin aspart, v
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted to hospital as observation today due to pneumonia due to Covid 19. Patient was tested for COVID-19 and was positive on 9-10-21.


VAERS ID: 1696242 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

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

Write-up: four hours after vaccination, pt started with hives on that arm that spread to the other arm and both ankles over night


VAERS ID: 1696257 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-19
Onset:2021-09-10
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Facial pain, Fatigue, Pain in jaw, Paraesthesia oral
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Osteonecrosis (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: Nebido - Testosterone Depot. It''s for Klinerfeldt syndome.
Current Illness: Acid Reflux
Preexisting Conditions: Klinerfeldt Syndrome
Allergies: eggs
Diagnostic Lab Data:
CDC Split Type:

Write-up: a few days after taking my second dos I was extremely tired the first week. 15 days after the injection my jaw bone started to hurt. A lot. Now I''m taking 3x Extra Strength Tylenol PMs every 3 hours to keep the pain at away. When the pain does come back it goes straight to my jaw, upper jaw, left side of my face reaching up to my left temple. I have never experienced this kind of pain ever. Well, maybe when I was growing up. It feels like growing pains in my face. All my teeth are tingling. Very annoying. Will this go away?


VAERS ID: 1696266 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-28
Onset:2021-09-10
   Days after vaccination:44
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / N/A - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19 pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen, albuterol sulfate inhaler, apixaban, vit D3, cyclobenaprine, folic acid, gabapentin, levothyroxine, metformin, metoprolol, prednisone, sitagliptin, warfarin
Current Illness: unknown
Preexisting Conditions: type II diabetes, asthma, CKD stage IIIa, history of DVT, hypothyroidism, obstructive sleep apnea, morbid obesity
Allergies: vicodin, ibuprofen
Diagnostic Lab Data: COVID antigen test 9/10/21- POSITIVE
CDC Split Type:

Write-up: Patient presented to ED 9/10/21 and was admitted for acute hypoxic respiratory failure secondary to COVID-19 pneumonia. COVID antigen test was positive 9/10/21. Patient was discharged to home 9/13/21.


VAERS ID: 1696297 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bone pain, Chills, Confusional state, Fatigue, Headache, Injection site pain, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Osteonecrosis (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: Vitamin D, Vitamin C, Zinc
Current Illness: COVID + $g14 days prior to vaccine
Preexisting Conditions: None, other wise healthy
Allergies: No allergies.
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fever $g103, Bone pain, Confusion, Fatigue, Nausea, Muscle Pain, Chills, Rigors, Injection site pain, Headache. Approximately 12 hours post vaccination Fever, chills, muscle pain, and headache began. These continued for the next 48 hours. Bone pain began approximately 24 hours post vaccination and continued for 12 hours. Fatigue began 36 hours post vaccination and still continues. Confusion began 94 hours post vaccination and still continues.


VAERS ID: 1696303 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysmenorrhoea, Heavy menstrual bleeding, Intermenstrual bleeding
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: Aleve, Prozac.
Current Illness: None
Preexisting Conditions: None
Allergies: Peroxide
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe menstruation cramping, heavy menstruation spotting/bleeding. Symptoms started one day after receiving vaccine with cramping. The next day followed by cramping and breakthrough spotting. Very regular periods otherwise. Last period was sept 1-4th.


VAERS ID: 1696308 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-07
Onset:2021-09-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deafness
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: taking 5mg eliquis
Current Illness: None
Preexisting Conditions: Atrial fibrillation
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: About three days after the second dose of the Moderna covid 19 vaccine my grandfather has lost his hearing. He is no longer able to talk on the phone due to hearing loss. He lives alone so as you can see this is very very alarming.


VAERS ID: 1696314 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-07
Onset:2021-09-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anticoagulant therapy, Dyspnoea, Pulmonary thrombosis
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prozac
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blood Clots both lungs, Hospital stay x4 days, shortness of breathe, heparin IV x3 days and oral blood thinner x6 months


VAERS ID: 1696316 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Exposure during pregnancy, Headache, Heart rate increased, Product preparation error, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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: Pepcid ASA Folic acid Vit D 5000 units Prenatal Vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: Codeine
Diagnostic Lab Data: Patient works for Dr., her PCP and he checked on her. She also let OB aware. She is going to have check up with OB this week - Did not go to ER. She did had headache about 6 PM pm 9/10/21. Still has lingering headache.Reports heart rate was 115-120 even resting Saturday and Sunday. Reports her heart rate has gone down now. Had a fever on Saturday - Temp 101.2
CDC Split Type:

Write-up: G4P0 EDC 11/21/2021 Hx of IVF Patient went to pharmacy for Pfizer dose #2. At 1:42 PM patient states that pharmacy called her to tell her Pfizer was reconstituted with Moderna Vaccine instead of sodium chloride.


VAERS ID: 1696361 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema of eyelid, Eye swelling, Fatigue, Headache, Malaise, Migraine, Rash macular
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro 10mg, Multivitamin, Vitamin D, Vitamin C, Turmeric Curcumin, Co-Q10
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Continuous headache ranging from moderate to severe migraine every day since injection, now on day 4. Splotchy, red swollen left eye on day 4. Fatigue, malaise.


