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

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



Case Details (Reverse Sorted by Onset Date)

This is page 23 out of 8,010

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VAERS ID: 1772106 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-05
Onset:2021-10-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 3 LA / SYR
FLUA4: INFLUENZA (SEASONAL) (FLUAD QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Flushing, Rash erythematous, Rash pruritic, Skin warm
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamin
Current Illness: None
Preexisting Conditions: Crowns disease (in remission since 2008, no meds since 2015)
Allergies: Sulfa based antibiotics (rash)
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I was 5 weeks 1 day pregnant at the time of vaccination. On Tuesday, I got flu and third covid vax at the same time. Thursday afternoon I started getting an itchy red rash bilaterally on my neck/shoulder. By evening it had spread down my chest to my stomach. It felt itchy/hot. I took half a unison pill, slept 11 hours and woke to see it about 80% improved. I still feel flushed but not as itchy. I don?t know if it is related to vaccination but can?t think of another likely cause.


VAERS ID: 1772143 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zolpidam 5mg, Lisinopril 10mg, Metformin 500mg, Daily Multivitamin, Melatonin 10mg
Current Illness: None
Preexisting Conditions: Insomnia, leg injury.
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: 102.9 degree fever while taking acetaminophen. Severe chills and aches.


VAERS ID: 1772147 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

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

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

Write-up: Severe left arm pain at injection site, as well as my left arm pit.


VAERS ID: 1772154 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Electrocardiogram, Injection site pain, Lethargy
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: Cephalexin, Ceclore
Diagnostic Lab Data: EKG (10/7/2021), chest x-ray (10/7/2021)
CDC Split Type:

Write-up: Lethargy, pain at injection site, acute chest pains


VAERS ID: 1772172 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 LA / IM

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

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

Write-up: EXPIRED/BEYOND USE DATE VACCINE GIVEN


VAERS ID: 1772174 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna


VAERS ID: 1772203 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 1 LA / IM

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

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

Write-up: EXPIRED/BEYOND USE DATE VACCINE GIVEN


VAERS ID: 1772207 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 2 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: No adverse event
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: Unisom OTC
Current Illness: COVID Positive: 09/14/2021
Preexisting Conditions: Diverticulitis
Allergies: NKDA
Diagnostic Lab Data: A F/U has been scheduled
CDC Split Type:

Write-up: No symptoms just instructed to report into VEARS .


VAERS ID: 1772226 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-05
Onset:2021-10-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Joint range of motion decreased, Pain in extremity, Product administered at inappropriate site
SMQs:, Drug abuse and dependence (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: gabapentin, duloxetine, hydroxychloroquine, metoprolol tartrate, multivitamin
Current Illness: none
Preexisting Conditions: hypertension, fibromyalgia, chronic hypertendonitis
Allergies: sulfa
Diagnostic Lab Data: none
CDC Split Type:

Write-up: vaccine was administered too high. pt is experiencing joint and arm pain and limited range of motion


VAERS ID: 1772227 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 LA / IM

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

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

Write-up: expired/beyond use date vaccine given


VAERS ID: 1772236 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 LA / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension and hyperlipidemia
Allergies: ACE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient given vaccine after open vial expiration time


VAERS ID: 1772250 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 1 LA / IM

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

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

Write-up: EXPIRED/BEYOND USE DATE VACCINE GIVEN


VAERS ID: 1772260 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

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

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

Write-up: Patient received dose #3 only a week after dose #2 after telling clinician that they did not receive dose #2 and it was entered into system by mistake. Found administration forms showing they did receive dose #2.


VAERS ID: 1772263 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-10-05
Onset:2021-10-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, 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:
Current Illness:
Preexisting Conditions:
Allergies: Sulfa antibiotics and prednisone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Experienced under both arm pits a rash that is described as a rug burn that is painful. Doesn''t think there is swelling of the lymph nodes?


