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

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



Case Details (Reverse Sorted by Onset Date)

This is page 220 out of 4,799

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VAERS ID: 1370979 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Headache, Lethargy, Malaise, Pain, Pain of skin, Pyrexia, Sensitive skin, Sleep disorder
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Skin began to ache and became sensitive about 11 hours after vaccine was received. Began having chills, lethargy, body aches (it felt like both inside of body and outside of skin), nausea, and high fever. Took Tylenol and Advil to attempt to alleviate symptoms. Could not get to sleep until about 12:30 a.m. and woke up at 2:30 a.m. with headache, extreme chilling, and intense body aches. I didn''t know if I could walk. I put a sweatshirt and a coat on, and my teeth were chattering uncontrollably. I can''t remember the last time that I was that sick. I contemplated going to the ER but didn''t think I could drive. The entire day was a headache, nausea and lethargy. When at the clinic, I stated that I had heard that there could be some minor side effects with the 2nd shot and was told, "Nah, people make things up." I''m so glad that I''m vaccinated, but people need to be forewarned of those kinds of side effects. They have to be aware because that was dangerously sick and was totally unprepared to combat it. 103+ degree fever and this kinds of symptoms aren''t things that a person should have to try to make it through alone.


VAERS ID: 1370982 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 AR / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Medium, Additional Details: During the 15 minute monitoring period patient complained of dizziness and lightheadedness. Sat on floor, gave pt bottle of water and instructed her to lower her head. She never lost consciousness. She called her father to pick her up as she refused any suggestion of 911. By the time her family member arrived she was feeling much better. I walked her out to the parking lot and spoke to her ride. I called her at 7:10pm and she had slept/napped and felt back to normal.


VAERS ID: 1370984 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 3 AR / IM

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

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

Write-up: Error: Booster Given Too Early.


VAERS ID: 1370985 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-19
Onset:2021-06-01
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Carditis, Chest pain, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within a week went to hospital with severe chest pains. Diagnosed with inflammation around and in my heart


VAERS ID: 1370987 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / IM

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

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

Write-up: Systemic: slight numbness left leg,patient was able to walk-Mild, Systemic: Numbness (specify: facial area, extremities)-Mild, Additional Details: patient complained of slight numbness in his left leg after the shot. according to daughter he sometimes gets numbness in his leg. it has happened before, just not with a vaccine.


VAERS ID: 1370996 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

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

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

Write-up: Fatigue, aches, fever, chills


VAERS ID: 1371009 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Headache, Influenza like illness, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Flu-like symptoms. Headache, slight fever, body aches, loss of appetite. Began approximately 7hrs post injection, peaked in intensity approximately 15hrs post injection, then declined in intensity until fully dissipated approximately 48hrs post injection.


VAERS ID: 1371031 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Error: Booster Given Too Early


VAERS ID: 1371035 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-17
Onset:2021-06-01
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site erythema, Injection site pruritus, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: About 8 hours after my second shot, I developed a fever, headache and body ache. Those symptoms and general tiredness lasted about 36 hours and then vanished. Then, about two weeks after my second Moderna shot, the injection site (upper left arm) was itchy. There is now a red spot around the site, about 1-2 cm wide at the moment (17 days after). No pain.


VAERS ID: 1371037 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High


VAERS ID: 1371049 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Headache, Hyperhidrosis, Influenza like illness, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Citalopram 20 mg per day
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Flu symptoms- fever, chills, headache, sweating, lasting until morning of the next day (June 2). full recovery morning of June 3.


VAERS ID: 1371057 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-05-22
Onset:2021-06-01
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site rash, Injection site swelling, Rash erythematous, Rash pruritic, Swelling of eyelid
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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: none but multivitamin
Current Illness: none
Preexisting Conditions: none
Allergies: sulfa and nickel
Diagnostic Lab Data: none
CDC Split Type:

Write-up: I first got a swollen arm at site, and a slight rash, which went away then came back a week later slightly. then I developed what I thought were bug bites on my eyelids, itchy and red bumps. The next day I had a few more. The third day I woke with my eyes almost swollen shut and more itchy red bumps on my face, spread to my neck, now my chest and back. a few at a time


VAERS ID: 1371061 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: D.C.  
Vaccinated:2021-05-04
Onset:2021-06-01
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine phosphokinase increased, Chest pain, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Pericarditis, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None reported
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: Troponin elevation, CK elevation, diffuse ST seg elevation on EKG
CDC Split Type:

Write-up: Pericarditis with troponin elevation and chest pain


VAERS ID: 1371072 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Headache, treated with acetaminophen, lasted 24 hours Body ache and chills, lasted 36 hours, went away naturally


VAERS ID: 1371084 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

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

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

Write-up: Fever, fatigue, achiness This reaction started at 8PM and continued to worsen until 12PM. I continued to have a fever all night and throughout the next day until 10PM the following day. I took Tylenol every few hours, but still had a fever and body achiness. I am feeling better today but am still sick. I have stayed in bed and remained at home.


VAERS ID: 1371100 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-31
Onset:2021-06-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 RA / IM

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

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

Write-up: Site: Bruising at Injection Site-Medium, Site: Itching at Injection Site-Medium, Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium


VAERS ID: 1371122 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Slight body aches and fatigue
Other Medications: None
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Tree nut allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Slight body aches started ~8 hours after injection, followed by chills, fatigue, and body aches at ~10 hours after injection. Took 2 Tylenol (500 mg each) at 12 hours after injection. 24 hours after injection, slight body aches and fatigue persisted. Took 2 Tylenol again at ~26 hours and at ~31 hours after injection to help relieve body aches. 48 hours after injection, no side effects were present.


