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From the 7/23/2021 release of VAERS data:

Found 506,830 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 227 out of 5,069

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VAERS ID: 1394850 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-03
Onset:2021-06-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Rash vesicular
SMQs:, 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: Losarthan, Zyrtec, anti acid
Current Illness:
Preexisting Conditions: Systemic mastocytosis
Allergies: Alcohol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash blisters both arms and 1 leg


VAERS ID: 1394889 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-01
Onset:2021-06-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004C21A / 2 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Dizziness, Fatigue, Headache, Panic attack
SMQs:, Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

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

Write-up: Chest pain, head ache, dizziness, fatigue, panic attacks


VAERS ID: 1394945 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Areflexia, Asthenia, Ataxia, Coronavirus infection, Headache, Limb discomfort
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: headache, ataxia, weakness, loss of DTR in lower extremites, treated with steroids. clinical improvement over 7 days. discharged home to follow up with pediatrician, pediatric neurology, pediatric infectious disease, and pediatric rehab. patient also found to have coronavirus (NOT COVID 19) acute infection during illness as well.


VAERS ID: 1395082 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Unknown  
Location: Wisconsin  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Hypoaesthesia, Rash
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed rashes all over body more than 24 hours after the second dose and also indicated numbness in the arm. Patient also reported tightness in the chest


VAERS ID: 1395149 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C2IA / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Chills, Dyspnoea, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: After experiencing the expected side effects, such as fever, chills and body aches, I woke up the next day (two days after my second dose of Moderna vaccine) at 5:50 a.m. because I experienced chest pain and shortness of breath. I am concerned it may be myocarditis, and I have not seen a medical professional for this. I recovered after two days but sometimes experience pangs of chest pain time to time.


VAERS ID: 1395198 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain, Computerised tomogram normal, Inflammation, Laboratory test normal, Ultrasound abdomen normal
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: PCN, Tobramycin, Bee Sting
Diagnostic Lab Data: Lab work, US and CT scan
CDC Split Type:

Write-up: Severe abdominal pain on 6/5/21 off and on from 8:30am through 6:30pm. Went to Hospital Emergency Department. They performed blood tests which showed some inflammation (but obviously don?t know where) so they performed an Abdominal US which was normal. Patient continued to have severe abdominal pain and they proceeded with a CT scan with and without contrast, which was also normal. They couldn?t say if it was a reaction from the vaccine but possibly, since everything was WNL.


VAERS ID: 1395303 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-05
Onset:2021-06-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWOLSO / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Babinski reflex test, Ear pain, Eye movement disorder, Facial pain, Facial paralysis, Facial spasm, Fatigue, Grip strength decreased, Headache, Impaired driving ability, Irregular breathing, Mobility decreased, Muscle spasms, Neck pain, Pain, Pain in extremity, Seizure, Sleep disorder, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Cardiomyopathy (broad), Hearing impairment (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Arthritis (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Citirizine 10mg/day, liposomal vitamin C 500mg 2x/day, Zinc, vitamin b complex, b12 sublingual, multivitamin, 10-15mg liquid iron,
Current Illness:
Preexisting Conditions: fibromyalgia, spinal degenerations, some arthritis, IBS/leaky gut, asthma
Allergies: amoxicillin, Bactrim, latex, nickle, many food allergies but NO anaphylaxis - mostly increased eczema and rashing as symptoms.
Diagnostic Lab Data: I was denied many tests and treatments like EMG''s, EEG''s, MRI''s, and CT''s. They did a foot scrape test for encephalitis that I passed. Some elevated immune cell indicators but I did just get a vaccine. I did convince them to get me an MRI of my brain, but got scheduled July 3rd which is weeks from now with plenty of time for damage to possibly occur. Not sure if this will be permanent or temporary yet.
CDC Split Type:

Write-up: 5 minutes after the injection I lost function in both arms and controlling my eyes. Couldn''t hold my phone up. The pharmacist helped me to the floor and I began to convulse and spasm, especially on the left side. These convulsions, spasms, facial and body ticks came in waves of extreme, almost bone-breaking tension, then I would go limp, then repeat. It is day 9 after the injection and the convulsions, spasms, and general tremoring continues. Extreme overall body pain like electric shocks and vibrations that wake me from sleep when I can get it. The left side of the body worse. Blinding headaches began after 2 days. Left facial droop and generalized flat facial affect as I can''t smile without spams. Eyes spasm when I try to look around. Extreme fatigue and irregular breathing (diaphragm spasm?). Grip strength impaired and I drop everything and food and liquids fall from my mouth. Sharp shooting electric pain through the left arm, neck, skull, face, ear, and shoulder blade. The ear will spasm to where my ear touches my shoulder and I can''t move it. I cannot drive. And have had to be dependent on others for everything.


VAERS ID: 1395449 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Electrocardiogram, Full blood count, Metabolic function test, Pulse abnormal, Pyrexia, Troponin
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa antibiotics, cephalosporin antibiotics, penicillins
Diagnostic Lab Data: 6/5/2021. EKG x 3, troponin, CBC, CMP.
CDC Split Type:

Write-up: She woke up the next morning (approximately 14 hours after injection) complaining that she was having difficulty breathing. I?m an RN so I checked her sats and pulse. Sats were ok at 99% but pulse was 150. Mild fever of 100.5. Gave her water and rechecked pulse but it was still 140-150. Called her doctor


VAERS ID: 1395680 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-29
Onset:2021-06-05
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Burning sensation, Lymphadenopathy, Muscle spasms, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre 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: second dose cause severe vomiting for a couple of hours
Other Medications: vitamin d, peppermint and a probiotic (40 billion)
Current Illness: none
Preexisting Conditions: arthritis
Allergies: sulfa medications
Diagnostic Lab Data: I haven''t seen a doctor yet, but have a mammogram scheduled for the 28th, which I thought may reveal more information about the the armpit issue.
CDC Split Type:

Write-up: Pain, burning and swelling in armpit of right arm, beginning June 5th and continuing through today. Yesterday, my thumb muscle became painful and cramped and this morning that pain has traveled to my index finger where I feel pain, a lump on my first joint of my index finger and some tingling in my index finger.


VAERS ID: 1395851 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-09
Onset:2021-06-05
   Days after vaccination:88
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cardiac monitoring normal, Catheterisation cardiac normal, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: 1 Baby Aspirin 1 multivitamin
Current Illness: none
Preexisting Conditions: none
Allergies: None reported
Diagnostic Lab Data: Heart catheterization and heart monitoring in the hospital for 5 days.
CDC Split Type: COVID 19

Write-up: Reporting today because the doctor at the hospital told me that he didnot understand what caused my heart attack. When he did the heart cath there were no clogged arteries or evidence of hypertension.


VAERS ID: 1396010 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-25
Onset:2021-06-05
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN0181B (?) / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Haemoptysis, Sputum abnormal, Sputum purulent, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acebutolol 200mg/day, PreserVision AREDS 2 chewable
Current Illness: MAI/MAC, bronchiectasis, mitral, central serous retinopathy
Preexisting Conditions: MAI/MAC since 2006, bronchiectasis (02/19/2019 heart calcium CT requires followup lung CT for definitive diagnosis)
Allergies: sulfa drugs (hepatomegaly)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hemoptysis. On 06/05, a one-time event (old, dark clots) occurred. On 06/06, there were several instances, some older clots, some lighter/fresher blood. Then 4 days of no blood, but "normal" (usual) infected sputum colors (preexisting lung infection; see continuation page). Then on 06/11 beginning @ 7:57am, fresh (light) blood streaks/tinged sputum, which occurred a number of times over the span of approximately 5 hours, until "normal" pale yellow infected sputum was expectorated. Then on 06/12 beginning @ 9:30am, fresh blood again, which again occurred a number of times over the span of about 5 hours until the usual infected colors of sputum were expectorated. Additional information for Item 18: I have a history of MAI/MAC infection and resultant hemoptysis since 2006. However, until the first Pfizer dose, it had been 2 years since the last incident of hemoptysis, which was due, at least in large part, to malnutrition spanning a couple of months, for reasons unrelated to the lungs. I believe my most recent hemoptysis episodes are a result of my immune system being distracted by the Covid-19 vaccine, thus allowing the Mycobacterium avium (and/or other) to more effectively attack my lung tissue. There was no hemoptysis yesterday (06/13), but this has me concerned about the second dose causing additional, possibly worse, problems for my immune system, as it needs to be concentrating on my lung infection full-time; it has been keeping the MAC (and/or other) generally under control, assuming hemoptysis is a good indicator, which my X-rays over the years of monotherapy with Ethambutol suggest is the case. I discontinued Ethambutol on 06/15/2012, with no further hemoptysis until 04/26/2019, and then no hemoptysis until 11 days after the first Pfizer Covid-19 dose. It seems reasonable to conclude that the vaccine led to these latest hemoptysis events and perhaps allowed the preexisting bacterial infection to cause additional lung damage.The physician noted above is my current pulmonologist. I was to have follow-up lung CT scan and lung function tests, but did not do so in 2020 because of Covid-19 concerns. I had planned to see Dr. and my other doctors after being fully-vaccinated, but since lung function tests cannot be performed on patients with active/recent hemoptysis, this may cause an even further delay in my obtaining appropriate diagnostics and treatment.