VAERS ID: 1772267 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 3 LA / IM

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

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

Write-up: EXPIRED VACCINE GIVEN


VAERS ID: 1772271 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 1 LA / IM

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

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

Write-up: Patient came to clinic to state he was needing his second dose of Pfizer which he received "about a month ago". Patient was adamant he received the vaccine at the clinic, but we had no record of it. He also lost his white CDC card so didn''t have that to show. He was asked multiple times if Pfizer was the one he needed, and he said yes every time. After pt received the Pfizer vaccine as a second dose, he was told to check with the pharmacy in the store to see if maybe they gave him his first dose there since we do not share the same registration system. He did and found out his fist COVID dose was actually Moderna and it was given 129 days prior.


VAERS ID: 1772274 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

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

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

Write-up: Client received dose #3 after denying receiving dose #2 a week prior even though dose #2 was in database. Able to find the administration record for dose number #2 so he was confused or dishonest.


VAERS ID: 1772275 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Syncope, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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), Hypersensitivity (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: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Shakiness-Mild


VAERS ID: 1772278 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 1 RA / 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Error: Improper Storage (temperature)-


VAERS ID: 1772279 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 3 LA / IM

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

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

Write-up: EXPIRED VACCINE GIVEN


VAERS ID: 1772284 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, Chest pain, Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: High blood pressure, general weakness and severe chest pains.


VAERS ID: 1772297 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 3 RA / IM

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

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

Write-up: EXPIRED VACCINE GIVEN


VAERS ID: 1772303 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia, Injection site pain
SMQs:, Taste and smell disorders (narrow), Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Site: Pain at Injection Site-Mild, Systemic: metallic taste in mouth happened within 5 minutes of shot-Mild


VAERS ID: 1772315 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-04
Onset:2021-10-07
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 061E / 3 RA / IM

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

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

Write-up: Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium


VAERS ID: 1772319 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, Chest pain, Chills, Headache, Nausea, Peripheral swelling
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

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

Write-up: an hour after the vaccine headache cheat pain nausea swelling in right arm weak chills


VAERS ID: 1772331 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Fatigue, 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: Vitamin C, D, E
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Extremely fatigued, dizziness, and nausea.


VAERS ID: 1772334 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: dermal fillers 6 years ago
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient reports hives, facial, lip and nose edema, and chest pressure. Took allergy med and Tylenol and all resolved today except for some nose edema. Of note she has had dermal fillers in her face and nose 6 years ago,


VAERS ID: 1772356 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna


VAERS ID: 1772362 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 3 LA / IM

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

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

Write-up: EXPIRED VACCINE GIVEN


VAERS ID: 1772369 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna


VAERS ID: 1772374 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Administration error mixed series mRNA vaccine Pfizer and Moderna


VAERS ID: 1772376 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna


VAERS ID: 1772383 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 3 LA / IM

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

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

Write-up: EXPIRED VACCINE GIVEN


VAERS ID: 1772396 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 3 RA / IM

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

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

Write-up: EXPIRED VACCINE GIVEN


VAERS ID: 1772566 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache, Hypoaesthesia, Incorrect dose administered, Incorrect product formulation administered, Pain
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Medication errors (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: depo birth control injection
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Parent was instructed to monitor patient. to give Tylenol if needed and due to being friday evening advised to er with any further complications.
CDC Split Type:

Write-up: Patient was given 6 doses of undiluted pfzier vaccine. Patient given injection 10/07/2021 and mistake was caught 10/8/2021. fatigue, headache, body ache, arm feels numb


VAERS ID: 1772577 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Chills, Erythema, Headache, Peripheral swelling, Product preparation issue
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Medication errors (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: tylenol
Current Illness: none
Preexisting Conditions: none
Allergies: morphine
Diagnostic Lab Data: none. mistake was caught on a friday evening while office was closing. patient advised if symptoms worsened to visit er.
CDC Split Type:

Write-up: patient was possibly given 6 doses of undiluted pfzier. chest pain headache chills arm red and swollen


VAERS ID: 1772587 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1772588 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-05
Onset:2021-10-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Full blood count, Lymphadenopathy, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Valtrex
Current Illness:
Preexisting Conditions:
Allergies: Latex Penicillin Seclor Zithromax
Diagnostic Lab Data: CBC-10/8 results not yet recieved
CDC Split Type:

Write-up: Received vaccine on 10/5. Felt some tenderness on shoulder on 10/6. Morning of 10/7 woke up to a lump the size of a large grape just above the right collar bone. Get another under right arm pit. Confirmed with urgent care it was a reaction from vaccine and something was going on with my lymph nodes. Seen by primary care physicians office and confirmed infection in my lymph nodes. Also informed a reaction from vaccine again but was informed it is known to happen. Discovered another lump in my neck at time of visits. Prescribed antibiotics and doctor ordered CBC testing.