VAERS ID: 1371134 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

Write-up: Error: Wrong Dose of Vaccine - Too High


VAERS ID: 1371168 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-25
Onset:2021-06-01
   Days after vaccination:68
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Diarrhoea, Exposure to SARS-CoV-2, Nasal congestion, SARS-CoV-2 test positive
SMQs:, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ?nateglinide 120 mg tablet 1 tab(s) orally 3 times a day (before meals) ?Januvia 100 mg tablet 1 tab(s) orally once a day ?One Touch Ultra glucose monitor as directed ?One touch Ultra test strips as directed test bid ?One Touch
Current Illness: 6-1-2021: Pt here for possible COVID-19 exposure through his wife, she was diagnosed yesturday, pt has been fully immunized for COVID; pt reports occasional stuffy nose and mild diarrhea otherwise no other symptoms. 5-13-2021: 58 y/o M c/o white discoloration on interior cheek both sides. R$g$g$gL. Sx present for 3-4 months. When he opens his mouth it stretches or feels like that. Occasional stinging. But no real pain. Dentist did not comment on it last week. Pt is a non smoker. Non tobocco user. Dx: Candidal stomatitis Tx Plan: Start nystatin suspension, 100000 units/mL, 5 ml, orally, 4 times a day, 7 days, 140 ml, Refills 0 Notes: we can try to see if the nystatin clears this up, but if no response, He will f/u with ENT for eval.
Preexisting Conditions: Hyperlipidemia. Diabetes mellitus. Colon polyp (2019). Male erectile dysfunction, unspecified.
Allergies: Lipitor: muscle pain
Diagnostic Lab Data: PCR tested on 6-1-2021, Result came back positive on 6-2-2021
CDC Split Type:

Write-up: 6-1-2021: Pt here for possible COVID-19 exposure through his wife, she was diagnosed yesterday, pt has been fully immunized for COVID; pt reports occasional stuffy nose and mild diarrhea otherwise no other symptoms. Doctor F 6/2/2021 9:17:26 PM $g + PCR lab for COVID-19; pt notified, pt doing rather well with minimal symptoms, pt reported that he has been vaccinated with Moderna; pt instructed to take Vitamin D3, vitamin C and zinc


VAERS ID: 1371189 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 1 LA / IM

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

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

Write-up: patient returned to store with a very enlarged lower lip on 6/2/21 patient reported this started after receiving dose of covid-19 vaccine saying it started on 6/1/21 advised to take Benadryl and if not resolved by end of day to consult doctor attention


VAERS ID: 1371202 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / -

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

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

Write-up: Chills Fever Headache Fatigue Arm soreness


VAERS ID: 1371230 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: UNKNOWN
Diagnostic Lab Data: FIRST RESPONDERS TOOK BLOOD PRESSURE AND BLOOD SUGAR.
CDC Split Type:

Write-up: PATIENT HAD SYNCOPE REACTION TO RECEIVING SHOT AND APPEARED TO HAVE A SEIZURE THAT LASTED A FEW SECONDS. PATIENT CAME TO AND WAS CONSCIOUS AND COHERENT.


VAERS ID: 1371257 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lip blister, Lip swelling, Paraesthesia oral, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Within 3 hours of vaccination, lips tingling, swelling and blistering noted. Progressively more swelling throughout evening. Took 50 mg benadryl and 400 mg ibuprofen before bed on the night of the vaccination. Woke in AM with increased swelling of lips (taut, shiny, scattered hives around lips). Went to urgent care and received a Rx for methylprednisolone 6-day pack. Took first day''s dose along with more benadryl and by end of day 2, swelling began to decrease. Was told to follow up with primary care doctor and allergist.


VAERS ID: 1371294 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-31
Onset:2021-06-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyshidrotic eczema, Inflammation of wound
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control, Emgality, magnesium, vitamin d, b12, iron + vitamin c
Current Illness: No
Preexisting Conditions: POTs, chronic migraine, fibromyalgia
Allergies: Eggs, dairy, peanuts, latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dyshidrotic eczema formed overnight on both hands after vaccine; including tops of fingers, finger webbing, and palms. Any scrape, cut, or abrasion on both hands became red, swollen, and irritated almost immediately after vaccine. Treating with steroid cream with little relief. A rash formed around the vaccine area after the first dose two weeks after I received the vaccine.


VAERS ID: 1371359 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Myalgia, Pyrexia, SARS-CoV-2 test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: No
Allergies: None
Diagnostic Lab Data: Covid-19 test: Negative 6/3/2021
CDC Split Type:

Write-up: Fever, Headache, Shivering, and muscle pain


VAERS ID: 1371360 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Hyperhidrosis, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: Celexa, omeperazole
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills, body aches, headache, fatigue, sweating.


VAERS ID: 1371386 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-24
Onset:2021-06-01
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Deep vein thrombosis, Exposure during pregnancy, Oedema peripheral, Pain in extremity, Peripheral vein occlusion, Thrombosis, Ultrasound Doppler abnormal
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? Yes
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: Prenatal Vitamin daily
Current Illness: No others listed per H&P; excessive weight gain with this pregnancy.
Preexisting Conditions: None per H&P
Allergies: No known allergies
Diagnostic Lab Data: Doppler confirmed
CDC Split Type:

Write-up: 30yof, 36w pregnant, came to clinic on 6/1 with 2 week history of lower leg tenderness and edema. Doppler confirmed on 6/1 that patient had an acute proximal DVT in the left lower extremity, with occlusive thrombus within the distal femoral vein. She denies personal history of clot; this is her 2nd pregnancy; she notes no family history of clot; this pregnancy is complicated by excessive weight gain (current BMI 32.28 kg/m2). Pt received Pfizer COVID vaccine on 4/24/21.


VAERS ID: 1371390 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

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

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

Write-up: Headache, high fever (102+) for first 24 hours, 99-100 temp following, fatigue, severe pain in arm, aches, hot arm where shot was administered, everything hurts.


VAERS ID: 1371395 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-29
Onset:2021-06-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Fatigue, Feeling abnormal, Head discomfort, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Low dose combined birth control, Adderall XR 15mg, Adderall 10mg tablet, and B complex vitamin supplement
Current Illness:
Preexisting Conditions: Headaches, IBS, TMJ
Allergies: Penicillin, amoxicillin, and ceclor
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe headache onset 3 days post vaccine. Residual head pressure, nausea, brain fog, dizziness, extreme fatigue for 2 days following. Currently ongoing.


VAERS ID: 1371401 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-01
Onset:2021-06-01
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: ASTHMA, HTN
Allergies:
Diagnostic Lab Data: POSITIVE COVID-19 BY PCR ON 5/17/2021
CDC Split Type:

Write-up: INITIALLY ADMITTED ON 5/17/2021 TO HOSPITAL AND SUBSEQUENTLY TESTED POSITIVE FOR COVID-19, $g14 DAYS POST VACCINATION. NOW ADMITTED TO ANOTHER HOSPITAL ON 6/1/2021 FOR ARDS.