VAERS ID: 1396077 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Electrocardiogram normal
SMQs:, Other ischaemic heart disease (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: one-a-day gummy vitamins
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: ECG as noted above; interpreted as "normal" by the doctor
CDC Split Type:

Write-up: Within 24 hours of receiving his 2nd vaccination, my son began complaining about heart pain. He described them as sporadic, and mild in nature - mostly an annoyance. The pain was not associated with increased heart rate or increased/labored breathing. He has never experienced anything similar in the past and is in exceptionally good health (He runs long distance cross country and track for his high school). Three days from his vaccination, I took him to his primary care physician where the performed and ECG which the doctor interpreted as "normal", and most likely not Myocarditis. He recommended Advil (3 tablets up to 4 times a day) for a few days, to reduce any potential inflammation, which he began immediately. Once he began the Advil regiment, his conditions ceased to come back and he has not experienced any further episodes even after he stopped taking Advil. Is is now exactly 7 days after his 2nd vaccine.


VAERS ID: 1396349 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-05
Onset:2021-06-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Chills, Dizziness, Fatigue, Illness, Lymphadenopathy, Malaise, Nausea, Panic attack
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 23, tdap vaccine
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph nodes within 5 minutes. After 3 hours, malaise, dizziness, fatigue, weakness, chills, nausea. Symptoms worsened over the past 10 days. Uncontrollable and inexplicable panic attacks, debilitating episodes of sickness.


VAERS ID: 1396456 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-02
Onset:2021-06-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Topamax 50mg daily
Current Illness: n/a
Preexisting Conditions: occasional Migraines
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient reported 72 hours post vaccination started experiencing a severe migraine with nausea and has not gotten better since.


VAERS ID: 1396555 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-03-22
Onset:2021-06-05
   Days after vaccination:75
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / SYR

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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: creatine (for weight lifting)
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Positive Ice Cube test on forearm
CDC Split Type:

Write-up: Confirmed COLD URTICARIA: swelling of hands and feet, and hives.


VAERS ID: 1396680 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cough
SMQs:, Anaphylactic reaction (broad)

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

Write-up: terrible cough


VAERS ID: 1396780 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Nausea, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash on right foot, on/off nausea


VAERS ID: 1396805 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-05
Onset:2021-06-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Electrocardiogram, Loss of consciousness, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: EMS was called, vitals were done as well as an EKG on site
CDC Split Type:

Write-up: Approximately a minute and a half after the show was administered my daughter passed out and started convulsing for approximately 2 minutes.


VAERS ID: 1396997 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-03
Onset:2021-06-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

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

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

Write-up: full body rash


VAERS ID: 1397482 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-31
Onset:2021-06-05
   Days after vaccination:66
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (broad)

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

Write-up: Bell''s Palsey


VAERS ID: 1398681 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-06-05
Onset:2021-06-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 presented with increased tenderness and swelling in her arm where she received second moderna shot


VAERS ID: 1398946 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-05-24
Onset:2021-06-05
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Chest X-ray, Cough, Fatigue, Headache, Pain, Pyrexia, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension and hyperlipidemia.
Allergies: Statins and sulfa drugs.
Diagnostic Lab Data: Pt has had a negative chest x-ray (06/11). She has tested negative for COVID twice (06/08 and 06/14).
CDC Split Type:

Write-up: Pt received the vaccine on 05/24, on 06/4-5 she started developing symptoms; fatigue, body aches, cough, stomach discomfort, headache low-grade temperature. As of 06/15 - her symptoms have not improved much. Oxygen levels have gone down to lower 90s but compensate back up to mid to upper 90s. She has been treated with Ivermectin and a Medrol Dose pack. She has been using an incentive spirometer.


VAERS ID: 1399020 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Gait disturbance, Hypotonia, Weight bearing difficulty
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: THE EVENING OF 6/5/21, C/O DEVELOPING HA, CHILLS, FATIGUE, COULDN''T WALK DUE TO HIS LEGS BEING SO FLACID AND COULD NOT BARE WEIGHT, ACTUALLY HAD TO BE CARRIED TO BED BY HIS SON.


VAERS ID: 1399265 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pyrexia, Vaginal ulceration
SMQs:, Severe cutaneous adverse reactions (broad), Neuroleptic malignant syndrome (broad), Anticholinergic 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? Yes
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: None
CDC Split Type:

Write-up: Fever onset 6/5/21. Vaginal Ulcer onset 6/6/21. 1st Pfizer dose received 5/14/21. 2nd Pfizer dose received 6/4/21.


VAERS ID: 1399285 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-06-03
Onset:2021-06-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Axillary pain, Breast pain, Breast swelling, Injection site erythema, Injection site pain, Injection site swelling, Lymphadenopathy
SMQs:, Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Lipodystrophy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec daily
Current Illness: Diagnosed with COVID-19 in late March 2021, symptomatic.
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: No immediate reaction. Starting around 48 hours after vaccination (Saturday 6/5), client noted swelling, redness and pain at site of injection that spread to left axillary and breast area. Swelling was significant enough that mother described it as "he looked like he had a breast". They sought medical attention on Monday 6/7 at pediatrician''s office. Swelling had decreased but was still present. Pediatrician advised ibuprofen. Symptoms resolved within 5 days post vaccination.


VAERS ID: 1399370 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / SYR

Administered by: School       Purchased by: ?
Symptoms: Alanine aminotransferase normal, Aspartate aminotransferase normal, Atelectasis, Band neutrophil count, Blood albumin decreased, Blood bilirubin increased, Blood calcium, Blood chloride increased, Blood creatinine normal, Blood glucose increased, Blood lactate dehydrogenase increased, Blood magnesium increased, Blood potassium normal, Blood urea, Brain natriuretic peptide increased, C-reactive protein increased, Carbon dioxide decreased, Computerised tomogram abnormal, Haematocrit decreased, Haemoglobin decreased, Hypoalbuminaemia, Hyponatraemia, Hypoxia, Laboratory test abnormal, Lung consolidation, Lymphocyte count normal, Lymphopenia, Metabolic function test, Multi-organ disorder, Neutrophil count, Platelet count decreased, Procalcitonin normal, Proteinuria, Pyrexia, Red blood cell sedimentation rate increased, Respiratory distress, Rheumatological examination, Serum ferritin normal, Tachycardia, Tachypnoea, Thrombocytopenia, Troponin increased, White blood cell count increased
SMQs:, Acute renal failure (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Biliary system related investigations, signs and symptoms (narrow), Pulmonary hypertension (broad), Hyponatraemia/SIADH (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Proteinuria (narrow), Tubulointerstitial diseases (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (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? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 6/8 CBC: WBC 14.9, Hgb 12.5, Hct 34.9, Platelet 52, ANC 72, Lymphs 16, Bands 2, BMP 135, K 4.5, Cl 109, CO2 17, BUN 9, Cr 0.89, Glc 148, Ca 8.2, Albumin 2.7, T Bili 2.7, ALT 20, AST 17, Mg 4.3, LDH 413, Ferritin 188 ESR 52, CRP 29, Procal 0.77 Please call for rest of labs
CDC Split Type:

Write-up: Patient was admitted from PCP for extreme tachycardia and tachypnea and developed multi organ involvement with tachycardia (HR to 140-150s), slight elevation in BNP (H of 490), Troponin (H of 0.244), mild proteinuria (50-70 proteins), respiratory distress with tachypnea (RR 50s) and hypoxia requiring escalation in O2 supplementation. Also with daily fevers until starting steroids. Laboratory findings concerning for slight hypertriglyceridemia, normal Ferritin, worsening thrombocytopenia, lymphopenia, hyponatremia, and hypoalbuminemia. CT with bibasilar atelectasis vs. consolidation, but no evidence of PE. Extensive ID and rheumatological evaluation performed and unremarkable so far. Received 2 days of Doxycycline. Was started on pulse dose steroids and began to show improvement in all markers.


VAERS ID: 1400283 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None indicated
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: No tests done. Patient advised to go to an urgent care center.
CDC Split Type:

Write-up: Patient experienced syncope the night after receiving the second Moderna vaccine for COVID-19 on 06/04/2021. She got up at 2AM (~8hrs after shot) on 06/05/2021 to use the restroom and loss consciousness and fell and hit her head on the floor. Patient reported a headache that lasted several days after incident, but is now resolved. Patient called clinic after hours on 6/14/2021 to report these events and she was advised to seek medical attention ASAP for a neurological evaluation.