VAERS ID: 1772591 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

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

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

Write-up: Administration error mixed series mRNA vaccine Pfizer and Moderna.


VAERS ID: 1772595 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-01
Onset:2021-10-07
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Diarrhoea, Dizziness, Headache, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (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: 1st Covid shot 21 days ago, flu shot several years ago
Other Medications: Sertraline, Topamax, CoQ10, Melatonin,
Current Illness:
Preexisting Conditions: migraine
Allergies: natural rubber latex, sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: severe Chills/shakes lasting ~ 2 hrs, starting 7 hrs. after shot low grade fever, fluctuating between 99 and 101, beginning 12 hrs. after shot and still continuing headache, beginning 3-4 hours after the shot and continuing diarrhea beginning 12 hours after shot nausea, weakness, dizziness, beginning a few hours after shot and still continuing


VAERS ID: 1772598 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia, Muscle spasms, Nausea, Neck pain, Pain in extremity, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? 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: Left arm pain Left neck pain Left arm numbness and tingling constant Left leg intermittent numbness and tingling Nausea Dizziness Muscle spasm of the left side of the neck -Treatment: cyclobenzaprine nightly, warm compress to the left neck, supplements encouraged, zofran prescribed for nausea.


VAERS ID: 1772601 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 2579B / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol Eliquis Sertraline Bupropion Vit D and B-12 Melatonin Propaphenone prn
Current Illness: None
Preexisting Conditions: Atrial fibrillation
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chills, leg pain, headache , fever progressing up to 102


VAERS ID: 1772616 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-10-05
Onset:2021-10-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 ABS924 / 3 RA / SC

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Flatulence, Rash pruritic, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Levothyroxine Ocella
Current Illness: none
Preexisting Conditions: Hypothyroidism Chronic urticaria
Allergies: none
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe chest pain waking me up from sleep on 10/7/2021 at 3 am. Pain was behind the sternum area/ felt like "gas pain" in esophagus - almost like excessive gas but unable to burp. It did hurt swallowing liquids and solid. resolved spontaneously after 24v hours. Severe generalized itchy rash on 10/8/2021: the rash involved my back, Lips/face, legs and arms. I do have chronic urticaria usually well controlled by antihistamines but this rash was very acute and way more severe - something that I have NEVER encountered before. I went directly to the ED for that and received steroid therapy.


VAERS ID: 1772617 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301258A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Body temperature increased, Pain
SMQs:, Neuroleptic malignant syndrome (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:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Weakness, extreme aches, temp over 102.


VAERS ID: 1772619 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Fatigue, Full blood count, International normalised ratio, Metabolic function test, Prothrombin time, Urinary incontinence, Urine analysis
SMQs:, Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, atorvastatin, cervedilol, clonidine, eliquis, midodrine, mirtazapine, pantoprazole, toujeo, and vit b12.
Current Illness: CVA in September 2021.
Preexisting Conditions: CVA, HTN, IDDM, and GERD
Allergies: NKDA.
Diagnostic Lab Data: PT has CBC, CMP, UA, and PT/INR.
CDC Split Type:

Write-up: After receiving vaccine patient began experiencing urinary incontinence and was altered compared to her baseline per spouse. Pt had c/o fatigue and weakness.


VAERS ID: 1772620 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Urethral spasm
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: Turmeric Curcumin 1500mg once a day
Current Illness:
Preexisting Conditions:
Allergies: Coconut, stevia, tetanus, penicillin, latex.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Urethral spasm lasting 5 minutes.


VAERS ID: 1772763 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Bone pain, Headache, Injection site erythema, Injection site swelling, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Osteonecrosis (broad)

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

Write-up: Client reports redness and swelling to injection site (Left Arm) as well as headache and and body (bone) aches that started a few hours after receiving the vaccine on 8/7/21 and is ongoing today 10/8/21.