VAERS ID: 1371452 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 LA / IM

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

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

Write-up: Pt was seen at plant for 2nd Covid 19 vaccine with other employees. He had card with Pfzier identified as first Covid vaccine given. He was in line to receive Moderna 2nd vaccine per scheduled vaccines with plant. Advised partifipants they were getting 2nd Moderna and discussed my personal side effects as well as effectiveness of Moderna. After vaccine given one of coworkers noted half of employees, 5 people including patient was there for 2nd Pzier vaccine. Pt was advised of error and discussed potential side effects. He was monitored for 30 minutes with no adverse effects. Hours later contacted employer and pt remained asymtomatic. He is scheduled for recheck exam. Pt did not have an adverse reaction.


VAERS ID: 1371453 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 LA / IM

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

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

Write-up: Pt was seen at plant for 2nd Covid 19 vaccine with other employees. He had card with Pfzier identified as first Covid vaccine given. He was in line to receive Moderna 2nd vaccine per scheduled vaccines with plant. Advised partifipants they were getting 2nd Moderna and discussed my personal side effects as well as effectiveness of Moderna. After vaccine given one of coworkers noted half of employees, 5 people including patient was there for 2nd Pzier vaccine. Pt was advised of error and discussed potential side effects. He was monitored for 30 minutes with no adverse effects. Hours later contacted employer and pt remained asymtomatic. He is scheduled for recheck exam. Pt did not have an adverse reaction.


VAERS ID: 1371531 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Improper dilution of vial resulted in wrong microgram dose


VAERS ID: 1371544 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthma, Dyspnoea, Injection site erythema, Injection site induration, Pharyngeal swelling, Spirometry abnormal, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Asthma/bronchospasm (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (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: Symbicort 160 mcg 2 puffs BID Albuterol prn Fasenra
Current Illness:
Preexisting Conditions: Severe persistent asthma
Allergies: Trees, grasses, pollens, molds, cat/dog dander
Diagnostic Lab Data: Spirometry 6/3/21: FVC 3.50 96% FEV1 2.66 85% FEV1/FVC 76. Baseline FEV1 96% previously. Mild obstruction. Physical exam: expiratory wheezing.
CDC Split Type:

Write-up: Site reaction - induration, erythema. More concerning - asthma exacerbation. Patient well controlled previously on ICS/LABA and Fasenra injections. Wheezing, short of breath, sense of throat swelling.


VAERS ID: 1371549 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Improper dilution of vial resulted in 15 microgram dose


VAERS ID: 1371554 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

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

Write-up: Improper dilution of vial resulted in 15 microgram dose


VAERS ID: 1371555 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mirtazapine, Xanax, trazadpne, paxil
Current Illness: 1st vaccine in May kept me from doing daily activities for about a week
Preexisting Conditions: None
Allergies: Ultram
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 10 hours after I received my injection and I started running a very high fever. I was also vomiting everything that I tried to eat or drink, taking ibuprofen or Tylenol did not do anything to get rid of some migraine like headache that contributes to nausea and vomiting. It?s been two days now and I?m still running a fever averaging around 101, and I am still very tired and sore. I don?t know if this has anything to do with it but I do know that my blood type is O negative


VAERS ID: 1371572 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Fatigue, Feeling abnormal, Headache, Myalgia, Neck pain, Pain in extremity, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Robaxin (muscle relaxant)
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Very tired 3hrs after vaccine shot on 6/1/21. Fever 100.5 approx 16hrs after vaccine on 6/2/21. Fever 101.9 approx 18hrs after vaccine 6/2/21. Took ibuprofen. Fever hovered at 100+ to 101+ & occasionally spiking to 102+ 6/2/21. Fever broke approx 4am (approx 41hrs after vaccine shot) 6/3/21. 6/2/21 - fever, headache, L arm, shoulder, neck & shoulder blade pain, full body muscle pain & weakness. Pain was barely relieved by ibuprofen. Weakness , pain & feeling miserable don?t even begin to describe how badly I felt!! 6/3/21 - very painful arm, shoulder, neck, shoulder blade. Weak. 99,9 temp with ibuprofen.


VAERS ID: 1371629 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-25
Onset:2021-06-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / SYR

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

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

Write-up: Site: Redness at Injection Site-Medium, Systemic: it became red at the injection site a week after the vaccine-Medium, Additional Details: Pt said she was fine for 1 week then she npticed her arm where we did the injection is red around the injection site. she has some appointments and will take benadryl after so shes not sleepy she said. She said she didnt take anything for it. she sais she feels fine otherwise. no swelling or itching all over or difficulty breathing


VAERS ID: 1371639 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / IM

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

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

Write-up: Patient received a first dose of Moderna and a second dose of Pfizer. Patient stated that they are doing fine.


VAERS ID: 1371664 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-31
Onset:2021-06-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

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

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

Write-up: second dose given only after 1 week apart from first dose, tried calling patient numerous times but no one picks up


VAERS ID: 1371669 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Interchange of vaccine products
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: Pt had received a dose of Moderna on 4/9/2021. Pt is incarcerated in Jail. Unable to check accuracy of information while doing jail clinic. Received a dose of J&J while at jail clinic.


VAERS ID: 1371688 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

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

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

Write-up: Pt participated in Clinic. Unable to check accuracy of information while doing clinic. Pt had already received a dose of Pfizer on 4/5/2021. Received a dosage of J&J on 6/1/2021


VAERS ID: 1371698 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / IM

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

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

Write-up: vaccination error, patient given 2nd dose only after 7 days from first dose


VAERS ID: 1371769 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Confusional state, Depressed mood, Dyspnoea, Fatigue, Headache, Muscular weakness, Myalgia, Nausea, Pain in extremity, Peripheral swelling, Pyrexia, Swelling face
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 32 years old 1 month ago First dose of moderna
Other Medications: Effexor, Buspar, Wellbutrin, lisinapril
Current Illness: None
Preexisting Conditions: Depression, Anxiety
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen & painful arm Facial swelling Joint and muscle pain/weakness Exhaustion Fever Shortness of breath Headache Nausea Confusion Feeling more depressed


VAERS ID: 1371771 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-29
Onset:2021-06-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

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

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

Write-up: small dots on skin that look a bit like Petechiae. This is on her left mid-thigh. She also had very itchy nose and ears.


VAERS ID: 1371783 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-01
Onset:2021-06-01
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Patient was diagnosed with COVID-19 on 06/01/2021


VAERS ID: 1371784 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-02-17
Onset:2021-06-01
   Days after vaccination:104
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 3 RA / IM

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

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

Write-up: Patient rec''d 3 Moderna vaccines. He rec''d his first one on 2/17/21. He then rec''d a liver transplant on 3/21/21. His doctor told him to start the Moderna series over again. He rec''d a second vaccine on 4/29/21 and a third vaccine on 6/1/21.