VAERS ID: 1400313 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-04-13
Onset:2021-06-05
   Days after vaccination:53
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 LA / IM

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

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

Write-up: Positive diagnosis COVID-19 on June 15, 2021


VAERS ID: 1400613 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-03
Onset:2021-06-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Risperdol consta injection, metformin, losartan, victoza injection,Trazadone, hydroxyzine pamoate, clonazepam, atorvastatin, metoprolol, breo inhaler, ventolin inhaler, furosemide, elquis, baclofen, benztropine, duloxetine
Current Illness: N/A
Preexisting Conditions: diabeties, high cholesterol and blood pressure, degenerative disk spacing in lower back, breathing problems, sleep apnea
Allergies: penicillin, sulfa drugs, tetracyclines, bupropion, clarithromycin, and bee stings
Diagnostic Lab Data: N?A
CDC Split Type:

Write-up: red itchy bumps on both arms and large bumps that have turned white on left elbow and red itchy bumps on right hand.


VAERS ID: 1400884 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Fatigue, Nasal congestion, Pyrexia, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Today is day 12 after his 2nd dosis and my son still has: fever, tiredness, heavy cough, congestion, fatigue running nose,


VAERS ID: 1400889 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-18
Onset:2021-06-05
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Mass, X-ray
SMQs:, Extravasation events (injections, infusions and implants) (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: Lipitor , Coreg, entresto, Tylenol, Aleve
Current Illness: bronchitis
Preexisting Conditions: heart disease, heart failure
Allergies: none
Diagnostic Lab Data: I went to orthopedic clinic they took several x rays and said it is probably a rotator cuff injury.
CDC Split Type:

Write-up: Severe pain at injection area , it is not constant but generally every day since 06/05 2021 especially at night. Also there is a lump on my shoulder.


VAERS ID: 1401453 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-03
Onset:2021-06-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: School       Purchased by: ?
Symptoms: Testicular torsion
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 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: Testicular torsion


VAERS ID: 1402055 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-05
Onset:2021-06-05
   Days after vaccination:61
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO150 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asymptomatic COVID-19, SARS-CoV-2 antibody test, SARS-CoV-2 test
SMQs:, COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ammonium lactate (LAC-HYDRIN) 12 % lotion aspirin 81 mg tablet clopidogreL (PLAVIX) 75 mg tablet levothyroxine (SYNTHROID) 50 mcg tablet melatonin 10 mg tablet,disintegrating multivitamin (THERAGRAN) tablet nystatin (MYCOSTATIN) 100,000 uni
Current Illness: Non
Preexisting Conditions: Nervous High-frequency hearing loss of right ear Stroke syndrome Tinnitus of both ears Right chronic serous otitis media Sensorineural hearing loss, bilateral Chest discomfort Respiratory Obstructive sleep apnea Chronic rhinitis Deviated nasal septum Hypertrophy of nasal turbinates Circulatory Cardiomyopathy Hypotension Iliac artery aneurysm, right Digestive Esophageal reflux Musculoskeletal Facial droop TMJ (temporomandibular joint disorder) Neck sprain Lumbar sprain Endocrine/Metabolic Hypercholesterolemia Hyperglycemia Hypothyroidism Other Insomnia Male erectile disorder of organic origin Paranoid schizophrenia Verbal auditory hallucination
Allergies: No Known Allergies
Diagnostic Lab Data: COVID-19 (SARS CoV-2,RNA Molecular Amplification) COVID-19 PCR
CDC Split Type:

Write-up: asymptomatic


VAERS ID: 1402451 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest pain, Echocardiogram, Electrocardiogram, Immunoglobulin therapy, Myocardial necrosis marker increased, Myocarditis, Vaccination complication
SMQs:, Myocardial infarction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Blood test, EKG, Echo. Blood test showed enzyme levels were elevated.
CDC Split Type:

Write-up: Had chest pains on 06/05 he was admitted into the hospital on 06/06. His heart enzymes were elevated and was diagnosed with myocarditis which was directly linked to the vaccine. He was given IVIG treatment to bring down his enzyme levels.


VAERS ID: 1402618 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-05
Onset:2021-06-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dehydration, Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (narrow)

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

Write-up: Patient fainted within a minute after receiving her COVID vaccine at the vaccine clinic on 6/5/2021. Her father was watching the administration process and asked if the needle stayed in her arm after the needle retracted. The nurse answered, ''These needles retract back into the syringe.'' Father continued, ''She did received the whole vaccine? It looked like it stayed in her arm..'' The patient looked at the syringe and fainted when she didn''t see the needle at the end of the syringe. The vaccinator noticed the patient''s head tilt back and the vaccinator held her head and helped her to the ground and elevated her legs. Patient recovered within a minute after fainting. Patient was able to walk to the observation room with little to no assistance where vitals were taken. 102/80-87. Pulse Ox 96%. No respiratory symptoms,. Color good and felt back to normal by the time we got her back to the observation room. Drank 2 bottles of water. Patient had played soccer that morning, had eaten but admitted that she was dehydrated.


VAERS ID: 1402790 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-05
Onset:2021-06-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Fatigue, Influenza B virus test, Injection site pain, Loss of personal independence in daily activities, Myalgia, Nasal congestion, Pain, Pyrexia, Rhinorrhoea, Streptococcus test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: injection site soreness and low grade fever with some infant/pediatric vaccines
Other Medications: Zyrtec
Current Illness: None
Preexisting Conditions: Seasonal allergies (pollen)
Allergies: Penicillin
Diagnostic Lab Data: Tested negative for strep throat and influenza B on 07 June 2021
CDC Split Type:

Write-up: Low grade fever, pain at the injection site, severe chills, severe muscle and body aches, severe fatigue and tiredness, severe nasal congestion, severe runny nose, unable to perform normal daily activities for 3 days, continued with residual symptoms and mild to moderate activity impairment for 9 days.


VAERS ID: 1402890 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-29
Onset:2021-06-05
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Bilevel positive airway pressure, Blood creatinine normal, Blood fibrinogen increased, C-reactive protein increased, COVID-19, Dyspnoea, Endotracheal intubation, Fibrin D dimer, Liver function test normal, Mechanical ventilation, Procalcitonin, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amitriptyling, amlodipine, atorvastatin, glipizide, lisinopril, metformin, metoprolol, ozempic
Current Illness:
Preexisting Conditions: diabetes, arthritis, hyperlipidemia, htn
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Went to hospital on 6/5/21 with dyspnea and was diagnosed with COVID-19. Placed on supplemental O2, then BiPAP. Intubation attempted 6/8 but could not so used bag-valve mask x 3-4 hrs until EMS arrived to intubate her and transport her to our hospital. Received dexamethasone 6mg BID x 2 days then daily x 8 days; remdesivir x 5 days, tocilizumab 800mg x 1 on 6/8. Also received ceftriaxone + doxycycline in case of CAP for 5 days. Lab values at our hospital (starting 6/8) were: WBC 17.7 -- $g 13.6 -- $g 11.3 -- $g 10.3 -- $g 8.9 -- $g 9.8. CRP 15.3 -- $g 8.16 -- $g 4.08 mg/dL Procalcitonin 2.26 -- $g 1.26 -- $g 0.64 d-dimer 4567 -- $g 1586 -- $g 2235 fibrinogen 543 -- $g 496 -- $g 387 LFTs and SCr within normal limits during stay Other meds include: cisatracurium infusion 6/8 -- $g 6/12 midazolam infusion 6/8 -- $g 6/12 norepinephrine infusion 6/8 -- $g 6/9 propofol infusion 6/8 -- $g 6/15 Remained on ventilator 6/8 until 6/15 when she was extubated for comfort care measures. As of 6/16/21 when this report is being submitted, patient is still alive however is on hospice. Total duration of hospitalization at our facility is 9 days so far; was admitted to other hospital from 6/5 through 6/8 prior to transfer to us.


VAERS ID: 1403696 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-05
Onset:2021-06-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH CW0175 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Fatigue, Hypersensitivity, Oropharyngeal pain, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Two hours after the second dose of the vaccine my daughter developed a sore throat. The next day she felt better but her throat still hurt. On the fifth day she complained that she felt like she couldn''t breathe so I took her to the ER. She was diagnosed with an Allergic reaction because her throat was swollen and she was prescribed some Prednisone. They gave her Benadryl and Steroids. It has been nine days and it seems to be a little better but her throat still hurts and she is very tired.


VAERS ID: 1403773 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, 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: Shellfish
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fatigue, headache, low grade fever starting that night lasting about 36 hours


VAERS ID: 1403779 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA I DON''T KNOW / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Chills, Decreased appetite, Fatigue, Feeling abnormal, Hypoaesthesia, Injection site pain, Mental impairment, Myalgia, Pulmonary pain, Pyrexia, Sensory loss, Sleep disorder, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (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), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: No tests. My family doctor died a while back and have yet to find a new. Too busy to get testing done. Just want someone to be aware of what I experienced.
CDC Split Type:

Write-up: First shot one month prior, no issues at all. Soreness at the injection site. Second shot: Next day, high fever, chills, severe muscle and joint pain. Two days after, violent vomiting. increased joint pain, fever, trouble thinking clearly. Three days after, numbness in my left hand, and loss of sensation in my entire right foot. As of 6-16, loss of feeling still continues. 1 week after, chest and lung pain, I think my heart is hurting, almost like random stabbing pains through it, random waves of muscle and joint pain. Issues sleeping. Issues with thinking clearly. I have felt run down since receiving my second shot. Loss of appetite and foggy brain.