VAERS ID: 1696368 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-24
Onset:2021-09-10
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: HTN, prostate CA
Allergies: no known allergies
Diagnostic Lab Data: COVID-19
CDC Split Type:

Write-up: Patient admitted to hospital with COVID-19 status


VAERS ID: 1696481 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-19
Onset:2021-09-10
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 9/13 SARS/COV-2, NAAT positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1696496 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF 2588 / 2 LA / SYR

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

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

Write-up: About an hour after receiving the vaccine I started to feel a weird sensation on the left side of my face and broke out in hives on the left side of my forehead, neck, and by my nose. Had to go to the hospital due to having an allergic reaction to the vaccine and had to take steroids and pepcin for the next two days because the hives kept coming back.


VAERS ID: 1696499 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 RA / IM

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

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

Write-up: Patient was given Pfizer COVID 19 vaccine at 11 years of age. No negative outcomes at this time


VAERS ID: 1696537 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-19
Onset:2021-09-10
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: positive covid-19 PCR test on 9/12/21
CDC Split Type:

Write-up: symptoms of covid-19, mild


VAERS ID: 1696593 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Burning sensation, Headache, Injection site pain, Lymph node pain, Lymphadenopathy, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: SORE ARM & AT INJECTION SITE, HEADACHES, SWOLLEN LYMPH NODES IN ARMPIT REGION CAUSING SHARP PAINS, TINGLING TO THE ELBOW & BURNING FEELING


VAERS ID: 1696609 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-08
Onset:2021-09-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood creatinine, C-reactive protein increased, Chest X-ray, Chest discomfort, Chest pain, Differential white blood cell count, Dyspnoea, Electrocardiogram, Fibrin D dimer, Full blood count, Inflammatory marker increased, Metabolic function test, Musculoskeletal pain, Pericarditis, Red blood cell sedimentation rate increased, SARS-CoV-2 test negative, Troponin
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: Penicillin, IV contrast dye, Augmentin
Diagnostic Lab Data: 9/13/21 EKG, chest xray, CBC w auto diff, D-Dimer quantitative, CRP elevated (1.3), Sed rate elevated (24), Creatinine, CMP, Troponin x2, covid swab inflammatory markers elevated
CDC Split Type:

Write-up: 9/10/21 tightness in chest began at 12pm. Shortness of breath very mild Friday night, 9/11/21 chest tightness increasing and more shortness of breath. 9/12/21 chest pain and tightness, short of breath and sharp pain under left shoulder blade began. 9/13/21 went to ER 8am at the advice of PCP. Diagnosed with acute pericarditis. Given aspirin, Solu-medrol, nebulizer treatment, labs drawn, chest xray and ekg performed. Covid swab (negative). Sent home with prescription for anti-inflammatories, inhaler and to rest and monitor vital signs and symptoms for worsening.


VAERS ID: 1696613 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-27
Onset:2021-09-10
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 RA / IM

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

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

Write-up: hospitalization (non-ICU)


VAERS ID: 1696618 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-20
Onset:2021-09-10
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Private       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: hospitalization (non-ICU)


VAERS ID: 1696645 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-16
Onset:2021-09-10
   Days after vaccination:237
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM

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

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

Write-up: hospitalization (non-ICU)


VAERS ID: 1696662 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mirena IUD, Magnesium, Probiotic, Vitamin D, Omega-3, Vitamin B.
Current Illness: N/A
Preexisting Conditions: Obese
Allergies: Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shingles - unk outcome at this time. Presented which shingles and nerve pain.


VAERS ID: 1696674 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Feeling cold, Headache, Heart rate increased, Throat tightness, Tinnitus, Vision blurred
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypersensitivity (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: flu shot when 18 caused the hole in arm .
Other Medications: Symbicort vitamin C vitamin D meloxicam
Current Illness:
Preexisting Conditions: hypothyroid arthritis asthma
Allergies: albuterol, Zoltan
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1 hour after vaccine blurred vision in left eye . Throat felt like it was closing up and ear ringing . all lasted about 2 hours. 9/10 -9 /13 severe headaches and chills . Heart rate over 100


VAERS ID: 1696685 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-11
Onset:2021-09-10
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Malaise, 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: Lyrica, Lipitor, Prinzide, Tylenol PM
Current Illness:
Preexisting Conditions:
Allergies: Codeine
Diagnostic Lab Data: COVID-19
CDC Split Type:

Write-up: Patient received 2nd Pfizer vaccine on 03/11/2021. Patient developed symptoms of Covid-19 on 09/10/2021. A rapid Covid-19 test was completed and positive results were received on 09/10/2021.


VAERS ID: 1696688 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-02
Onset:2021-09-10
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac, BeYaz, Irbsertan
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain, fever


VAERS ID: 1696696 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

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

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

Write-up: The patient received her first dose of the COVID-19 vaccin (Pfizer). Standard dose was administered with no adverse reaction at first. Patient states later in the evening she began to notice swelling in her left arm, an area on her left thigh, redness on left side of face, and a headache. The same swelling was noted the next day. She called the pharmacy in the afternoon on Saturday 9/11/21 to inquire about the reaction and what she should do. I recommended taking tylenol, using cold compresses, and calling her physician. With her permission, I called her on Tuesday 9/14/21 at which time she stated that the swelling had gone down as of mid day Monday 9/13/21, but headache is still present. She also stated that she called her doctor, but had not responded back to her.