VAERS ID: 1371799 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Delaware  
Vaccinated:2021-05-18
Onset:2021-06-01
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Ischaemic stroke, Magnetic resonance imaging head abnormal, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Guillain-Barre 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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Migraine with aura
Allergies: None
Diagnostic Lab Data: MRI on 6/2
CDC Split Type:

Write-up: Acute L thalamic ischemic stroke Initial symptoms of right sided paresthesias


VAERS ID: 1371804 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Heart rate increased, Paraesthesia, Paraesthesia oral, Pharyngeal paraesthesia, Pharyngeal swelling, Respiratory rate increased, Swelling face
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin, Phenergan, Codine
Diagnostic Lab Data: I was not instructed to have any tests or labwork completed.
CDC Split Type:

Write-up: At 8:55 AM, on June 1, 2021, a slight tingling was felt in the fingertips of my rught arm. I then felt an increase of heart rate and my husband noticed my breathing was more rapid. I began to feel a slight tingling on the back undersides of my tongue and the top of my throat. I got up to walk and had to sit back down due to throat swelling and breathing reatriction. It was apparent to others around me due to the thick choked breathing I was experiencing. I felt my throat and jawline/cheeks feel puffed up. A nurse appeared to assist me, check my breathing and heart rate, and monitor my symptoms. I was not given an EPI injection, but was treated qith an adult dose of liquid benedryl, and 30 mg of Prednisone. I was then instructed to take benedryl at 4 hour intervals along with a dose of Zyrtec one I got home and again at bedtime then a single dose of Zyrtec for the next few days. I stayed an extra 30 min after the initial reaction took place for monitoring.


VAERS ID: 1371824 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Decreased appetite, Dizziness, Fatigue, Headache, Hyperhidrosis, Myalgia, Pain, Pain in extremity, Paraesthesia, Paraesthesia oral, Pyrexia, Thirst, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: .25mg Clonazepam
Current Illness: None known
Preexisting Conditions: None known
Allergies: Allergic reactions to SNRI class of antidepressants
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Day 1 *Shot rec''d at 1:10pm *10-15 minutes later tip of tongue started tingling & started sweating - told provider I was either having a reaction to shot or anxiety attack (felt quick drop in blood pressure, profuse sweating & thirst, felt faint) - provider offered water & a fan & asked me to wait another 5-10 minutes under observation to see if it passed * Intense reaction diminished by 2:30, but tongue & fingers and toes remained tingling * Headache & body aches started almost immediately after injection, but didn''t increase until about 6:30p * Around 6:30p, went to bed with sudden spike in fever, chills, body aches (joints, back, neck), intense headache * Fever spiked between 99-104 & intense side effects through the next 6-7 hours (usually run about 97.4 on current thermometer) * Vomited twice * Two ibuprofen slightly relieved discomfort & pain and fever didn''t spike as high after 10p Day 2 * Improvement - Side effects more in-line with what I''d expected - slight fever spiking throughout the day, headache, muscle aches, arm pain, fatigue, lack of appetite Day 3 * Improvement from day 2 - no fever, lessening headache & muscle ache, increased arm pain


VAERS ID: 1371839 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-21
Onset:2021-06-01
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Public       Purchased by: ?
Symptoms: Burning sensation, Pruritus, Rash macular
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: The patient states her arm that she received the vaccine in started itching on 6/1/2021 and has red blotches. She states it continues to itch and burn. Reports no open skin areas.


VAERS ID: 1371849 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Hypertonic bladder
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Patient received vaccination, became anxious and lightheaded. lost control of her bladder. opened an ammonia inhalant and patient felt better.


VAERS ID: 1371912 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-20
Onset:2021-06-01
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / N/A LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dry mouth, Injection site pain, Thirst
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (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: None
Current Illness: None
Preexisting Conditions: Fibromyalgia, arthritis
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm was sore for several days at injection site, had severely dry mouth for 4-5 days, continuously thirsty. For 2 days, starting 6/1/21-6/3/21 woke up & room was spinning, dizzy spells. No treatment, for dizzy spells had to just close my eyes & wait at least 45 min for it to go away.


VAERS ID: 1371923 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-24
Onset:2021-06-01
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood bilirubin normal, Blood urine present, Chromaturia, Fibrin D dimer increased, Full blood count normal, Gait disturbance, Influenza A virus test negative, Influenza B virus test, Musculoskeletal pain, Myalgia, Myoglobin blood present, Myositis, Pain in extremity, Protein urine present, Renal function test normal, Respiratory syncytial virus test negative, Rhabdomyolysis, SARS-CoV-2 test negative, Troponin normal
SMQs:, Rhabdomyolysis/myopathy (narrow), Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Proteinuria (narrow), Tubulointerstitial diseases (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: nil
Current Illness: nil
Preexisting Conditions: nil
Allergies: nil
Diagnostic Lab Data: bloods: CBC, clotting and renal chemistry and troponin within normal limits 2 jun and 3rd Jun 2021 d-dimer and myoglobin positive (qualitative tests only available) 2 Jun 2021 liver biochem - ALT 81, AST 279 U/l on 2 Jun, and ALT 357, AST 1368 U/l on 3 Jun 2021. Bilirubin etc normal. urine: dark red/brown colour. Positive dip for blood and protein 2 and 3rd Jun 2021 viral: PCR negative for SARS-CoV2, Influenza A&B and RSV negative 2 jun 2021
CDC Split Type:

Write-up: initially no symptoms until on day 8 after vaccine (1 Jun 2021), rapid onset progressive severe muscular pains in calves, thighs, buttocks and then upper arms. Within 24 hours unable to walk easily. No other symptoms and no physical signs of infection. Urine became dark brown at 24 hours and clinically has myositis with suspected rhabdomyolysis - was admitted for iv fluids and analgesia and is improving clinically but gait still disturbed. No demonstrable weakness and no neuro deficit or symptoms. no other obvious cause for acute myositis so consider ?vaccine related.


VAERS ID: 1371942 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

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

Write-up: Became very drowsy around 4:00pm on June 1. I felt completely wiped and stayed in bed the rest of the evening and the next day. Symptoms went away around 4:00pm on June 2nd. After my 1st COVID vaccine, I was very lethargic, achy, and had a fever.