VAERS ID: 1772768 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not reported
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Patient received a Vaccine 6/18/21 MODERNA, then came to and received a 2nd dose of PFIZER on 10/07/2021. Patient had no ASE''s.


VAERS ID: 1772783 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-28
Onset:2021-10-07
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscular weakness, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: lisinopril, hydrochlorothiazide, simvastatin, furosemide
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: severe muscle pain and muscle weakness occurred 8 days after vaccinated, improved with tylenol


VAERS ID: 1772980 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Scleral disorder
SMQs:, Scleral disorders (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: none
Current Illness: Covid + 9/15/2021
Preexisting Conditions: ADHD
Allergies: Allergy to molds
Diagnostic Lab Data: none
CDC Split Type:

Write-up: scleral injection of one eye morning after vaccination, following day bilateral injection but slowly improving throughout the day


VAERS ID: 1772982 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-10-01
Onset:2021-10-07
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rosuvastatin 40mg tablets, Lisinopril 10mg tablets, Fenofibrate 145mg tablet, Carvedilol 3.125mg tablet
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given the Pfizer-BioNTech vaccines for his Booster shot but patient wanted the Moderna vaccines to complete his 3 series. At the time of call on 10/07/21, patient does not appear to show any adverse effects.


VAERS ID: 1772986 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-06-06
Onset:2021-10-07
   Days after vaccination:123
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21-2A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Angiogram cerebral abnormal, Arteriogram carotid normal, Ataxia, Back pain, Balance disorder, Blood potassium decreased, Blood urea decreased, Cough, Cranial nerve disorder, Diplopia, Dizziness, Dysarthria, Dysphonia, Dysstasia, Extra dose administered, Eye disorder, Eye movement disorder, Feeling abnormal, Gait disturbance, Gaze palsy, Headache, IIIrd nerve paralysis, Magnetic resonance imaging head normal, Malaise, Memory impairment, Muscle disorder, Musculoskeletal discomfort, Nasopharyngitis, Neurological symptom, Neutrophil count increased, Neutrophil percentage increased, Nystagmus, Ophthalmoplegia, Oropharyngeal discomfort, Paraesthesia, Red blood cell sedimentation rate increased, Retention cyst, Rhinorrhoea, SARS-CoV-2 test negative, Sinus polyp, Speech disorder, Strabismus, Upper respiratory tract infection, VIth nerve paralysis, Vertigo, Vision blurred, Visual field defect
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (narrow), Ocular motility disorders (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Hypokalaemia (narrow), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lo Loestrin OCP
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: Potassium 3.4 BUN 5 ALT 43 Neutrophil % 78 Neutrophil # 8.70 SARS-CoV-2 Not Detected MRI Brain- unremarkable MRA Head- unremarkable intracranial vasculature Multiple mucosal retention cysts/polyps noted in the maxillary sinuses. Ct angio head- no stenosis or occlusion and no sinus thrombosis. Erythrocyte Sedimentation Rate- 26
CDC Split Type:

Write-up: 3rd Moderna dose recorded in system on 6/6/21 (no lot number documented) ER note by Dr: History of Present Illness: The patient is a 19 y.o. female who presents to the ED with Double Vision Yesterday onset with diplopia with lateral vision to each side but normal when looking forward. No previous episodes. Mild headache with some tingling to the neck fingers and both arms. Vision otherwise not impaired. Also with back pain over the past 2 days. No recent neck injury or head injury in the last week. Also with speech issues with difficulty saying certain words. Also with recent cold symptoms with cough, runny nose and muscle. No exposure to covid and had negative COVID test. Positive BCP. No fever documented. Feels she has forgotten how to walk and knees are giving out. BP- 108/87, 99/55, 99/62 SpO2- 97%, 97%, 97%, 97% Constitutional: Appears well-developed in no acute distress. Hair is significantly impaired where she needs assistance from her mother to walk to the examination room. Eyes: Pupils are equal, round, and reactive to light. With extraocular movements she does demonstrate some significant abnormalities with each eye demonstrating some impairment with medial gaze causing strabismus with lateral gaze that is much more severe to both sides. Neurological: The patient is alert, she has no focal sensory or motor deficits to the extremities, she does have cranial nerve deficits as described previously there is no facial droop. She does have a gait disturbance. Given aspirin, but will start on heparin if thrombus noted. ER note by Ernesto Nunez, RN: Reporting double vision since waking up this morning, dizziness since yesterday, and pain to the back of the head that has been going on for about a week. States that she has been feeling ill for a few days but tested negative for COVID. Unsteady gait, requires someone to help balance to help her stay upright. H&P note by Dr: Information obtained from: patient, mother and history review via medical record. Chief Complaint: Double vision. History of Present Illness: Patient is a 19 y.o., White female right-handed student who presents with sudden onset of diplopia, disequilibrium, tingling of extremities, posterior neck and lower back discomfort, and distorted speech. She states that last evening she began with diffuse odd feeling of dizziness and tingling in her hands and throughout her extremities but was otherwise normal. She and her mother felt that this was likely due to vertigo from recent URI. However, upon arising this morning she noticed considerable diplopia and progressive worsening of symptoms. Has also noted difficulty with ambulation, feeling unsteady and mother describes significant stepping, unsure gait. She denies significant headache, chest pain, shortness of breath, nausea, vomiting, fever, chills, dysuria, incontinence or visual field cuts. She has not had previous similar symptoms. She is up-to-date on her childhood vaccines and has received 2 doses of Moderna COVID-19 vaccine completed on 4/24/21. ED evaluation revealed what appeared to be significant bilateral abducens paralysis. Imaging was pursued with MRA of the brain, MRI of the brain and CT angiogram of the head and neck which have revealed no significant pathology. Case was discussed with the on-call neurologist who felt the patient should be admitted for further evaluation and would like an MRI of the brain with contrast for further investigation. She will be admitted with internuclear opthalmoplegia and other neurologic symptoms for further evaluation and treatment. Vaccinations: Pneumovax- Does not meet criteria to receive. Influenza- Will order influenza vaccine. COVID- Yes Moderna 2nd 4/24/21. Family History: Brother, 17 y.o., being evaluated for possible seizure disorder HTN--father No family history of clotting disorder Social History: Occasional ETOH Denies marijuana or other illicit drugs No tobacco Student at WVU Temp- 37.1 ?C (98.7 ?F), HR- 104, BP- 145/86, RR- 20, SpO2- 98% Neurologic: Pt has "full" mouth voice, some mild dysarthria, obvious dysconjugate gaze, difficulty with abduction of eyes bilaterally, few beats nystagmus on extreme lateral gaze, ? Bilateral 3rd CN palsy, MM strength 5/5 thru-out exam, no dysdiadochokinesia, heel to shin normal, no past pointing. No truncal ataxia in seated position. Ataxia with standing, unsteady, steppage gait. No major sensory deficit. Internuclear opthalmoplegia, bilateral --examination of EOM has been somewhat inconsistent and difficult due to significant diplopia and provoked dizziness --patient has other symptoms including ataxia, steppage gait and paresthesias --etiologies would would include multiple sclerosis, ischemic injury, Miller-Fisher syndrome, MG or infectious/inflammatory process --will check MRI of brain with contrast in a.m. with MS protocol --chexk Lyme titer, ANA, dsDNA, CRP, ESR, hypercoagulability studies --may require LP for further investigation and to rule out meningoencephalitis or demyelinating process --consult neurology to direct further investigation and treatment --serial Neuro exam --monitor closely for development of muscle weakness --assess for VAERS reporting if inflammatory etiology discovered Note by RN: ? double vision, eyes crossed and unable to focus, dizziness, talking "different" (nasally sound to voice, and "weird" feeling when swallowing.


VAERS ID: 1772994 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-10-05
Onset:2021-10-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Mucinex and benzonatate
Current Illness: active covid 19
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: strength test
CDC Split Type:

Write-up: right hand and fingers tingling


VAERS ID: 1773160 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-03-10
Onset:2021-10-07
   Days after vaccination:211
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: overweight eczema asthma seizure disorder other depressive disorder
Allergies: ketorolac - unknown reaction
Diagnostic Lab Data: none
CDC Split Type:

Write-up: there was no adverse reaction to any dose of vaccine. This was an administration error of a 3rd Pfizer dose in a patient who was too young (17). Pfizer lot # of 3rd dose = FF2590, given on 10/7/2021 IM in right deltoid. System will not let me enter on next page, but patient also received Flulaval lot #24BM2 intramuscularly in left deltoid on 10/7/2021.