VAERS ID: 1404276 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-03
Onset:2021-06-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Lymphadenopathy, Memory impairment, Neck pain
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: none
Preexisting Conditions: none
Allergies: smarty pants multivitamin for kids Mon-Fridays only
Diagnostic Lab Data: Reviewed symptoms with pediatrician prior to scheduling second shot
CDC Split Type:

Write-up: My son developed neck soreness and and an enlarged lymph node that weekend. On Monday following the vaccination a severe headache started which lasted 4 days, even with tylenol and ibuprofen. On Tuesday, he started complaining about not remembering what he did the day before when he woke up in the morning..memory started coming back around noon. The memory issues lasted one week and began to dissipate thankfully. After a few weeks got a call to schedule his second shot. Called the pediatrician and the pediatrician told us not to administer the second vaccine due to adverse reaction to the first. We are monitoring his memory issues..he is almost a straight A student in school last year and on an Advanced Learning Plan in high school due to high IQ. We will know if this is long lasting after attending school and monitoring his grades and headaches in the fall.


VAERS ID: 1404476 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-02
Onset:2021-06-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vein disorder
SMQs:

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

Write-up: A lot of blood vessel were highly visible in his center chest area. This adverse event disappeared after approximately five day.


VAERS ID: 1404682 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Decreased appetite, Fall, Injection site pain, Loss of consciousness, Moaning, Muscular weakness, Myalgia, Nausea, Pyrexia, Syncope, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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:
Current Illness:
Preexisting Conditions:
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: I received the 2nd shot of Moderna Covid-19 vaccine on 6/4/21 at 4pm and started to have a lot of pain in the arm that received the vaccine from shoulder to wrist and 102.3 fever by 11pm on the same day. I took Tylenol and went to bed. Next morning on 6/5/21, I woke up with a lot of muscle aches and weakness and couldn''t function, so I mostly spent the morning laying down. I didn''t eat and drank very little. By 12pm on that day I started to feel nauseous, I got up and walked to the kitchen to have a drink. At that point everything started to go dark in front of my eyes and I fainted and fell on the floor. I was told by my son that I was unconscious for 2 or 3 minutes and when I started to regain my consciousness, I realized I was moaning and my face was covered with cold sweat. I had fever between 99.8 and 100.8 that whole day on 6/5/21 and felt better with no fever the next day on 6/6/21.


VAERS ID: 1405239 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:2021-06-05
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Hypervigilance, Pain in extremity, Therapeutic response unexpected, Tremor, Unevaluable event
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Automobile accident; Nerve damage; Shingles; Tremor
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210619387

Write-up: HEARING IS BETTER/MENTAL FOCUS/VISION IS GETTING/BETTER THOUGH PROCESS; POSITIVE CHANGES; FEELING AWAKENED; TREMORS; SHOULDER AND ARM PAIN; This spontaneous report received from a patient concerned a 65 year old male. The patient''s height, and weight were not reported. The patient''s past medical history included shingles, car accident, nerve damage on the entire body, and tremor in the right side of his body. The patient was previously treated with polio vaccine for drug used for unknown indication. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown expiry date: UNKNOWN) dose was not reported, administered on 05-JUN-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 05-JUN-2021, the subject experienced tremors. On 05-JUN-2021, the subject experienced shoulder and arm pain. On 07-JUN-2021, the subject experienced hearing is better/mental focus/vision is getting/better though process. On 07-JUN-2021, the subject experienced positive changes. On 07-JUN-2021, the subject experienced feeling awakened. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from shoulder and arm pain, and tremors, and the outcome of hearing is better/mental focus/vision is getting/better though process, positive changes and feeling awakened was not reported. This report was non-serious.


VAERS ID: 1405903 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-06-05
Onset:2021-06-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / OT

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Pain, Pyrexia, Vaccination site pain
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data: Test Date: 20210605; Test Name: Fever; Result Unstructured Data: Test Result:99.5
CDC Split Type: USPFIZER INC2021666007

Write-up: Slight fever (99.5); Soreness at the injection site; Stomach pain; Pain is in a ''V'' shape that starts under ribs, goes down below belly button and back up to the other side of the ribs; This is a spontaneous report from a contactable consumer (patient''s mother). A 11-year-old female patient (daughter) received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Lot number: EW0191) via Intramuscular route of administration in left arm on 05Jun2021 at 10:00 AM (age at vaccination 11-year-old) as 2nd dose, single dose for COVID-19 immunization. Medical history and concomitant medication were not reported. She was not pregnant. Previously patient took first dose of bnt162b2 on (Lot number: EW0182) via Intramuscular route of administration in left arm on 15May2021 at 12:30 PM as single dose for COVID-19 immunization. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient did not receive any other medications within 2 weeks of vaccination. On 05Jun2021 at 04:00 (PM), Patient experienced slight fever (99.5), soreness at the injection site, stomach pain which started later in the day (on the day vaccine was given) and has continued to today and pain is in a V shape that starts under ribs, goes down below belly button and back up to the other side of the ribs. Patient did not received treatment for adverse events. The patient was not diagnosed with COVID-19, Prior to vaccination. The patient has not been tested for COVID-19, since the vaccination. The outcome of event pain at injection, pyrexia, stomach pain was resolved, whereas not resolved for pain. Reporter submitted that report on behalf of her daughter and reported that all symptoms (vaccination site pain, fever, abdominal pain upper) had all resolved. Information on Lot/Batch number was available. Additional information has been requested.


VAERS ID: 1405973 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 RA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021672839

Write-up: Hives; rashes from head to my toe.; This is a spontaneous report from a contactable consumer. A 25-year-old patient of an unspecified gender received BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; formulation: Solution for injection, Batch/Lot number: EW0172), dose 1 via an unspecified route of administration, in Arm Right on 04Jun2021 (at the age of 25-year-old), as 1st dose, single dose for COVID-19 immunization. The patient medical history and concomitant medications were not reported. Prior to the vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. The patient told the person about the allergic reactions she had to an antibiotic (name unspecified) and she think it was okay to get the vaccine. The reactions she had with the antibiotic was hives in her body, nothing life threatening. The patient got the vaccine on Friday (04Jun2021) and she felt fine no pain, no headache nothing. she was perfectly fine but Saturday afternoon (05Jun2021). The patient started getting rashes from head to toe and started feeling the same hives again, no other symptoms other than hives. she got it from her hip all the way to waist completely covered hives. Patient asked if they can get second dose of vaccine. The outcome of the event hives was not resolved and unknown for rash. Information on Lot/Batch number was available. Additional information has been requested.


VAERS ID: 1406005 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high (Mother has high blood pressure); Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None, Comment: patient had no history
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021676627

Write-up: he noticed swelling on the upper L side of his body "underneath arm pit, by ribs"; he noticed pain on the L side of his body; This is a spontaneous report from a contactable consumer (patient) via Medical information team. A 27-years-old male patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Lot number: unknown), via an unspecified route of administration, administered in left arm on 04Jun2021 at 14:00 (at the age of 27-years-old) as single dose for covid-19 immunisation. The patient did not receive additional vaccines on the same date of the Pfizer Suspect. The patient had no relevant medical history. The patient family medical history relevant to events was reported as her mother has high blood pressure. The patient did not receive any other vaccinations within four weeks prior to the first administration date of the suspect vaccine. The patient did not receive any concomitant medications. The patient previously received first dose of BNT162B2 via an unspecified route of administration, administered in left arm on 14May2021 (at the age of 27-years-old) as single dose for covid-19 immunisation. On 05Jun2021, the patient experienced pain on the upper left side of his body and resolved the following day. On 08Jun2021, he noticed swelling on the upper left side of his body underneath arm pit, by ribs; on the left side of his body that has continued. After he woke today, he took pictures, and he saw the difference. He noticed the swelling after he got out of the shower and he felt it throughout the day. He is chubby but the other side of his body was not the same. It was like he had a roll with sweat underneath it. He was calling to see if this is a serious concern, and he will go to the doctor after work if he needs to. The outcome of event pain was resolved on 06Jun2021 and for another event it was not resolved. Information on the batch/lot number has been requested.