VAERS ID: 1371953 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / UNK LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immunisation, Injection site pain, Mobility decreased, Syringe issue
SMQs:, Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad), Medication errors (broad)

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

Write-up: Patient was being administered 2nd dose when the syringe leaked contents out and the full dose was not administered. A second syringe was administered with 0.3ml since it was unknown how much was actually administered on the first attempt. Patient has been experiencing muscle pain in the injection site and is having trouble lifting arm up completely


VAERS ID: 1371982 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Atrial flutter, Chest discomfort, Chills, Dyspnoea, Hyperhidrosis, Joint swelling, Musculoskeletal stiffness, Nausea, Oedema peripheral, Oropharyngeal pain, Pollakiuria, Productive cough, Pyrexia, Swelling, Wheezing
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (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: 2012
Other Medications: None
Current Illness: Rheumatoid Arthritis, Asthma, Basilar Migraines.
Preexisting Conditions: Rheumatoid Arthritis, Asthma, Basilar Migraines
Allergies: Tetracycline, Codeine, nuts, casin, fermented food
Diagnostic Lab Data: None at this time.
CDC Split Type:

Write-up: Wheezing, productive cough, 102.2 fever, bilateral leg edema, joint pain with edema, shortness of breath, chills, urinating every 45min - 1hour, A-Flutter, tightness in chest and back, profuse sweating, sore throat, neck swelling, and nausea. Took otc pain reliever.


VAERS ID: 1372009 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-18
Onset:2021-06-01
   Days after vaccination:103
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 RA / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Exposure during pregnancy, Single umbilical artery, Ultrasound scan
SMQs:, Congenital, familial and genetic disorders (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (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: Prenatal vitamins
Current Illness: None known
Preexisting Conditions: None
Allergies: Seasonal blooming/hay fever
Diagnostic Lab Data: 6/1/2021 anatomy scan
CDC Split Type:

Write-up: Conception 2/2/2021 Due date 10/25/2021 This is my second pregnancy. First was a live birth and is a healthy 21 month old. No complications during that pregnancy. At our June 1 anatomy scan, we learned that the baby is healthy and has all expected parts except for the umbilical cord, which has two blood vessels instead of the normal three. This is called SUA (single umbilical artery) and we''re told it occurs in 1/100 pregnancies, and often leads to no other issues. So far, all other genetic and chromosomal scans have come back normal. The doctor explained that the umbilical cord forms and is visible by 8 weeks. The first dose was at 2.5 weeks so if the vaccine could have had an adverse effect on the cord during its formation, I received it within the window that it could have had an effect. Other potential problems are increased likelihood of low birth weight and maternal high blood pressure. All other signals point to a healthy mom and child so far.


VAERS ID: 1372038 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

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

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

Write-up: Improper dilution of vial resulted in 15 microgram dose. Parent informed.


VAERS ID: 1372041 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Gait disturbance, Muscle spasms, Myalgia, Pain, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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:
Other Medications: Topirimate, Tizanidine, Cetirizine, Blisovi 24, Loratadine
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash all over my body and uncontrollable painful muscle spasms all over my body to the point that I could barely walk.


VAERS ID: 1372075 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature fluctuation, Feeling cold, Headache, Hot flush, Injection site erythema, Injection site induration, Injection site pain, Injection site pruritus, Injection site rash, Injection site reaction, Injection site swelling, Injection site warmth, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), 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: Pneumonia shot
Other Medications: Enbrel, cymbalta
Current Illness:
Preexisting Conditions: Fibromyalgia, psoriatic arthritis
Allergies: Penicillin, codeine, hydrocodone, nsaids, latex, bactrum
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, arm pain, injection site swelling, site redness, site hardness, site pain, site itching, site rash


VAERS ID: 1372098 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 1 LA / IM

Administered by: School       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: DOSE ONE OF A PFIZER VACCINE WAS GIVEN TO AN 11 YEAR OLD.


VAERS ID: 1372108 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received second dose on day 15.


VAERS ID: 1372309 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-25
Onset:2021-06-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 LA / IM

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

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

Write-up: patient says they have redness at injection site which is warm and swollen. this happened about a week later. it looks like it might be cellulitis. the doctor told patient to talk to pharmacist first before coming back to their office


VAERS ID: 1372323 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-03
Onset:2021-06-01
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Neuropathy peripheral, Pain, Pain in extremity
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Neuropathy in hands and feet. Pain shooting down arms and legs


VAERS ID: 1372331 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-05-29
Onset:2021-06-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Ear discomfort, Hypoacusis, Sleep disorder, Tinnitus
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Otezla
Current Illness: None
Preexisting Conditions: 1 year with PSA and Psoriasis
Allergies: None
Diagnostic Lab Data: Reported on the text message daily follow up with no response, also emailed them with a response to return to the clinic I recieved it at, which was set up in tents at the old airport so I could not return. Called my Health Care Provider and waiting for nurse to call back
CDC Split Type:

Write-up: Saturday shot, on Tuesday my ears started feeling clogged, by late Tuesday they were clogged enough that I felt I had about a 50% loss of hearing and loud ringing in my ears. kept me up late Tuesday, by wednesday morning I my hearing was slowly getting better. by midmorning it was feeling getting better as far as hearing. Ringing in ears is still very intense in both ears as of time of this report.


VAERS ID: 1372362 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

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

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

Write-up: 06/01/2021 @ 07:00PM - Full body rash, made worse with any type of friction (severe burning and itching)- still ongoing Using Benadryl(2 tabs QID), NSAID (800mg TID), colloidal oatmeal baths(QD)- no relief of symptoms


VAERS ID: 1372544 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Dizziness, Fatigue, Headache, Injection site pain, Myalgia, Nausea, Night sweats, Pyrexia, Vision blurred, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lo Loestrin Fe (once daily); Vyvanse 60mg (once daily); Escitalopram 20mg (once daily); Buspirone 15mg (twice daily); One A Day Women''s Vitacraves (once daily); Iron supplement (once daily); Biotin supplement 1,000mcg (once daily); CoQ10 2
Current Illness: Anxiety; ADHD
Preexisting Conditions:
Allergies: Bee stings (Only reaction: swelling at site of sting)
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: All of the following side effects occurred for 36 hours following my vaccination: Extreme fatigue; headache; fever; chills; night sweats; nausea; vomiting; dizziness; blurred vision; weakness; muscle aches throughout entire body; pain at injection site (only experience 24 hours after injection)


VAERS ID: 1372574 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling cold, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (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: wellbutrin; birth control
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: clindamycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: about 5 minutes after receiving, patient experienced tingling in fingers, which changed from one finger to another then also down outer aspect of palm of right hand. Shortly after, legs started feeling cold sensation in them and then started feeling "achey " in legs; called physician, who recommended patient wait longer than typical wait period, which patient did...waited one hour after shot. assisted her to standing and walked to vehicle. followed up with a phone call to her twice through out day and patient was ok.