VAERS ID: 1696722 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 59267-1000-03 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Fatigue, Flushing, Palpitations, Tinnitus
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypersensitivity (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: Zoloft 100 mg daily Seroquel 125 mg daily
Current Illness: Cold-upper respiratory infection. COVID negative on test on 09/09/21. Was told could still get vaccine on 09/10/21 due to no fever and negative test.
Preexisting Conditions: Depression and anxiety, heart arrythmia
Allergies: Penicillin Doxycycline Capzasin Indoor/outdoor allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Flushing feeling followed by racing heart episodes off an on. Lightheaded. Feelings at times of impending doom or death. Ringing in ears. Tiredness


VAERS ID: 1696770 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Rash
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I noticed after I got out of the shower around 10 pm the day of my 2nd dose I had a rash on the top of my right shoulder across my chest and collarbone and up the sides of my neck. The rash did not itch or hurt and was gone the next day. I also started my menstrual cycle the day after my shot and have been bleeding very heavily for 3 days (Sunday, Monday and Tuesday 9/12-9/14. not showing signs of letting up.


VAERS ID: 1696784 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Confusional state, Decreased appetite, Dizziness, Fatigue, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: flu shot 10 years ago (egg allergy)
Other Medications: Claritin, Nasonex, CBD oil, elderberry with zinc, Women''s One a Day Vitamin, probiotic
Current Illness: None
Preexisting Conditions: Allergies (seasonal and food), asthma, insomnia; GERD
Allergies: Penicillin, Amoxicillin, Sucralfate liquid
Diagnostic Lab Data: thermometer reading of 102.4
CDC Split Type:

Write-up: Fever(102.4)(101 with medication), shaking/chills for 48 hours, nausea and vomiting; dizziness, confusion for 48 hours; loss of appetite on 2nd day; fatigue; pt used tylenol and ibuprofen for 48 hours; lingering fatigue since shot


VAERS ID: 1696878 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-02
Onset:2021-09-10
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: Rapid test for Covid 9/12 +
CDC Split Type:

Write-up: Client was vaccinated with Pfizer vaccines for Covid on March 2 and March 30, 2021. Covid symptoms started 9/10/2021 - sinus congestion, cough, headache. Tested positive for Covid with rapid test on 9/12. Client vaccinated x 2 and reported as a case of breakthrough Covid.


VAERS ID: 1696882 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 1 UN / IM

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

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

Write-up: Moderna 0.5ml dose was administered to 15 year old patient.


VAERS ID: 1696909 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-07
Onset:2021-09-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 RA / IM

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

Write-up: reported swelling at injection site starting 2 to 3 days after vaccine. also redness that traveled down the arm (maybe halfway to elbow). took almost 5 days to mostly resolve.


VAERS ID: 1696952 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-18
Onset:2021-09-10
   Days after vaccination:115
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril 20mg, Glipizide 5mg, Crestor 20mg, Naltrexone 50mg, Atomoxetine 80mg, Fexofenadine 180mg, Zoloft 100mg, Omeprazole 40mg, Mobic 15mg.
Current Illness:
Preexisting Conditions: Hypertension, Hypercholesterolemia, GERD, Diabetes, Depression
Allergies: N/A
Diagnostic Lab Data: SARS COV-19 PCR
CDC Split Type:

Write-up: Progressive shortness of breath and fever. Patient is fully vaccinated with Covid-19 Pfizer vaccine with positive SARS COV-19 PCR test.


VAERS ID: 1696956 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 LA / IM

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

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

Write-up: What the patient wrote below. "However I had a bad reaction to the 2nd covid shot. I woke up with a big lump in my arm. And a bad headache. And I felt nauseous. So bad I had to go to the emergency room and get a shot I feel better much better now. Thank you." Called the patient today and she is fine now and she is completely ok and she is happy now.


VAERS ID: 1696979 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arrhythmia, Chest discomfort, Dyspnoea, Electrocardiogram normal, Fatigue, Ventricular extrasystoles
SMQs:, Anaphylactic reaction (broad), Ventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu. Vaccine severe anaphylactic almost intubated two week hospital stay
Other Medications: Claritin Flonase Flovent 220 2 puffs bid
Current Illness: None
Preexisting Conditions: Asthma and seasonal allergies
Allergies: FLU VACCINE PENICILLIN
Diagnostic Lab Data: Ekg today normal rhythm but pushing on my chest still present
CDC Split Type:

Write-up: I started having PVCs Friday the day after the vaccine I do not have a history of PVCs. The irregular heart rhythm caused me to catch my breath. I had quick onset fatigue and all this has occurred daily since the 9th. My chest feels like someone is pushing on it.