VAERS ID: 1773161 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Diarrhoea, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 200mg, Ropinerole 4mg, Tylenol
Current Illness: None
Preexisting Conditions: Obesity, arthritis, anxiety and depression
Allergies: None
Diagnostic Lab Data: None - I didn?t go to my doctor. I went home and rested.
CDC Split Type:

Write-up: Explosive diarrhea without any warning 24 hours after booster shot. It happened in two seconds and was down my jeans pant leg and on the floor before I could do anything. This is very embarrassing, but nothing like that has happened to me before. I had really bad muscle pain and headache, but took Tylenol and felt better. I went to work and then this happened.


VAERS ID: 1773162 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-10-04
Onset:2021-10-07
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Blood test, Chest discomfort, Computerised tomogram normal, Dyspnoea, Echocardiogram, Hypoaesthesia, Myocarditis, SARS-CoV-2 test negative, Troponin increased, X-ray normal
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad), Sexual dysfunction (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Blood test came back for increased levels of troponin. CT scan, X-rays, heart ultrasound, and covid test all came back negative
CDC Split Type:

Write-up: Acute Myopericarditis - started having a tight chest and numb arm after second vaccine dose. Then had a stabbing sharp pain to my heart and couldn?t breathe. Had to rush to hospital and be put in emergency room for 2 days with medication to treat pain and the myopericarditis


VAERS ID: 1773409 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-10-07
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Cold sweat, Expired product administered, Peripheral coldness, Vaccination site pain
SMQs:, Medication errors (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211014289

Write-up: COLD SWEAT; ADMINISTRATION OF EXPIRED VACCINE; COLD ARM; LOT OF PAIN IN THE ARM WHERE SHE GOT THE VACCINE/ PAIN FROM SHOULDER TO ELBOW; This spontaneous report received from a patient concerned a 43 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A, and expiry: UNKNOWN) dose was not reported, administered on 07-OCT-2021 for prophylactic vaccination. No concomitant medications were reported. On 07-OCT-2021, the patient experienced cold sweat. On 07-OCT-2021, the patient experienced administration of expired vaccine. On 07-OCT-2021, the patient experienced cold arm. On 07-OCT-2021, the patient experienced lot of pain in the arm where she got the vaccine/ pain from shoulder to elbow. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from cold sweat, cold arm, and lot of pain in the arm where she got the vaccine/ pain from shoulder to elbow, and the outcome of administration of expired vaccine was not reported. This report was non-serious.


VAERS ID: 1773415 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: North Dakota  
Vaccinated:0000-00-00
Onset:2021-10-07
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211014668

Write-up: POTENTIALLY EXPIRED VACCINE ADMINISTERED (VIAL WAS OPENED ON 06-OCT-2021 AT 9 AM AND VACCINE ADMINISTERED ON 07-OCT-2021 AT AROUND 12:30 TO 1 PM); This spontaneous report received from a pharmacist concerned a 19 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 211A21A expiry: 14-DEC-2021) dose was not reported, administered on 07-OCT-2021 for prophylactic vaccination. No concomitant medications were reported. On 07-OCT-2021, the patient experienced potentially expired vaccine administered (vial was opened on 06-oct-2021 at 9 am and vaccine administered on 07-oct-2021 at around 12:30 to 1 pm). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of potentially expired vaccine administered (vial was opened on 06-oct-2021 at 9 am and vaccine administered on 07-oct-2021 at around 12:30 to 1 pm) was not reported. This report was non-serious.


VAERS ID: 1773457 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye pain, Eye swelling, Pain, Swelling of eyelid
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Glaucoma (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swelling and pain in right eye occurred within 10 minutes of getting shot. Eye swelled nearly shut overnight and over 24 hours later is still swollen with a burning pain.


VAERS ID: 1774939 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / SYR
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS - / UNK - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Appendicitis, Computerised tomogram abnormal, Laboratory test abnormal
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: Wellbutrin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Labs and CT scan showed appendicitis.
CDC Split Type:

Write-up: Appendicitis occurring day after vaccination.