VAERS ID: 1372588 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-20
Onset:2021-06-01
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Pain, Tic
SMQs:, Dyskinesia (broad), Dystonia (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: Seasonal allergies
Allergies: None
Diagnostic Lab Data: Referral to neurologist
CDC Split Type:

Write-up: Motor tics - head thrusting every 2-5 minutes, painful


VAERS ID: 1372600 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-18
Onset:2021-06-01
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram head, Electroencephalogram, Generalised tonic-clonic seizure, Magnetic resonance imaging
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Mirtazapine, Prozac, Daytrana
Current Illness: None
Preexisting Conditions: AD/HD, Anxiety/Depression
Allergies: None
Diagnostic Lab Data: CT of head - negative EEG and MRI pending
CDC Split Type:

Write-up: Tonic Clonic seizure


VAERS ID: 1372756 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 LA / IM

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

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

Write-up: Pt is 17 yrs old and Moderna vaccines are currently only approved 18 yrs and older.


VAERS ID: 1372905 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

Write-up: Vaccine was stored in the freezer for 19 days, instead of 14 days. The vaccine was supposed to be removed from the freezer on 5/27 and placed in the fridge however it was not and was stored in the freezer and given to the patient.


VAERS ID: 1372910 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / IM

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

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

Write-up: Vaccine was stored in the freezer for 19 days, instead of 14 days. the vaccine was supposed to be removed from the freezer on 5/27 and placed in the fridge however it was not and was stored in the freezer and given to the patient.


VAERS ID: 1373091 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 RA / SYR

Administered by: School       Purchased by: ?
Symptoms: Back pain, Bone pain, Diarrhoea, Fatigue, Headache, Heart rate increased, Irritability, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Osteonecrosis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: High fever 38.8 degrees in Celsius or 101.84 degrees in Fahrenheit, right arm pain, back pain, bone pain, splitting headache, heart speeding up, diarrhea, fatigue, feeling very irritated. No treatment but drinking a lot of cold water. Body temperature back to normal and feeling much better 2 days after the shot.


VAERS ID: 1388037 (history)  
Form: Version 1.0  
Age: 46.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 2021-06-05
   Days after onset:4
Entered: 2021-06-03
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / -

Administered by: Other       Purchased by: Other
Symptoms: Axillary pain, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

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

Write-up: Pain under armpit & all around arm down to elbow since the vaccine


VAERS ID: 1373140 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Confusional state, Disturbance in attention, Feeling abnormal, Impaired driving ability
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (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: Minutes before I took An Arthritis Pain 640mg.
Current Illness: High pressure Osteoarthritis Gastritis Nasal allergy Lumbar pain from operation of 09/2015 Depression Anxiety Insomnia.
Preexisting Conditions: High pressure Depression Insomnia Gastritis Asthma Anxiety Osteoarthritis.
Allergies: Lobster, Aspirin.
Diagnostic Lab Data: I do not have results of anything from June 1, 2021 because I did not go to a doctor or hospital. I was driving straight home and I almost couldn''t get there.
CDC Split Type:

Write-up: Symptom that gave me in an unknown event for the first time of a dazed, confused head and difficulty concentrating and I was driving When it gave me this time after about 4 hours of the vaccine. He had not given me again since the first time September 5, 2020.


VAERS ID: 1373247 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2021-06-01
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Wrong product administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210603388

Write-up: WRONG VACCINE ADMINISTERED; This spontaneous report received from a health care professional concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient was previously treated with mrna 1273 for prophylactic vaccination. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 204A21A, and batch number: 204A21A expiry: UNKNOWN) dose was not reported, administered on 01-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 01-JUN-2021, the subject experienced wrong vaccine administered. The action taken with covid-19 vaccine was not applicable. The outcome of wrong vaccine administered was not reported. This report was non-serious. This case, from the same reporter is linked to 20210604872.


VAERS ID: 1373253 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Georgia  
Vaccinated:0000-00-00
Onset:2021-06-01
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Injection site pain, Skin mass
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210603951

Write-up: TWO BIG KNOTS ON SHOULDER; INJECTION SITE SORENESS; This spontaneous report received from a patient concerned a 45 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported.The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 042A21A, and batch number: 042A21A expiry: UNKNOWN) dose was not reported, administered on 01-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 01-JUN-2021, the subject experienced injection site soreness. On 02-JUN-2021, the subject experienced two big knots on shoulder. The action taken with covid-19 vaccine was not applicable. The patient recovered from injection site soreness on 01-JUN-2021, and had not recovered from two big knots on shoulder. This report was non-serious.


VAERS ID: 1373256 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-06-01
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210604689

Write-up: FEELS ACHES AND PAINS; FEELING SICK TO STOMACH; FEELS LIKE GETTING A HEADACHE; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported.The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 201A21A, expiry: UNKNOWN) dose was not reported, administered on 01-JUN-2021 19:00 for prophylactic vaccination. No concomitant medications were reported. On 01-JUN-2021, the subject experienced feels aches and pains. On 01-JUN-2021, the subject experienced feeling sick to stomach. On 01-JUN-2021, the subject experienced feels like getting a headache. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from feeling sick to stomach, feels aches and pains, and feels like getting a headache. This report was non-serious.


VAERS ID: 1373257 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Michigan  
Vaccinated:0000-00-00
Onset:2021-06-01
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: USJNJFOC20210604703

Write-up: POOR QUALITY PRODUCT ADMINISTERED; INCORRECT STORAGE OF DRUG; This spontaneous report received from a pharmacist concerned a 46 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 1821288, and expiry: UNKNOWN) dose was not reported, administered on 01-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 01-JUN-2021, the subject experienced poor quality product administered. On 01-JUN-2021, the subject experienced incorrect storage of drug. The action taken with covid-19 vaccine was not applicable. The outcome of the poor quality product administered and incorrect storage of drug was not reported. This report was non-serious.