VAERS ID: 1696995 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injected limb mobility decreased, Injection site bruising, Product administered at inappropriate site
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Drug abuse and dependence (broad), Medication errors (narrow)

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

Write-up: Pt came into clinic today (4 days since vaccine administration) reporting that she has had severely limited ROM after her inj. Upon inspection, pt had obvious bruising that was too high of placement for an IM deltoid injection. Pt reports gradual improvement and declined wanting to be seen by physician or having any further work up.


VAERS ID: 1697006 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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: Nome
Current Illness: None
Preexisting Conditions: Testicular cancer
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Passed out 5 minutes after injection.


VAERS ID: 1697011 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-21
Onset:2021-09-10
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Current Outpatient Medications: ? atorvastatin (LIPITOR) 20 mg tablet, Take 1 tablet (20 mg total) by mouth daily., Disp: 90 tablet, Rfl: 3 ? biotin 1 mg tablet, Take 1 mg by mouth daily., Disp: , Rfl: ? CHOLECALCIFEROL, VITAMIN D3, OR
Current Illness: no acute illnesses at the time a vaccination or prior
Preexisting Conditions: palpitations wearing an event monitor 25 Aug 2021 - 08 Sep 2021 Hypercalcemia /hyperparathyroidism, hyperlipidemia on long-term statin, restless leg syndrome on maintenance medications, chronic headache, chronic fatigue, sleep apnea
Allergies: Skin rash from some adhesive tapes Skin rash from azithromycin
Diagnostic Lab Data: video visit Sep 14, 2021
CDC Split Type:

Write-up: No immediate adverse event but onset of diffuse bilateral hive like confluent erythematous rash both axillae chest breast about 21 days after the 3rd Moderna vaccine (Sept 11-12) She did not have a rash after the earlier Moderna vaccines.. First dose 1/13/2021, 2nd dose 2/11/2021. Patient is not immunocompromised and is not guideline- eligible candidate for the "early booster" 3rd shot.


VAERS ID: 1697207 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol sulfate (VENTOLIN HFA) 90 mcg/actuation HFA inhaler Inhale 2 Inhalations by mouth every 6 (six) hours as needed for Wheezing. amitriptyline (ELAVIL) 25 MG tablet Take 1 tablet by mouth at bedtime. benzonatate (TESSALON) 100 MG c
Current Illness:
Preexisting Conditions: Depression and Asthma
Allergies: PCN (Rash)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt w/ hx of allergy to PCN (Rash). PMH significant for Depression and Asthma. 7mins post vaccination pt c/o lightheadedness Vitals: 90/47, HR 82. Pt states she has a hx of low BP. She did not have breakfast before coming for vaccination. Pt monitored for a total of 30mins, given crackers & H2O. Symptoms self resolved.


VAERS ID: 1697356 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Back pain, Chills, Diarrhoea, Dizziness, Dysarthria, Feeling abnormal, Headache, Hyperhidrosis, Lethargy, Mobility decreased, Nasal congestion, Nausea, Pain, Polymenorrhoea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Slurred speech, early menstrual cycle, Extreme excruciating debilitating headache for days, lower back pain, body aches, fever, chills, sweating, unable to get out of bed for days, nausea, diarrhea, lethargy, loss of muscle strength, dizziness, foggy brain, nasal congestion. These began in the evening I received the vaccine (Thursday) And lasted until Tuesday , September 14. I was in bed for 6 days.


VAERS ID: 1697393 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia, Lymph node pain, Lymphadenopathy
SMQs:, Taste and smell disorders (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: Orthocyclin, Metoporolol
Current Illness: None
Preexisting Conditions: PCOS, endometriosis, medullary sponge kidney, hbp, interstitial cystitis, IBS
Allergies: Vantin, morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Metallic taste in mouth ongoing (currently day 4); painful, enlarged cervical lymph node, ongoing, left side (currently day 4).


VAERS ID: 1697584 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Chills, Dizziness, Fatigue, Lip swelling, Lymphadenopathy, Nausea, Pain, Paraesthesia, Pruritus, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Amlodipine Metformin Lisinopril Atorvastatin
Current Illness:
Preexisting Conditions: High Blood Pressure Diabetes
Allergies: Mango Macadamia nuts Almonds Cumin Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Tingling in hands(like pins and needles), dizziness, slight swelling of lips occurred about 20 minutes after the vaccine was administered. I was already on my way home. Tingling and dizziness dissipated after about 1 hour. Hives and itching on top of right foot and left forearm began later on in the evening (around 9:00pm). These reactions lasted for three days. I did not take benedryl, as it has an interaction with one of my medications. Fatigue and a mild temperature set in around 10:00pm. On Saturday, September 11, at around 1:00pm I became very nauseous, achy and fatigued and developed intense chills and a fever of 102.6. I took Ibuprofen. By 5:00 pm My fever reached 103.2. This continued for the next 24 hrs. The temperature is now in the 99.8 range and I am still fatigued and have swollen lymph nodes.