VAERS ID: 1406006 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Pruritus, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (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? 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: 20210526; Test Name: COVID-19 virus test; Test Result: Negative
CDC Split Type: USPFIZER INC2021676700

Write-up: Itching all over body/lot of itching/itching felt like it was on the inside of her body, like a running itch, like ants running around constantly/itching was on the patient''s back, scalp, feet, private area, arms, and legs; This is a spontaneous report from a contactable consumer (patient). A 54-year-old female patient received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Formulation: Solution for injection, Lot Number: EW0177), via an unspecified route of administration in right arm on 04Jun2021 15:50 as 0.3 mL single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. The patient wanted to report that on Saturday and Sunday she had a lot of itching on 05Jun2021. The itching felt like it was on the inside of her body, like a running itch, like ants running around constantly. The itching was on the patient''s back, scalp, feet, private area, arms, and legs. The patient would scratch her stomach and then it would go to her legs. Monday was when the patient wasn''t itching near as bad as she was. The patient almost got some Benadryl but didn''t know if she could take it. The itching got better. still the patient occasionally feels itching. This makes the patient nervous about getting the second dose. The patient was scheduled for her second dose of the vaccine on 25Jun2021. The patient gets a covid test about every 3 weeks to make sure she was safe. All of the patient''s covid tests have been negative. The patient underwent lab tests and procedures which included COVID-19 virus test: negative on 26May2021. Outcome of the event was not recovered. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1406567 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-22
Onset:2021-06-05
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain lower
SMQs:, Retroperitoneal fibrosis (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: Muti vitamin, b complex, calcium magnesium
Current Illness: None
Preexisting Conditions: None
Allergies: Dairy
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Started period on 6/5/21. Had excruciating period cramps pain in low abdomen on 6/5/21 and again throughout that week. Never have cramps before in general and especially never this bad. Cramps again on 6/14/21- 6/17/21.


VAERS ID: 1406798 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-05
Onset:2021-06-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: Injection site extravasation
SMQs:, Extravasation events (injections, infusions and implants) (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: An unknown quantity of vaccine leaked from arm.


VAERS ID: 1407132 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-30
Onset:2021-06-05
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal distension, Dysmenorrhoea, Fluid retention, Heavy menstrual bleeding, Menstruation irregular, Palpitations, Weight increased
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Fertility disorders (broad)

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

Write-up: Heart palpitations, and early heavy period with severe cramps an bloating, water and weight gain


VAERS ID: 1407213 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Influenza virus test, Nausea, Pain, Pregnancy test, Pyrexia, SARS-CoV-2 test negative, Urine analysis, 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), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Junel Fe
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Tested negative for COVID-19, influenza, UTI, pregnancy, and other infections
CDC Split Type:

Write-up: High fever above 102 degrees, nausea and vomiting that required intravenous fluids, chills, body aches


VAERS ID: 1407515 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-05
Onset:2021-06-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect product formulation 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 Vaccine Formulation (ex. different manufact. initial and booster)


VAERS ID: 1407715 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-05
Onset:2021-06-05
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes zoster, Neuralgia, Noninfective gingivitis, Pain in jaw
SMQs:, Peripheral neuropathy (narrow), Gingival disorders (narrow), Osteonecrosis (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 40mg Cymbalta
Current Illness: NA
Preexisting Conditions: Endometriosis Migraine
Allergies: Cipro
Diagnostic Lab Data:
CDC Split Type:

Write-up: June 5 - Trigeminal Neuralgia like pain in left lower jaw June 10 - Sores developed on lower left gum - started regimen for Shingles


VAERS ID: 1407837 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-05
Onset:2021-06-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Lethargy, Pallor, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: LETHARGIC, PALE, DROWSY, TREATMENT- AMMONIA INHALANT OUTCOME- FEELING FINE, DISCHARGED HOME WITH MOTHER


VAERS ID: 1407850 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-01-06
Onset:2021-06-05
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 01/06/2021 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Biopsy skin, Biopsy skin abnormal, Blood fibrinogen increased, Eosinophil count, Perivascular dermatitis, Red blood cell vacuolisation, Skin lesion, Urticarial vasculitis
SMQs:, Malignancy related therapeutic and diagnostic procedures (narrow), Vasculitis (narrow), Skin tumours of unspecified malignancy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: famotidine, vitamin d
Current Illness: none
Preexisting Conditions: GERD
Allergies: sulfa and wewllbutrin
Diagnostic Lab Data: biopsy tissue shows urticarial vasculitis (within the dermis, there is a perivascular infiltrate of neutrophils with prominent eosiophils and focal extraasated erythrocytes and fibrin deposition in blood vessel walls.
CDC Split Type:

Write-up: Diagnosed with urticarial vasculitis on 06/09/2021 after biopsy of skin lesions


VAERS ID: 1408219 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-05
Onset:2021-06-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Condition aggravated, Fatigue
SMQs:, 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:
Other Medications: Loloestrin Allegra Azelastine Nasocort
Current Illness: None
Preexisting Conditions: Mold and dust allergy Leaky gut No sinus issues or antibiotics needed for 6 mos prior to vaccine No generalized fatigue for 4 weeks prior to vaccine
Allergies: Shrimp Wheat
Diagnostic Lab Data: None to date
CDC Split Type:

Write-up: My daughter had been battling migraines and joint pain and generalized fatigue for over three years. We started seeing a functional medicine specialist in April and radically altered her diet due to food sensitivities. Approximately two weeks prior to the Covid vaccine she had been free of migraines for over four weeks and free of generalized fatigue and joint pain for over two weeks. Within two hours of receiving the Covid vaccine her generalized fatigue and joint pain was back and has not yet resolved as of today.


VAERS ID: 1408426 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Malaise, Palpitations, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: SILDENAFIL, FLOMAX, LEVOTHYROXINE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: BEES - ANAPHYLACTIC
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT STATED THAT HE RECEIVED THE VACCINE ON FRIDAY, AT THE END OF THE DAY ON SATURDAY, HIS CHEST STARTED TO FEEL HEAVY AND HE HAS LABOR BREATHING. HE WOKE UP SUNDAY AND DIDN''T FEEL WELL. HE TOOK A NAP AT AROUND 4PM ,THEN WOKE UP AND COULDN''T BREATH WITH HEART PALPITATIONS. HE WAS ABLE TO ARRIVE TO THE EMERGENCY ROOM AND TRIED TO WALK HIMSELF IN. HE COLLAPSED ON THEIR YARD.


VAERS ID: 1409457 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-06-05
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Dysstasia, Feeling of body temperature change, Hyperhidrosis, Pain, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210611927

Write-up: SHAKING; CAN NOT STAND; DIZZY; SWEATING; HOT AND COLD; PAIN ALL IN BODY; This spontaneous report received from a patient concerned a 27 year old male. The patient''s weight was 200 pounds, and height was 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: 203A21A expiry: UNKNOWN) dose was not reported, administered on 04-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 05-JUN-2021, the subject experienced shaking. On 05-JUN-2021, the subject experienced can not stand. On 05-JUN-2021, the subject experienced dizzy. On 05-JUN-2021, the subject experienced sweating. On 05-JUN-2021, the subject experienced hot and cold. On 05-JUN-2021, the subject experienced pain all in body. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from shaking, can not stand, dizzy, sweating, hot and cold, and pain all in body. This report was non-serious.


VAERS ID: 1409468 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Georgia  
Vaccinated:0000-00-00
Onset:2021-06-05
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blister, Pain in extremity
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: METOPROLOL; LOSARTAN
Current Illness: Heart rate high
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210626895

Write-up: HUGE BLISTERS ALL OVER TOES AND FEET; FEET HURTING; This spontaneous report received from a patient concerned a 46 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included elevated heart rate. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A, expiry: UNKNOWN) dose was not reported, administered on 05-JUN-2021 for prophylactic vaccination. Concomitant medications included losartan for elevated heart rate, and metoprolol for elevated heart rate. On 05-JUN-2021, the subject experienced feet hurting. On 06-JUN-2021, the subject experienced huge blisters all over toes and feet. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from feet hurting, and huge blisters all over toes and feet. This report was non-serious.


VAERS ID: 1409768 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-03
Onset:2021-06-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Pain in extremity, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021701878

Write-up: Itch/ the caller experienced itching on both arms; she had a sore arm; This is a spontaneous report received from contactable consumer (patient) via a Pfizer sponsored program COVAX US Support. A female patient of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection) via an unspecified route of administration on 03Jun2021 as 1st dose single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. The patient previously received flu shot. It was reported that the patient received her first dose of Pfizer-BioNTech COVID-19 Vaccine on 03Jun2021 (Thursday), and her second dose was scheduled for 24Jun2021. The patient stated, she just wanted to check in because she did find had no real reaction, the shot was like a flu shot. On 05Jun2021, at first the patient experienced a sore arm and then that went away. The patient stated both her arms started to itch which was on Saturday 05Jun2021 (reported as two days later). Arm itching had stopped. The clinical outcome of the evets was recovered on an unknown date in Jun2021. Information on the lot/batch number has been requested.


VAERS ID: 1410032 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-24
Onset:2021-06-05
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 2 AR / -

Administered by: Other       Purchased by: ?
Symptoms: Menstrual disorder
SMQs:

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

Write-up: I missed my period this month and so have many of my friends that got the vaccine


VAERS ID: 1410035 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site rash, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow)

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

Write-up: patient called today stating she developed nausea and fatigue that has lasted over a week from the first shot. she also has a rash on her shoulder from the injection site. Moderna covid vaccine


VAERS ID: 1410094 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 RA / IM

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

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

Write-up: PATIENT WAS GIVEN A VACCINE THAT WAS OUTSIDE OF THE ALLOWABLE TIMEFRAME OF A RECONSTIUTED VACCINES. WHICH MAY HAVE AFFECTED THE EFFICACY. PATIETN WAS INFORMED , INCEDNT REPORTS WERE SUBMITTED. PATIENT VOICED UNDERSTANDING. WOULD LIKE TO HOLD OFF A BIT ON REDOING VACCINE DUE TO SCHEDULE CONFLICT, WILL INFORM OFFICE WHEN ABLE TO SCHEDULE.