VAERS ID: 1774942 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: asa, statin, plaivx, flonase, zestoretic, claritin, metformin, toprol xl,
Current Illness: none
Preexisting Conditions: dm, htn, hld, MDS
Allergies: latex
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pruritis, periorbital edema


VAERS ID: 1774954 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Copaxone and Meloxicam
Current Illness: None
Preexisting Conditions: Multiple sclerosis
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Started with a severe headache Thursday evening then added fever, chills, fatigue, and muscle aches all day yesterday. Slight improvement this morning.


VAERS ID: 1774956 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Headache, Hyperhidrosis, Myalgia, Pain in extremity, Peripheral swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Sore arm
Other Medications: Lantus, metformin, glipizide, farxiga, celexa, estimbe/simvastatin, plavix, lisinopril, omeprazole, Allegra, multivitamin, omega 3 fish oil
Current Illness: None
Preexisting Conditions: Type 2 diabetes, obstructive sleep apnea, history of TIA
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sore/swollen arm, chills, joint pain, headache, muscle ache, sweating profusely Treated with Tylenol and alkaselzer plus.


VAERS ID: 1774957 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-28
Onset:2021-10-07
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site pain, Injection site pruritus, Injection site rash, Injection site swelling, Rash
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: On day 7 my injection site became slightly painful. It broke out in a rash and began to swell and was very itchy. The next day the rash spread and the swelling was still there and still itches. Today the swelling is not as bad but the itching is still there. It now appears to be getting better.


VAERS ID: 1775008 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Presyncope
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (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
Preexisting Conditions: None
Allergies: PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Near syncopal episode, dizziness.


VAERS ID: 1775017 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: PFIZER LOT ER8732
Other Medications: Amlodipine, Fenofibrate, Gabapentin, Levothyroxine, Omeprazole, Potassium Chloride, Triamterene Hydrochlorothiazid, Alendronate, vitamin D3 and E
Current Illness: None
Preexisting Conditions: Essential tremors, Hashimotoes
Allergies: Amoxocillan, stating drugs
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe headache and muscle pain for 24 hours


VAERS ID: 1775032 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E214 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Electric shock sensation, Gait disturbance, Headache
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan ? Blood Pressure Rx
Current Illness: None
Preexisting Conditions: High BP ? controlled to Normal by Rx
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Within four (4) hours of injection I experience sensations of mild ?electrical? vibrations, throughout my chest area; plus a head ache. By 11 p.m. I felt unstable on my feel but d/n fall. Throughout the night, in bed, those sensations/discomfort continued. I was told symptoms were within norm. Finally, at 5 p.m. 10/8/21 ? I took two (2) Tylenol Tablets. The symptoms were greatly reduced. Today, 10-9/21 ? I am NOT back to normal but the electrical sensation in heart area is gone. Still, mild head ache and not ?bouncing? down the stairs. I have had almost every vaccination on the market Polio, Measles, Shingles, Flu, Etc. ?- I have NEVER experienced the discomfort of any Vaccination product like with Modern #3! Thankfully ? day three (3) is better! I will see my doctor 10/12 for regularly scheduled appointment.


VAERS ID: 1775033 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, prenatal vitamin
Current Illness: Miscarriage 2 weeks prior
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cold sweats, body ache, nausea


VAERS ID: 1775055 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Injection site erythema, Lymphadenopathy, Myalgia, Tenderness
SMQs:, Rhabdomyolysis/myopathy (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? 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: Injection site erythema and tenderness without purulence, left axillary tender lymphadenopathy, myalgia, fatigue.


VAERS ID: 1775063 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-03
Onset:2021-10-07
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 2 UN / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Ageusia, Anosmia
SMQs:, Taste and smell disorders (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknows
Diagnostic Lab Data:
CDC Split Type:

Write-up: employee lost sense of smell and taste


VAERS ID: 1775101 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Flushing, Hyperhidrosis, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Chills-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Additional Details: Patient was extremely nervous prior to being given shot and was sweating. After being given the Pfizer injection, pt fainted and paramedics were called and showed up to the site in a timely manner. The patient was treated on site and brought to stable status and in the end refused to go with paramedics for any further help or evaluations.