VAERS ID: 1697772 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-01
Onset:2021-09-10
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anal haemorrhage, Anal sphincterotomy, Arteriovenous malformation, Basophil count, Basophil percentage decreased, Blood pressure decreased, Colonoscopy normal, Dyspepsia, Eosinophil count, Eosinophil percentage decreased, Fatigue, Gastrointestinal haemorrhage, Haematocrit decreased, Haemoglobin decreased, Haemorrhoid operation, Immature granulocyte count, Lymphocyte count, Lymphocyte percentage, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume normal, Monocyte count, Monocyte percentage, Nausea, Neutrophil count, Neutrophil percentage, Platelet count, Red blood cell count decreased, Red cell distribution width normal, Surgery, Syncope, Transfusion, White blood cell count normal
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Congenital, familial and genetic disorders (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Probiotic, Ibprofen as needed, Tylonel as needed, (Cont.)
Current Illness: None
Preexisting Conditions: Hemorrhoids (current), anal fissure (current), history of c. diff (June 2020)
Allergies: None
Diagnostic Lab Data: (Cont.)
CDC Split Type:

Write-up: In the afternoon on Friday 9/10/21 I began feeling nauseous, having heartburn, and extreme fatigue. On the morning of 9/11/2021 I started having profuse anal bleeding and went to the emergency room where the bleeding continued. My blood pressure dropped to 79/55 and I fainted. I was given a blood transfusion and brought into surgery. The doctor did an EUA and did not find the source of the bleed. I was hospitalized overnight and did a colonoscopy prep and had a colonoscopy the next day. The doctor did not find the source of the bleed. She said it was probably an arteriovenous malformation in the small (cont.)


VAERS ID: 1697954 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Chills, Cough, Fatigue, Headache, Hyperhidrosis, Mouth ulceration, Oropharyngeal pain, Pain, Pharyngeal swelling, Pyrexia, Rash, Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Mouth sores/ulcers, sore throat, severe headache, fever, chills, sweating, rash over all major lymph node areas on the body, face rash, swollen throat, fatigue, cough and chest heaviness I experienced during Covid back in November has suddenly returned, aches


VAERS ID: 1700066 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Presyncope, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Healthy
Allergies: Unknown
Diagnostic Lab Data: None completed, scheduled for a workup for persistent tachycardia
CDC Split Type:

Write-up: Near-syncope, tachycardia


VAERS ID: 1700119 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lymphadenopathy, Oropharyngeal pain, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: 1 hour after receiving vaccine throat became extremely sore and slightly swollen with swollen glands. Sore throat lasted 5 days. Swelling of throat went away after 2 days.


VAERS ID: 1700156 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 2 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Axillary pain, Balance disorder, Discomfort, Dizziness, Headache, Injection site bruising, Injection site erythema, Lymphadenopathy, Pain, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pepcid, Tylenol and Ibuprofen
Current Illness: N/A
Preexisting Conditions: None
Allergies: Steri Strips and IV Cipro
Diagnostic Lab Data: No testing performed.
CDC Split Type:

Write-up: On 09/10/2021 had normal symtoms of body aches, large bruise at injection site and headaches; however on morning of 09/11/2021 I was awaken with temperature on 100.9, body aches, large bruise at injection site , large red area below injection site, light headness, dizziness, equilibrium off and continued to spread and enlarged lymph nodes in right axilla with pain and discomfort. on 09/13/2021 pt was prescribed Cephalexin 250mg po qid for 10 days, Acetaminophen 50mg po prn, Cetirizine 5mg po prn and Hydrocortisone 0.5% topical cream to use prn. I followed up with my Primary Care Dr. on 09/14/2021


VAERS ID: 1700173 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-10
Onset:2021-09-10
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Diarrhoea, Nausea, Pain, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: COPD, DM2
Allergies:
Diagnostic Lab Data: POSITIVE SARS-COV-2 BY PCR
CDC Split Type:

Write-up: This case meets vaccine breakthrough criteria review. SXS 1 WEEK OF COUGH, NAUSEA, DIARRHEA, BODY ACHES, CHILLS


VAERS ID: 1700183 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-04
Onset:2021-09-10
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram, Eyelid disorder, Facial paralysis, Hypoacusis, Hypoaesthesia eye, Hypoaesthesia oral
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Corneal disorders (broad), Hearing impairment (narrow), Periorbital and eyelid disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Buspirone 5mg 2x daily Cranberry supplement 1x daily Claritin 1x daily
Current Illness: None
Preexisting Conditions: None
Allergies: Diphenhydramine Effexor Phenylephrine HCl Doxylamine Succinate
Diagnostic Lab Data: CT Scan, Tuesday September 14th revealed no signs of stroke or other neurological abnormalities.
CDC Split Type:

Write-up: Facial palsy on the right side began 6 days after receiving second dose of Covid (Pizer) vaccine. Sypmtoms start with a numb tongue and gradually moved up to the right eye. Tongue numb, smile not even, facial drooping, right eyelid nonfunctional, hearing affected. Prescribed 60mg Prednisone taken 1x daily for 7 days started on day 5 of reaction. Treatment still ongoing and symptoms still present on Day 6 of reaction.