VAERS ID: 1410723 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-05
Onset:2021-06-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Oral mucosal erythema, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: perioral redness within 3 hours after 2nd dose. the next couple of days with diffuse hives.


VAERS ID: 1410819 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-27
Onset:2021-06-05
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes zoster, Rash, Scab, Varicella virus test negative
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Remicade (Infliximab) infusions
Current Illness:
Preexisting Conditions: Hidradenitis Suppurativa Crohns Disease
Allergies: Eggs, Sulfa Drugs
Diagnostic Lab Data: I was given a VZV PCR test. It came back negative but the doctor said that the test is not alway actuate.
CDC Split Type:

Write-up: On June 5 I broke out in painful rashes on my back shoulder (left). It then spread to the front of my shoulder (left) The doctor diagnosed me with Shingles. I prescribed Valacyclovir for 7 days and pain medication. As of today the rash is almost gone. I still have some areas that is scabbing over.


VAERS ID: 1410932 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Headache, Muscle spasms, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Headache, severe muscle aches and cramping, difficulty breathing. Effects lasted 6 days before subsiding.


VAERS ID: 1411752 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-05
Onset:2021-06-05
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Heavy menstrual bleeding, Hypertonic bladder, Menstrual disorder, Menstruation irregular, Pollakiuria, Polymenorrhoea
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: no
Preexisting Conditions: no
Allergies: penicillin
Diagnostic Lab Data: June 18, 2021 Excessively long bleeding during menstrual cycle.
CDC Split Type:

Write-up: I experienced overactive bladder and excessive urination starting a couple weeks after the 2nd dose of Moderna vaccine for Covid-19. I then experienced fatigue and headache along with an early and excessive menstrual cycle lasting longer than normal by 10 days so far. The bleeding is on and off heavy and I am very concerned that my menstrual cycle is interrupted and still going on for 15 days.


VAERS ID: 1412445 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature, Chills, Headache, Malaise, Nausea, Pain, Pyrexia, Vaccination site pain
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none
Allergies:
Diagnostic Lab Data: Test Date: 20210605; Test Name: High Fever; Result Unstructured Data: Test Result:102.7 to 103.2; Comments: 02:45
CDC Split Type: USPFIZER INC2021656454

Write-up: High fever 102.7 to 103,2; general full body malaise; Chills; extreme soreness at injection site; Nausea; Headache; body aches; This is a spontaneous report received from a contactable consumer (patient). A 15-year-old female patient (not pregnant) received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number: EW0217 and expiration date not provided), via an unspecified route of administration, in arm left, on 04Jun2021 15:45 (at the age of 15-year-old, not pregnant), at single dose, for COVID-19 immunization. Medical history and concomitant medications were reported as "none". Patient had no known allergies. No other medical history. Prior to vaccination, patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Patient did not receive any other medications within 2 weeks of vaccination. The patient previously took first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number: EL9264 and expiration date not provided), via an unspecified route of administration, in right arm, on 14May2021 15:45 (at the age of 15-year-old), at single dose, for COVID-19 immunization. On 05Jun2021 02:45, the patient experienced high fever 102.7 to 103.2, general full body malaise, chills, extreme soreness at injection site, nausea, headache, and body aches. The patient underwent lab tests and procedures which included body temperature: 102.7 to 103.2 on 05Jun2021 02:45. Since the vaccination, patient had not been tested for COVID-19. No treatment received for events. The outcome of evens was unknown.


VAERS ID: 1412454 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Investigation, Loss of consciousness, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 202106; Test Name: Testing; Result Unstructured Data: Test Result:unknown results
CDC Split Type: USPFIZER INC2021656560

Write-up: My daughter lost consciousness either from passing out or seizure; My daughter lost consciousness either from passing out or seizure; This is a spontaneous report from a non-contactable consumer (patient''s mother). A 14-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection), dose 2 via an unspecified route of administration, administered in Arm Right at the age of 14-year-old on 04Jun2021 12:00 (Batch/Lot number was not reported) as single dose for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. Prior to vaccination, the patient was not diagnosed with COVID-19. The patient was not pregnant. The patient previously took first dose bnt162b2 for COVID-19 Immunization. The reporter stated that ''my daughter lost consciousness either from passing out or seizure''. Event start on 05Jun2021 08:00. AE resulted in: Emergency room/department or urgent care. Since the vaccination, the patient has not been tested for COVID-19. The patient underwent lab tests and procedures which included investigation: unknown results in Jun2021. Therapeutic measures were taken as a result of events (Testing and pain meds /IV fluids). The outcome of event was recovering. Information on lot/batch number has been requested.


VAERS ID: 1412954 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-19
Onset:2021-06-05
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

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

Write-up: Pt suffered a heart attack


VAERS ID: 1413138 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Angina pectoris, Angiogram, Angioplasty, Computerised tomogram, Echocardiogram, Electroencephalogram
SMQs:, Embolic and thrombotic events, arterial (narrow), Other ischaemic heart disease (narrow)

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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: levaquin
Diagnostic Lab Data: eeg, echocardiogram, ct scan, angiogram
CDC Split Type:

Write-up: acute cardiac angina, angioplast


VAERS ID: 1413445 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-25
Onset:2021-06-05
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Pain in jaw, Pruritus, Swelling face, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Osteonecrosis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin c
Current Illness: No
Preexisting Conditions: No
Allergies: None that I am aware of
Diagnostic Lab Data: Was prescribed prednisone but it took a long time to work
CDC Split Type:

Write-up: Facial swelling on Saturday evening with itching on face and inside throat. Slight pain on right jaw


VAERS ID: 1413449 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-25
Onset:2021-06-05
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Ear infection, Heart rate increased, Pain in jaw, Pruritus, Swelling face, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Osteonecrosis (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin c
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: Was prescribed prednisone
CDC Split Type:

Write-up: Forgot to mention this in previous submission. Facial swelling, primarily on right side of face. Pain in lower right jaw with itching and itching in throat. Rapid heart rate.. It took 4 days for swelling to dissipate. Developed ear infection with rapid heart rate.


VAERS ID: 1413488 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Mobility decreased, Pain in extremity
SMQs:, Parkinson-like events (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient states that arm/shoulder is still significantly painful following injection over 2 weeks ago. Patient states she cannot comfortably lift her arm


VAERS ID: 1413535 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-05-28
Onset:2021-06-05
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Antiphospholipid antibodies, Blood homocysteine normal, Coagulation test normal, Dysphagia, Echocardiogram, Ejection fraction, Facial paralysis, Factor II mutation, Gastrostomy, Glycosylated haemoglobin, Hemiparesis, Ischaemic stroke, Low density lipoprotein increased, Mental disorder, Protein C, Protein S normal, Respiratory failure, Tracheostomy, Weaning failure
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Dyslipidaemia (narrow), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Congenital, familial and genetic disorders (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hearing impairment (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No prescription medications Multivitamin Vitamin D3 Vitamin C
Current Illness: none
Preexisting Conditions: Prostate cancer s/p prostatectomy Ankylosing spondylitis (not on immunosuppression) Recurrent UTIs - 4years ago
Allergies: ertapenem, TMP-SMX, clinda: reported nausea and vomiting.
Diagnostic Lab Data: A1C <6.5, LDL 180, TTE (6/11) normal LVEF, no valvular disease,TEE (6/11) without endocarditis or valvular disease. hypercoagulable work up: antiphospholipid <1.6 (WNL), protein C 102 (WNL), homocysteine 8.5 (WNL); prothrombin gene (normal), factor V leiden screen (negative), antithrombin (142^), & protein S (93, normal)
CDC Split Type:

Write-up: Acute Ischemic Multifocal Posterior Circulation strokes resulting in L sided weakness, L facial droop and dysphagia. Hospital course complicated by respiratory failure. Patient had placement of tracheostomy en g-tube given failure to wean off the ventilator and prolonged dysphagia with poor mental status to aid in swallowing


VAERS ID: 1413920 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Feeling hot, Injection site pain, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine pain, swelling, hotness for at least three days and then the symptoms all gone; happens every time
Other Medications: Metformin; Diabetes pills; Vitamin C; Vitamin D; Elderberry
Current Illness: NO
Preexisting Conditions: Diabetes type 2
Allergies: NO
Diagnostic Lab Data: No
CDC Split Type: vsafe

Write-up: So after I get the vaccine, the day after I feel hotness and feverish but when I took temperature it was only 99. I feel tiredness and pain where the vaccine was. The next day was less symptoms, just tired and exhausted. The arm where I got the vaccine was pain and swelling for about a week. I took some Tylenol on the first day and that is about it.


VAERS ID: 1414334 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-05
Onset:2021-06-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 reports feeling nauseated and lightheaded. Patient vs 106/87, 79, blood sugar 120, 97 oxygen. Water provides to patient. She states she feels better. Pt discharge home.