VAERS ID: 1373262 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Ohio  
Vaccinated:0000-00-00
Onset:2021-06-01
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Developmental disturbance
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210604744

Write-up: ADMINISTRATION OF EXPIRED VACCINE; This spontaneous report received from a health care professional concerned a 53 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included developmentally disabled. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 1802068 expiry: 25-MAY-2021) dose was not reported, administered on 01-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 01-JUN-2021, the subject experienced administration of expired vaccine. The action taken with covid-19 vaccine was not applicable. The outcome of administration of expired vaccine was not reported. This report was non-serious. This report was associated with product quality complaint: 90000181533.


VAERS ID: 1373266 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Minnesota  
Vaccinated:0000-00-00
Onset:2021-06-01
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN LC1820095 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Alcoholic (Every Fridays- one to two beers.); Non-smoker
Preexisting Conditions: Comments: The patient did not have any history of drug abuse or illicit drug use.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210604811

Write-up: ACHY LEGS; CHILLS; FEVER; HEADACHE; This spontaneous report received from a patient concerned a 35 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included alcoholic, and non smoker, and other pre-existing medical conditions included the patient did not have any history of drug abuse or illicit drug use. The patient experienced drug allergy when treated with guaifenesin for hyperactivity. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: LC1820095 expiry: 04-JUL-2021) dose was not reported, administered on 01-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 01-JUN-2021, the subject experienced headache. On 02-JUN-2021, the subject experienced achy legs. On 02-JUN-2021, the subject experienced chills. On 02-JUN-2021, the subject experienced fever. The action taken with covid-19 vaccine was not applicable. The patient recovered from chills on 02-JUN-2021, and had not recovered from headache, fever, and achy legs. This report was non-serious.


VAERS ID: 1373277 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Wisconsin  
Vaccinated:0000-00-00
Onset:2021-06-01
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210605047

Write-up: HEADACHE; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 01-JUN-2021 for prophylactic vaccination. The batch number was not reported. The company is unable to perform follow up to request batch/lot number. No concomitant medications were reported. On JUN-2021, the subject experienced headache. The action taken with covid-19 vaccine was not applicable. The outcome of headache was not reported. This report was non-serious.


VAERS ID: 1373999 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-06-01
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Malaise
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cancer
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210604773

Write-up: NOT FEELING WELL; This spontaneous report received from a consumer concerned a female of unspecified age. The patient''s height, and weight were not reported. The patient''s concurrent conditions included cancer. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 01-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. The batch number was not reported and has been requested. On JUN-2021, the subject experienced not feeling well. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of not feeling well was not reported. This report was non-serious. This case, from the same reporter is linked to 20210604721.


VAERS ID: 1374061 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-27
Onset:2021-06-01
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

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

Write-up: Shingles on left chest/back


VAERS ID: 1374112 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Diarrhoea, Dizziness, Feeling hot, Hypoaesthesia, Impaired driving ability, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Noninfectious diarrhoea (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: Vitamin d
Current Illness: No
Preexisting Conditions: Obese Pituitary tumor
Allergies: Allergic to mushrooms
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizziness Numbness in legs and feet Vomit diarrhea Extreme chest pain Warm legs to touch Cannot drive anymore


VAERS ID: 1374124 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

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

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

Write-up: HAD PHIZER VACCINE: HEADACHES, CHILLS, HOT FLASHES, NAUSEA, SLIGHT TEMPERATURE. STARTED AT 6:00PM DAY OF VACCINE AND TODAY IS FRIDAY THE 4TH AND I STLL HAVE HEADACHE


VAERS ID: 1374204 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2021-06-01
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Product temperature excursion issue
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210605045

Write-up: ADMINISTRATION ERROR; This spontaneous report received from a health care professional concerned patients of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patients received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 1808980 and expiry: 20-JUN-2021) dose was not reported, administered on 01-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 01-JUN-2021, the subjects experienced administration error. The action taken with covid-19 vaccine was not applicable. The outcome of administration error was not reported. This report was non-serious. This case, from the same reporter is linked.


VAERS ID: 1374209 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2021-06-01
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210605068

Write-up: ADMINISTRATION OF PUNCTURED VIAL AFTER 6 HOURS; This spontaneous report received from a pharmacist concerned multiple patients. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 1821288 expiry: 01-AUG-2021) dose was not reported, administered on 01-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 01-JUN-2021, the subject experienced administration of punctured vial after 6 hours. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administration of punctured vial after 6 hours was not reported. This report was non-serious.


VAERS ID: 1374214 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site swelling, Injection site warmth, Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 5/3/2021 I had a red spot on my arm left over from my first Covid dose. It was never painful, hot, or swollen.
Other Medications: Flonase
Current Illness: Seasonal allergies
Preexisting Conditions: Seasonal allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm became warm and sore half an inch below injection site. A 2in x 2.5in red, raised rectangular, tender swollen area arose. The affected area always remained below the injection site with only a light red mark that led from the injection site to the affected area. The following morning (6/2/21) the area had more than doubled. It remained hard, warm, tender, and raised with swelling. It was mildly painful. 6/3/21 the red area had spread out over more of my bicep and the stiffness began to diminish slightly. It was still warm and slightly painful. 6/4/21 the swelling is down considerably and the redness has almost completely cleared. The area is still tender.


VAERS ID: 1374226 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-06-01
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210603; Test Name: Body temperature; Result Unstructured Data: 101.5 F
CDC Split Type: USJNJFOC20210607427

Write-up: BODY ACHES/EVERYWHERE AROUND BODY; FEVER/EXTRA HIGH; VERY EXHAUSTED/EXHAUSTED AGAIN; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 31-MAY-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 01-JUN-2021, the subject experienced very exhausted/exhausted again. On 03-JUN-2021, the subject experienced body aches/everywhere around body. On 03-JUN-2021, the subject experienced fever/extra high. Laboratory data included: Body temperature (NR: not provided) 101.5 F. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from very exhausted/exhausted again, fever/extra high, and body aches/everywhere around body. This report was non-serious.


VAERS ID: 1374359 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 3 RA / IM

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

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

Write-up: PATIENT CAME IN TO GET COVID VACCINE, AND AFTER ADMINISTRATION UPON ENTERING THE VACCINATION INTO facility, WE NOTICED IT WAS REPORTED THAT HE HAD ALREADY RECEIVED BOTH DOSES OF PFIZER PREVIOUSLY IN THE YEAR. WHEN ASKED ABOUT THOSE VACCINATIONS HE CLAIMED HE HAD NOT BEEN VACCINATED PRIOR. WE WERE NOT ABLE TO GET ANY INFORMATION FROM THE VACCINATION SITE OF HIS PREVIOUS DOSES, SO WE ARE UNSURE WHICH DOSE THIS TRULY WAS.