VAERS ID: 1700233 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Pain, Pain in extremity, Product preparation issue
SMQs:, Tendinopathies and ligament disorders (broad), Medication errors (broad)

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

Write-up: Patient was administered 0.3ml of improperly prepared vaccine. I mixed 0.8ml of diluent instead of 1.8ml. The patient then was administered 0.3ml. This was realized at 2:30 pm. 9/13/2021- I spoke with the patient''s mom to see how she did with post vaccination. Mom stated, "she has done fine, her arm was just a little sore when she lifted it, which is normal, other than that she''s good". I informed mom on the vaccine volume administration. Mom stated she understood and was okay with the outcome. According to CDC''s Pfizer guidance, no repeated doses needed.


VAERS ID: 1700237 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-08-12
Onset:2021-09-10
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006021A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Chills, Dizziness, Fatigue, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient reports intermittent increase in dizziness, fatigue, chills, and muscle aches Patient reports significant increase in baseline blood pressure reading before and after taking medication


VAERS ID: 1700287 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-08
Onset:2021-09-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Computerised tomogram thorax abnormal, Dyspnoea, Pulmonary embolism
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Azithromycin, vitamin D3, coenzyme Q10, Vitamin B12, Restasis eye drops, Prolia injection, Estrace vaginal cream, Allegra D, Diflucan, Prozac, Flonase nasal spray, hydrochlorothiazide, Synthroid, losartan, Mycostatin powder, Patanol eye dro
Current Illness: None
Preexisting Conditions: Interstitial lung disease, pulmonary nodules, IgA deficiency, hypothyroidism, hypoparathyroidism, HTN, allergic rhinitis, left ventricular dysfunction
Allergies: Innovar Aspirin
Diagnostic Lab Data: CTA chest on 9/14
CDC Split Type:

Write-up: Pt received the 3rd Covid vaccine on 9/8 and on 9/10 started having shortness of breath and chest tightness. She continued to have these symptoms and presented to our emergency department on 9/14 and was found to have an acute, large saddle pulmonary embolism.


VAERS ID: 1700292 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-08-18
Onset:2021-09-10
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac telemetry, Chest discomfort, Chest pain, Extrasystoles, Headache, Hyperhidrosis, Painful respiration, Somnolence, Toothache, Troponin increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Hypoglycaemia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: COVID-19 positive on 7/28
Preexisting Conditions:
Allergies: nka
Diagnostic Lab Data: Troponin levels 14.37 and 17.69 ng/ml 9/13/21
CDC Split Type:

Write-up: Pt received 2nd dose in series 9/10/21 and felt drowsy that day. On 9/11/21 patient reported lying on stomach all day and development of sharp chest pain covering his whole chest that lasted throughout the day. On 9/12 the patient was no longer experiencing chest pain, but experiencing profuse sweating. On 9/13 the patient awoke with headache in the back of the head and back of teeth, chest discomfort, and feeling of heart skipping beats. Later that day he reported to an urgent care and was referred to the local hospital. At the hospital he presented with non-radiating midsternal constant stabbing pain that worsens when taking breaths. Patient admitted for close cardiac monitoring: Cardiology consult, placed on continuous telemetry monitoring and started on aspirin, colchicine, and supportive therapy.


VAERS ID: 1700300 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-08
Onset:2021-09-10
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029K20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Hypoxia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Respiratory failure (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: ESRD, multiple myeloma, THN, uncontrolled diabetetes
Allergies: ACE inhibitors, lisinopril
Diagnostic Lab Data: SARS CoV 2 PCR COVID19 detected on 9/10/2021
CDC Split Type:

Write-up: He completed COVID vaccines in Feb, 2021. He was admitted to Hospital due to weakness, hypoxia at 85% on room air, and fever 101.2 on 9/10/21. On hospital day 6 (9/15/21), he is on room air and completed the course of Remdesivir.


VAERS ID: 1700312 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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:
CDC Split Type:

Write-up: The adverse event was that an expired Janssen COVID-19 Vaccine has been administered to the patient. There were no adverse event, symptoms or any health related issues regarding the patient after the vaccine dose was given. Only that the vaccine has been given after the expiration date, nothing else.


VAERS ID: 1700325 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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:
CDC Split Type:

Write-up: The adverse event was that an expired Janssen COVID-19 Vaccine has been administered to the patient. There were no adverse event, symptoms or any health related issues regarding the patient after the vaccine dose was given. Only that the vaccine has been given after the expiration date, nothing else.


VAERS ID: 1700343 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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:
CDC Split Type:

Write-up: The adverse event was that an expired Janssen COVID-19 Vaccine has been administered to the patient. There were no adverse event, symptoms or any health related issues regarding the patient after the vaccine dose was given. Only that the vaccine has been given after the expiration date, nothing else.


VAERS ID: 1700355 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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:
CDC Split Type:

Write-up: The adverse event was that an expired Janssen COVID-19 Vaccine has been administered to the patient. There were no adverse event, symptoms or any health related issues regarding the patient after the vaccine dose was given. Only that the vaccine has been given after the expiration date, nothing else.


VAERS ID: 1700381 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 1 LA / IM

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

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

Write-up: Patient given 1 dose of moderna prior to turning the approved date of 18 years of age. Second dose due one week prior to 18th birthday. Will be given following birthday.