VAERS ID: 1414382 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-22
Onset:2021-06-05
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Dysgeusia, Parosmia
SMQs:, Taste and smell disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole, Lisinopril
Current Illness: denies
Preexisting Conditions: High blood pressure, GERD
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient describes having a metal taste and smell two weeks following her vaccination on 05/22/2021.


VAERS ID: 1414631 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-01
Onset:2021-06-05
   Days after vaccination:65
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 RA / SC

Administered by: Other       Purchased by: ?
Symptoms: Vaccine positive rechallenge, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (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: vimpat 200 mg daily multi vitamins keppra 1000 mg daily
Current Illness: none
Preexisting Conditions: seizures
Allergies: nka
Diagnostic Lab Data: na
CDC Split Type:

Write-up: Patient started to loose weight after the first dose It became more pronounced after the second dose


VAERS ID: 1414980 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033CZA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Herpes simplex
SMQs:, Opportunistic infections (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: Fluocinonide
Current Illness:
Preexisting Conditions: Eczema, seasonal allergies
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Herpes Simplex 1 outbreak on corner of lip and center of upper lip, spread to tip of nose and inside of left and right nostrils. Lasted 7 days.


VAERS ID: 1414989 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Erythema, Lymphadenitis, Lymphadenopathy, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Severely swollen left armpit (lymphadenitis), system wide muscular and joint pain lasting approximately 4-5 days. Red skin on lower legs persisting now in third week past second injection.


VAERS ID: 1414998 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Unknown  
Location: New York  
Vaccinated:2021-06-05
Onset:2021-06-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 AR / IM

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

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

Write-up: Error: Improper Storage (temperature)


VAERS ID: 1415054 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac imaging procedure abnormal, Chest discomfort, Electrocardiogram ST segment elevation, Myocarditis, Pain, Troponin T increased
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Dexmethylphenidate (Focalin XR) 30mg 24hr capsule daily, dexmethylphenidate 10mg (Focalin) every evening, minocycline capsule once daily.
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKDA
Diagnostic Lab Data: Troponin T 1449 on admit, EKG with diffuse ST elevations. Cardiac MR showed inflammation of inferolateral wall consistent with myocarditis.
CDC Split Type:

Write-up: Myocarditis: presenting with body ache, left sided chest discomfort. Moderna vaccine #2 6/4/21.


VAERS ID: 1415094 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-02
Onset:2021-06-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 LA / IM

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

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

Write-up: She got her shot on June 2nd. Started itching on the 5th. Had a rash on her neck. The rash kept increasing so she called the ER on the 9th. The rash made her face swell and she had shortness of breath. She had to call an ambulance and was taken to the hospital. They prescribed her a steroid for 5 days. Gave her an injection of famotidine. Was at the hospital for about 4 hours. She is still having some itching on top of her head.


VAERS ID: 1415193 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-03
Onset:2021-06-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: C-reactive protein increased, Chest pain, Cough, Echocardiogram normal, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Pyrexia, Red blood cell sedimentation rate increased, Respiratory viral panel, SARS-CoV-2 test negative, Troponin increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Obesity (BMI 32)
Allergies: None
Diagnostic Lab Data: -ECG on presentation with ST segment elevation, this normalized by hospital day 3 -Troponin level on admission was 10.6 and peaked to 12.9 (hospital day 2) and decreased to 6.5 on day of discharge (6/8) - echocardiogram normal - CRP 4; ESR 18 - Coxsackie virus B PCR 1:8 (repeat labs pending) - Other respiratory viral panel, other viral studies normal; COVID-19 PCR negative
CDC Split Type:

Write-up: 2 days after vaccine, reported to have fever (unsure what temp). 3 days post vaccine, chest pain worse when lying down and dry cough. On that day, seen in ER with abnormal ECG (ST segment elevation) and elevated troponin level. Transferred and admitted to my hospital. Given ibuprofen for chest pain which improved quickly. Reassuring cardiac findings and improved troponin and ECG and discharged to home on hospital day 3. See below for labs


VAERS ID: 1415520 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-05-18
Onset:2021-06-05
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Crying, Fatigue, Fear, Feeling abnormal, Hallucination, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (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: Generic zoloft, Iron for anemia and digestive enzymes to maintain my autoimmune disorder - Celiac disease
Current Illness: Anemia, celiac disease
Preexisting Conditions: Celiac disease
Allergies: Codine and anything with any form of wheat gluten
Diagnostic Lab Data: None so far. Seeing family doctor for checkup on this Friday
CDC Split Type:

Write-up: I received my 2nd dose around 9 am...I went home and rested on the couch on and off and took it easy most of the day. No weird symptoms just really tired. Later that night I went to bed and in the middle of the night I shot straight of bed and screamed out my husbands name. I was feeling so fearful and the next thing I knew before I could get myself out of bed I started violently throwing up all over my bedroom and into the bathroom. Once in the bathroom I threw up until my stomach was empty. I could hear people crying and I saw real life pigs flying up to the sky. I also kept seeing flashes. When I was able to calm myself down, I took a shower and went back to bed. 2 hours later the exact thing happened. I have never retched so hard or so long in my life. I was praying to God to either take my soul or relieve me of the trauma. While I was cleaning up my mess the second time I was crying uncontrollably and I felt enormous pain and I could once again hear people crying and I was hallucinating or maybe it was real, I have no idea but I could see and feel all of the extreme agonizing pain and souls of those that had been infected. It sounds totally nuts I know but I am telling the truth. My husband was in the room the entire time and my kids were home. They could hear me throwing up all the way from the back of the house. My husband also got the same shot that day. His didn''t react like that.


VAERS ID: 1416015 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: C-reactive protein increased, Chest pain, Dyspnoea, Headache, Myalgia, Pain, Troponin
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), 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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Mirtazapine 30mg oral tablet, 1 Tablet by mouth every evening
Current Illness: NONE
Preexisting Conditions: Asthma-Childhood, has not required treatment for years.
Allergies: NONE
Diagnostic Lab Data: CRP inflammatory 14 on 6/6/21, Troponin level on 6/6/21 was 7.187 , normal range 0.000-0.030
CDC Split Type:

Write-up: 2 days after second dosage the patient began to experience chest pain and shortness of breath at rest and worse with minimal activity-body aches--myalgias--headache


VAERS ID: 1416173 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Adrenocortical insufficiency acute, Condition aggravated, Laboratory test, Nausea, Vomiting, X-ray
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Fludrocortisone, Prednisone
Current Illness: None
Preexisting Conditions: Adrenal insufficiency/Addison''s disease, iron deficiency anemia
Allergies: Citrus, dust, pollen, ragweed
Diagnostic Lab Data: Basic labs, x-rays
CDC Split Type:

Write-up: Nausea, vomiting, abdominal pain consistent with Addisonian crisis


VAERS ID: 1416515 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-05
Onset:2021-06-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Disease recurrence, Dizziness, Dyskinesia, Fatigue, Loss of consciousness, Muscle spasms, Paraesthesia, Seizure, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dyskinesia (narrow), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Asthma; Fibromyalgia (Hx of tremors and fibromyalgia); Tremor (Hx of tremors and fibromyalgia)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021658065

Write-up: Look faint; lose consciousness; Uncontrollable jerking movements and convulsions; lightheadedness; Tingling in her arms and fingertips; Weakness; Muscle spasms; Uncontrollable jerking movements and convulsions; Tired; Shaking; Shaking; This is a spontaneous report from a contactable pharmacist. A 31-years-old non-pregnant female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection), dose 1 intramuscular, administered in the left arm on 05Jun2021 at 15:30 (Batch/Lot Number: EW0180) as 1ST DOSE, SINGLE (at the age of 31-years-old) for COVID-19 immunisation. Medical history included tremors, fibromyalgia, and asthma. The patient had no known drug allergy (NKDA). Reaction to TDAP vaccine (nausea). The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient''s concomitant medications were not reported. It was unknown if the patient was diagnosed with COVID-19 prior to vaccination and if the patient has been tested for COVID-19 since the vaccination. The patient received the first Pfizer dose at 3:20pm. On a consent form, reaction to TDAP vaccine (nausea) and history (hx) of tremors and fibromyalgia were reported. The patient sat for her observation period. After a few minutes, the patient began to look faint. The patient stated lightheadedness, and she was given some water, juice, and some saltine crackers. The patient stated tingling in her arms and fingertips, and weakness-unable to raise the juice box to drink. The patient started to have muscle spasms and uncontrollable jerking movements and convulsions, still coherent, and breathing was not affected. The patient was lowered to the ground, with continued convulsions, worsening spasms, but reported no pain. The patient did not want her albuterol as breathing was okay and was provided 1/4 tablet of Benadryl to no avail. The patient began to state she was tired and began to lose consciousness, closing her eyes. The patient was still shaking when the paramedics came. Treatment for the events included Valium given at the hospital. The events resolved with sequel. The events required Emergency Room Visit and Physician Office Visit.; Sender''s Comments: Based on the close temporal relationship, the association between the events syncope and loss of consciousness with BNT162b2 can not be completely excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.