VAERS ID: 1374406 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

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

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

Write-up: Pt c/o nervousness/dizziness. BP 86/40, HR 86, RR 16 -- $g 105/48, 82, 16. Orthostatics 95/69,90 -- $g 95/68, 91 -- $g 93/66, 84. Pt stable and released from vaccination site.


VAERS ID: 1374431 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-05-03
Onset:2021-06-01
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Catheter directed thrombolysis, Dyspnoea, Pulmonary embolism
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), 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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levemir, novolog
Current Illness:
Preexisting Conditions: Diabetes
Allergies: Keflex
Diagnostic Lab Data: CTA chest for PE. EKOS for large burden of pulmonary emboli.
CDC Split Type:

Write-up: Patient presented to our facility complaining of shortness of breath. A CTA of the chest revealed bilateral pulmonary emboli.


VAERS ID: 1374487 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / N/A RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Seroquel 500mg hs, Miralax 17 grams am, lactulose 30ml am, senna 8.6/ dss50mg 2 tabs am, miconazole topical cream bid groin folds, sodium bicarb 1300mg bid, ammonium lactate lotion bid, sevelamer 800mg tid with meals, sodium zirconium 10 gr
Current Illness: Stage 5 renal disease Schizoaffective disorder
Preexisting Conditions: Stage 5 renal disease Schizoaffective disorder edema
Allergies: NSAIDS Penicillin Haldol
Diagnostic Lab Data: Assessed by medical provider 6/2/21
CDC Split Type:

Write-up: Patient was up at 2355 laying on floor wailing about abdominal pain. Rash present on all 4 limbs. Rash continued on 6/2 extends from wrist to elbow separate pink circular weals larger and more numerous on right side. 6/3 rash decreasing on legs and forearms improving.


VAERS ID: 1374505 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Kentucky  
Vaccinated:1989-04-01
Onset:2021-06-01
   Days after vaccination:11749
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Fatigue, Injection site bruising, Injection site erythema, Injection site mass, Injection site pain, Tachycardia, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (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: details unclear but did not include anaphylaxis or other severe reaction
Other Medications: unknown
Current Illness: none
Preexisting Conditions: endometriosis, PCOS
Allergies: unknown
Diagnostic Lab Data: none at this time
CDC Split Type:

Write-up: bruise then knot at injection site with large painful spreading redness; extreme fatigue, tachycardia, wheezing, weakness


VAERS ID: 1374518 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-28
Onset:2021-06-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Adrenal mass, Alanine aminotransferase normal, Angiogram abnormal, Angiogram pulmonary, Arthralgia, Aspartate aminotransferase normal, Blood chloride increased, Blood glucose increased, C-reactive protein normal, Chest X-ray normal, Computerised tomogram abdomen, Computerised tomogram abdomen abnormal, Computerised tomogram pelvis abnormal, Computerised tomogram thorax, Fibrin D dimer increased, Haematocrit decreased, Haemoglobin decreased, Haemoperitoneum, Headache, Hepatic lesion, Hypotension, Laboratory test, Musculoskeletal chest pain, Nausea, Painful respiration, Red blood cell count decreased, Red blood cell sedimentation rate increased, SARS-CoV-2 test negative, Scan with contrast, Scan with contrast abnormal, Splenectomy, Splenic haemorrhage, Splenic rupture, Tachycardia, Toxicologic test abnormal, Transfusion, Troponin increased, Vomiting, White blood cell count increased
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (narrow), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad), COVID-19 (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None noted
Current Illness: None noted
Preexisting Conditions: Hypertension
Allergies: Penicillin Ibuprofen Bactrim
Diagnostic Lab Data: Labs/Results:on admit: 6/2/2021 Covid neg, neg monospot , Tox positive for THC, Blood cultures pending. Glucose 140, ALT 8, Troponin HS 30/35 , CRP < 0.5, WBC 17.5, RBC 3.45, HGB 10.4, HCT 31.7, Sed rate 26 ,D-Dimber 477 6/3/2021 Chloride 109, AST 10, ALT 5, Troponin 13, WBC 23.6, RBC 2.33, HGB 7.1, HCT 21.6 Procedure _ blood transfusion 6/3/2021 - O positive-hemoglobin did drop again to 7.1, patient also became tachycardic with a heart rate in the 120s and slightly hypotensive in the 80s systolic, normal mentation, patient was given 2 units of blood, CT of the abdomen and chest are currently pending as well. Diagnostic studies: 6/2/2021-CXR- No acute cardiopulmonary disease is evident. - 6/2/2021-CTA chest and pelvis w/wo contrast . CT of pelvis w/contrast 1. Negative for pulmonary embolism. 2. Moderate to large amount of intraperitoneal hemorrhage. There is a low-density focus along the posterior margin of the spleen. While not excluded as a focus of laceration there is no provided history of trauma. Unfortunately, clearly seen on this exam. 3. Low-density lesion along the posterior inferior aspect of liver is favored for a hemangioma. 4. Nodule left adrenal gland is indeterminate. In the nonemergent outpatient setting, follow-up by means of adrenal gland mass protocol CT is recommended. 6/3/2021 -CTA abdomen and pelvis w/wo contrast Marked abnormal appearance of the spleen, suggesting at least a grade III type laceration, with intermittent recurrent bleeding from the spleen since the most recent exam.
CDC Split Type:

Write-up: Nausea, vomiting, headache, severe abdominal pain- intensity is 7, painful to breath, rib and shoulder pain. Referred to clinic Admitted 6/2/2021 Diagnosis: Ruptured spleen with massive hemoperitoneum Splenectomy performed


VAERS ID: 1374530 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-24
Onset:2021-06-01
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Rash macular
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: PATIENT CAME IN AND SAID ARM WAS SPLOTCHY WITH BRUISES AND UPPER ARM FELT KNOTTED UP ABOUT A WEEK AFTER GETTING A PFIZER COVID SHOT. PATIENT DOESN''T RECALL HITTING HIS ARM ANYWHERE. UPON QUESTIONING, PT IS ON BLOOD THINNERS. ARM IS NOT RED, RAISED, AND DOES NOT HAVE A RASH.


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