VAERS ID: 1700484 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphagia, Rash
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Pandoprozal
Current Illness:
Preexisting Conditions: Acid Reflux
Allergies: Shrimp
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: I received a rash within 5 minutes of having the vaccine. It started to spread to my back and chest. The pharmacist called the ambulance and gave me Benadryl. I went to the ER, and they kept me for 5 hours. They also gave me IV steroids. My throat also felt a little tough to swallow. I went and saw my doctor and he prescribed steroids for the rash as well.


VAERS ID: 1700489 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058621A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Feeling abnormal, Injection site pain, Night sweats
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Norvask (Blood Pressure)
Current Illness: N/A
Preexisting Conditions: High Blood Pressure
Allergies: NKDA
Diagnostic Lab Data: Have not seen a provider yet
CDC Split Type:

Write-up: My head is in a fog, dizziness, tired, left arm is still sore, night sweats


VAERS ID: 1700534 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-15
Onset:2021-09-10
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP 7534 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW 0169 / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Pancreatic disorder, 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: pancreatic issues with which she was admitted for
Preexisting Conditions: non verbal
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: admitted from Assisted Living Facility on 9/10 through 9/14 due to pancreatic issues. coincidentally found to be COVID (+) without any symptoms.


VAERS ID: 1700544 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-09
Onset:2021-09-10
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthropod bite, Chronic inflammatory response syndrome, Condition aggravated, Depression, Dizziness, Emotional distress, Endodontic procedure, Erythema, Fatigue, Feeling abnormal, Headache, Inflammation, Lethargy, Limb discomfort, Malaise, Mobility decreased, Skin infection, Skin lesion, Skin swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid; Cytomel; maybe Vit D
Current Illness: no
Preexisting Conditions: CIRS - chronic inflammatory response syndrome - have had it for a few years - ongoing - Hypothyroidism - that is managed by medication
Allergies: Diladid; softshell crab and salmon and bees (bees is a new one - I had to go to Urgent care about 3 weeks ago when I got stung by a bee twice - I had a severe hives reaction)
Diagnostic Lab Data: no
CDC Split Type: vsafe

Write-up: First off, I was down for the count for almost four days. I was very tired, lethargic. I was lying in bed for four days. Just feeling really punk. Maybe I took Tylenol. As time went on, I had a wellness physical with my doctor within a month and as she was looking at me, she asked what it was under my left arm. My left arm is more affected by something it seems because that is where I got the shot in. It was about 2 1/2 inch lesion and it was very red. It was not itching or anything. She referred to a dermatologist. It almost looked like a slug shape - it was raised and it was very red. He thought it was an infection. He gave me an antibiotic cream to put on it and it went crazy - I had to put my arm up to have it in a "L" shape. and it got itchy and burning. That was the wrong medicine and that irritated it terrible. I couldn''t take the cream. I went back to the doctor and the doctor prescribed a steroid cream for about two months. The redness did go down - but now I am scarred. It is not raised but it''s almost like a birthmark under there. I got two tick bites in the following week. I got a tick under my left arm under there. And also a tick embedded on my neck. I did go on an antibiotic for that. It scarred - the one that was on the arm that was on the same size as my lesion after the vaccine. The one on my neck didn''t scar. I have been fighting the re-occurrent symptoms of CIRS again since getting the second shot. And when I got the bee sting three weeks ago - it really set me back again with my chronic symptoms ( my CIRS chronic symptoms had leveled out and I was feeling better before I got the COVID vaccines). I have been very fatigued now since and shot and have had more dizziness; headaches; brain fog - the vaccine made my body get more inflamed - it got my body working harder again with inflammation happening and my body can''t handle it and my brain gets affected. I did get the bee sting in my left arm - three weeks ago. I went to Urgent Care and I have never had this before - crotch area to shoulders was hive - unbelievable itching and burning but my throat didn''t close. But they now have me carry an epi-pen. They gave me a shot of Steroids and shot of Benadryl and a Pepcid pill. I am still recovering now because I have had to have root canal - had to put novacaine around my mouth - and have been dealing with headaches/nausea from that. Anything extra is causing me to flatten out again. Wears on emotions too and depression sets in.


VAERS ID: 1700561 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac flutter, Chest pain, Injection site pain, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole, Atenolol, Norethindrone-eth Estr multi-vitamin/mineral
Current Illness: none
Preexisting Conditions: hot flashes high blood pressure heartburn history of tachycardia corrected in 1997 by electrocardiology
Allergies: citrus, fish, soy
Diagnostic Lab Data: none
CDC Split Type:

Write-up: first 36 hours had 10 episodes of heart trying to go into tachycardia, 1 episode of heart fluttering for about 5 seconds, 3 episodes of a sharp pain shooting across my left chest first 72 hours had slightly sore arm at injection site