VAERS ID: 1416516 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 RA / -

Administered by: Public       Purchased by: ?
Symptoms: Body temperature, Pyrexia, SARS-CoV-2 test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: VYVANSE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: ADHD; Asthma
Allergies:
Diagnostic Lab Data: Test Date: 20210605; Test Name: Fever; Result Unstructured Data: Test Result:103 to 104; Test Date: 20210605; Test Name: COVID-19 nasal swab (post-vaccination); Test Result: Negative
CDC Split Type: USPFIZER INC2021658069

Write-up: Ran 103 to 104 fever; This is a spontaneous report from a contactable consumer (patient). An 18-year-old male patient received the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot Number: EW0171; Expiration date was not reported) on the right arm on 04Jun2021 (13:30) as a 2nd dose, single, with route of administration unspecified, for COVID-19 immunization at the public health clinic. Medical history included attention deficit hyperactivity disorder (ADHD) and asthma. Concomitant medication included lisdexamfetamine mesilate (VYVANSE). The patient had previously received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot number: EW0171; Expiration date was not reported) on 14May2021 (13:30) (when the patient was 18 years old) for COVID-19 immunization. On 05Jun2021 (12:00 AM), the patient had run a 103 to 104 fever. The event had resulted into an emergency room/department or urgent care visit. High dose of Motrin and intravenous (IV) fluids were administered to the patient as treatment for the event. The outcome of the event was recovering. The patient was not diagnosed with COVID-19 prior to vaccination; and had been tested for COVID-19 since the vaccination. The patient had a negative COVID-19 nasal swab (post-vaccination) on 05Jun2021.


VAERS ID: 1416526 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-03
Onset:2021-06-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac discomfort, Eructation, Ophthalmic migraine, Panic attack, Photopsia, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ESCITALOPRAM; VITAMIN C [ASCORBIC ACID]; ZICAM [CLONAZEPAM]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Melanoma; Situational anxiety
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021664644

Write-up: heart feeling like a fist when tighten it for a blood draw/heart squeeze; burpy; ocular migraine; seeing the black and white flashy snake thing that makes it hard to focus; seeing the black and white flashy snake thing that makes it hard to focus; almost like a panic attack/Panic; This is a spontaneous report from a contactable consumer (patient) reported that a 41-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number: EW0167), via an unspecified route of administration, administered in arm right on 03Jun2021 18:30 (at the age of 41-years-old) as 1st dose, single for covid-19 immunization. The vaccine was administered at the Pharmacy/drugstore. The patient was not pregnant at the time of vaccination. The patient medical history included situational anxiety and melanoma. Concomitant medications included escitalopram; vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]); and clonazepam (ZICAM [CLONAZEPAM]); all were taken for an unspecified indication, start and stop date were not reported. It was reported that 2 mornings after (05Jun2021), she woke up at 5:45 am (after a really good sleep) with her heart feeling like a fist when tighten it for a blood draw. She also was burpy. She did meditative breathing and sat up. It helped, but kept coming back that day (almost like a panic attack -- but the patient never experienced that feeling). A few hours later she got an ocular migraine (no pain, just seeing the black and white flashy snake thing that makes it hard to focus). The visual went away within 30 minutes or so with no lights/eyes covered and in reclining position. Panic/heart squeeze continued on and off --- but underlying feeling -- all day. The next day, (today) heart is feeling a tad tight but no where like yesterday. Plan on talking to doctor tomorrow. She spoke to a medical friend and didn''t feel it was life threatening, so didn''t seek medical care over the weekend. It was unknown if the patient received any treatment for the events. The outcome of the events was recovered with sequel. Information on lot/batch number was available. Additional information has been requested.


VAERS ID: 1416528 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / OT

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Haematochezia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (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: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021664962

Write-up: Bloody stool; patient was very tired/ he got extremely exhausted; This is a spontaneous report from a contactable consumer (patient''s wife). A 53-year-old male patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection; Batch/Lot number was not reported), intramuscular on the right arm on 04Jun2021 13:00 (at the age of 53-years-old) as 1st dose, single for COVID-19 immunisation. The patient''s medical history was reported as none. The patient''s concomitant medications were not reported. The patient had no prior vaccinations within 4 weeks. The reporter didn''t know the lot number. The reporter called because last night (on 05Jun2021), at 09:00 PM, the patient was very tired and also had a bloody stool. The patient now hadn''t gone to the bathroom again. Since that time, he hadn''t had the bloody stool, but he got extremely exhausted after having the bloody stool. The reporter stated that the patient was a healthy person, so they needed to look out for any possible side effects once he got the vaccine. The reporter then added that''s everything and they were just following up because the instructions that he was given was to reach out to the company if they had side effects and reiterated that the patient had exhausted and blood stool at 9 pm last night. The outcome of the events was unknown. Information about lot/batch number has been requested.


VAERS ID: 1416532 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Fatigue, Heart rate irregular, Myalgia, Pyrexia, SARS-CoV-2 test
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), 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? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data: Test Date: 20210528; Test Name: Nasal swab; Result Unstructured Data: Test Result:Not known; Comments: Nasal Swab; Test Date: 20210605; Test Name: Nasal swab; Result Unstructured Data: Test Result:Not known; Comments: Nasal Swab
CDC Split Type: USPFIZER INC2021665347

Write-up: A little fever, muscle pain, tiredness. (All of the above expected); A little fever, muscle pain, tiredness. (All of the above expected); A little fever, muscle pain, tiredness. (All of the above expected); Chest pain and sudden changes in heart rate (totally unexpected); Chest pain and sudden changes in heart rate (totally unexpected); This is a spontaneous report from a contactable consumer (patient). A 13-years-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), dose 2 via an unspecified route of administration, in Arm Left on 04Jun2021 12:30 (Batch/Lot Number: EW0191) as single dose for covid-19 immunisation. There was no relevant medical history reported. The patient''s concomitant medications were not reported. On 05Jun2021 13:00, patient experienced a little fever, muscle pain, tiredness. (all of the above expected), chest pain and sudden changes in heart rate (totally unexpected). The patient reported that events resulted in visit to a doctor''s office, Emergency or urgent care department/room, Hospitalization, Disability or permanent impairment. Outcome of the events was recovering. Prior to vaccination, the patient was not diagnosed with COVID-19. The patient underwent nasal swab on 28May2021 and on 05Jun2021 pending result. Information on Lot/Batch number was available. Additional information has been requested.


VAERS ID: 1416764 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-05
Onset:2021-06-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / IM

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

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

Write-up: Error: Improper Storage (temperature)


VAERS ID: 1416881 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-26
Onset:2021-06-05
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 AR / IM

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

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

Write-up: swollen and painful lymph nodes since the beginning of June, she''s wondering if this a late reaction to the vaccine


VAERS ID: 1417041 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 RA / IM

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

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

Write-up: Welts and hives all over the body


VAERS ID: 1417091 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-06-04
Onset:2021-06-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Loss of consciousness, Pain in extremity, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall Methadone Gabapentin Fenofibrate Albuterol Nebulizer Descovey Tivicay Xyzal Valtrex Terbenifine Losartan Alive Multi Vitamin Probiotic Energy Supplement Turmeric Melatonin EpiPen
Current Illness: HIV Depression Carp atonal Lung Cancer
Preexisting Conditions: HIV Depression Carp atonal Lung Cancer
Allergies: Tegretol Abacavir Bee Stings
Diagnostic Lab Data: Vitals were checked by the EMT
CDC Split Type: vsafe

Write-up: I Experienced a sore arm on day 1 and I experienced vomiting on day 2 and 3 after the 2nd dose. On day 3 Around 9pm I got extremely hot around 10 pm I went to get something to eat and around 12am I was found outside of the store by the police. An EMT was called they checked my vitals and I declined to go to the hospital because I was feeling fine.


VAERS ID: 1417157 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-05-18
Onset:2021-06-05
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Herpes zoster, Pain in extremity, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ramipril 10mg/once daily Simvastatin 10mg/once daily
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: 18 days after receiving the first dose of the Pfizer COVID vaccine I began having pain in my left hip and thigh. The following day I began developing a painful rash on my left leg from my lower back, hip and thigh all the way to my toes which was diagnosed by two separate doctors as Shingles. I was prescribed 2 courses of Valacyclovir, 3 weeks of Prednisone and Gabapentin for pain. The Shingles infection is currently still ongoing (17 days now).


VAERS ID: 1417366 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-13
Onset:2021-06-05
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fatigue, Hyperventilation, Limb discomfort, Oedema peripheral, Pain in extremity, Peripheral swelling, Tachycardia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (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: Allergic to flower pollen
Diagnostic Lab Data: Have not yet been to a Dr.
CDC Split Type:

Write-up: Hyperventilation , tachychardia, and abnormal fatigue during and after mundane activities. Occassional light headedness. Swelling and edema in lower extremities. Aches/discomfort in both arms at times.


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