VAERS ID: 1700580 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-03
Onset:2021-09-10
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Adenovirus test, Asthenia, Bordetella test negative, COVID-19, COVID-19 pneumonia, Cardiomegaly, Chest X-ray abnormal, Chlamydia test negative, Coronavirus test negative, Dyspnoea, Enterovirus test negative, Human metapneumovirus test, Human rhinovirus test, Influenza A virus test negative, Influenza B virus test, Mycoplasma test negative, Plasmapheresis, Respiratory syncytial virus test negative, Respiratory viral panel, SARS-CoV-2 test positive, Viral test negative
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: (ZYLOPRIM) 300 mg (COREG) 12.5 mg cyanocobalamin 250 mcg (Expired) (COLACE) 100 mg ferrous sulfate 325 mg (65 mg iron) (Expired) (LASIX) 20 mg JANTOVEN 5 mg (PRINIVIL, ZESTRIL) 5 mg (Expired) oxygen (02) gas (PRAVACHOL) 80 mg (AL
Current Illness:
Preexisting Conditions: Nervous Hemispheric carotid artery syndrome Subconjunctival hematoma Circulatory Atrial fibrillation with slow ventricular response Aortic stenosis Atrial fibrillation Cardiomyopathy Diastolic congestive heart failure Coronary artery disease Mitral regurgitation Atrial fibrillation, unspecified type Hemangioma of liver Valvular heart disease Chronic diastolic heart failure Digestive Cirrhosis of liver with ascites, unspecified hepatic cirrhosis type Vitamin B12 deficiency Gastroesophageal reflux disease without esophagitis Erosive gastritis Genitourinary Acute-on-chronic renal failure Hematologic Iron deficiency anemia Infectious/Inflammatory COVID-19 Other Fall Ascites
Allergies: NKA
Diagnostic Lab Data: 09/10/21 1700 Respiratory virus detection panel Collected: 09/10/21 1525 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected X-ray chest 2 views Result Date: 9/8/2021 XR CHEST 2 VW IMPRESSION: No acute cardiopulmonary disease. END OF IMPRESSION: INDICATION: Abdominal pain.. TECHNIQUE: PA and lateral views of the chest. COMPARISON: 6/13/2018. FINDINGS: Support devices: Left chest wall pacemaker with lead overlying the right ventricle. Valve replacement. Sternotomy wires.. Lungs: Clear lungs. Mediastinum: Cardiomegaly. The cardiac silhouette is relatively unchanged when allowance preferred differences in positioning.. Other: No significant interval changes when compared to the prior study. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. Result Date: 9/10/2021 XR CHEST 1 VW PORT IMPRESSION: 1. Stable chest compared with 9/8/2021. 2. Stable severe cardiomegaly. Prior aortic valve replacement and left subclavian pacemaker. 3. No edema or pneumonia. END OF IMPRESSION: INDICATION: weak sob weak sob. TECHNIQUE: Portable projection of the chest is acquired. COMPARISON: 9/8/2021 FINDINGS: Patient is follow-up aortic valve replacement. Stable severe cardiomegaly. Lungs clear. Mediastinal pleural space and normal limits. Left subclavian single lumen pacemaker unchanged with electrode lead in expected location right ventricle. Bones and soft tissues are unremarkable. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.
CDC Split Type:

Write-up: ED to Hosp-Admission Discharged 9/10/2021 - 9/13/2021 (3 days) Hospital COVID-19 Principal problem HPI: Shortness of breath - Hospital Course: Patient is a 83-year-old male presenting Hospital vaccinated with Covid pneumonia. Patient was initially started on antibiotics also had a concern for superimposed bacterial infection but patient had 2 - procalcitonin''s and the antibiotics were discontinued. Patient was started on remdesivir, dexamethasone and convalescent plasma. Patient tolerated therapy well. Patient improved and was requesting discharge. Patient be discharged home. Fortunately patient was vaccinated and likely had mild form of Covid infection.


VAERS ID: 1700601 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 1 RA / IM

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

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

Write-up: Patient Recieved Moderna vaccine however she is only 15 years old


VAERS ID: 1700609 (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: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Device connection issue, Exposure via skin contact, Syringe issue, Underdose
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: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: During the administration of the vaccine the syringle seperate from the needle and the vaccine sprayed out of the side. The patient received an unknown amount of the vaccine but a significant amount of liquid was apparent on the patient''s arm.


VAERS ID: 1700676 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 LA / IM

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

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

Write-up: Patient reported swelling at the injection site the size of her hand


VAERS ID: 1700687 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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? Yes
Hospitalized? No
Previous Vaccinations: unknown
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: to my understanding none
CDC Split Type:

Write-up: patient passed out


VAERS ID: 1700694 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-07
Onset:2021-09-10
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Bronchiolitis, Cough, Headache, Influenza A virus test, Influenza B virus test, Nausea, Nucleic acid test, Oropharyngeal pain, Pain, Respiratory syncytial virus test, SARS-CoV-2 test, Streptococcus test
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Interstitial lung disease (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: GROUP A STREPTOCOCCUS SARS-COV-2, INFLUENZA A+B, AND/OR RSV NUCLEIC ACID TESTING PANEL performed 2
CDC Split Type:

Write-up: Reason for Visit Cough Generalized Body Aches Headache Diagnoses RSV bronchitis Nausea Cough Sorethroat Periodic headache syndrome, not intractable Generalized body aches


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