VAERS ID: 1775103 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Similar fever, aches, chills after Pfizer COVID-19 vaccine 3/31/21 (2nd shot). Symptoms lasted longer (36 hours after the vaccin
Other Medications: Fluticasone propionate inhaler, cetirizine, fish oil
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Overnight (12-24 hours) after vaccine: aches, chills, fever (100 degrees), fatigue


VAERS ID: 1775105 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-03
Onset:2021-10-07
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Grip strength decreased, Hypoaesthesia, Injection site erythema, Injection site pain, Injection site swelling, Musculoskeletal stiffness, Pain in extremity, Paraesthesia, Peripheral swelling, Trigger finger
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (narrow), Sexual dysfunction (broad)

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

Write-up: Site: Pain at Injection Site-Severe, Site: Redness at Injection Site-Severe, Site: Swelling at Injection Site-Severe, Systemic: stiff/frozen in position hand-Severe, Systemic: Joint Pain-Severe, Systemic: Numbness (specify: facial area, extremities)-Severe, Systemic: Tingling (specify: facial area, extemities)-Severe, Systemic: Weakness-Severe, Additional Details: pt can not hold/grasp items such as a pen. started with arm pain/swelling - now hand is "locked" in a position where thumb meets pointer and middle finger - went to urgent care who told them they could not help. iI referred to ER/neurologist for consultation.


VAERS ID: 1775106 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inflammation, Pain, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Armour thyroid 30 mg. B vitamin, Calcium Magnesium, D3.
Current Illness: Acute Bronchitis diagnosed 8/25, but recovered fine.
Preexisting Conditions: Asthma, allergies to tree pollen, mold, dust mites.
Allergies: Sulfa drugs. Lactose intolerant.
Diagnostic Lab Data: none. called my doctor.
CDC Split Type:

Write-up: swelling, inflamed, itching, sore. Began a couple hours after shot on 10/7 and persisted and ongoing.


VAERS ID: 1775110 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site swelling, Injection site vesicles
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: Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Additional Details: patient reported blisters formed at injection site


VAERS ID: 1775137 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Itchy arm, arm swelling, and hardness. No symptoms until one week post-injection.


VAERS ID: 1775193 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Head discomfort, Influenza like illness, Injection site pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: The evening I received the shot, I started experiencing pain / soreness around the injection site. The next day I felt very strange, with flu-like symptoms all day (fever, stuffy head, body aches)


VAERS ID: 1775198 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Fatigue, Headache, Impaired work ability, Lymphadenopathy, Malaise, Myalgia, Pain of skin, Sensitive skin
SMQs:, Rhabdomyolysis/myopathy (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 1/28/21, 47 years, same symptoms as current vaccine reaction
Other Medications: zyrtec, slynd
Current Illness:
Preexisting Conditions: overweight
Allergies: Fish/shellfish (anaphylaxis), tropical fruit, tree nuts
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Muscle pain (back. arms. legs), skin pain/sensitivity, headache, fatigue, malaise, swollen lymph nodes (all moderate to severe, unable to work)


VAERS ID: 1775209 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-24
Onset:2021-10-07
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Decreased appetite, Fatigue, Headache, Nausea, Vaccination site erythema, Vaccination site induration, Vaccination site pruritus, Vaccination site rash, Vaccination site warmth
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: Cymbalta, zyrtec, Adderal, atenolol, hydralazine, mucinex dm, Vitamin D,
Current Illness: None
Preexisting Conditions: Hypertension, ADD, anxiety, allergies, horseshoe kidney with obstruction
Allergies: CT contrast
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: Large, round, red, itchy, warm-to-touch rash at vaccine site with hard skin underneath with onset 13th day after vaccine. Increased fatigue and headaches a few days prior to onset and severe fatigue, nausea, headache and loss of appetite on day 15 after vaccine.


VAERS ID: 1775215 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW 0191 / UNK - / -

Administered by: Work       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Electrocardiogram, Palpitations, Troponin
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Omeprazole
Current Illness: None
Preexisting Conditions: GERD
Allergies: No known Allergies
Diagnostic Lab Data: troponin 10/8/2021 EKG --10/8/2021 CXR --10/8/2021
CDC Split Type:

Write-up: chest pain, palpitation started 1 day after vaccination


VAERS ID: 1775227 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-29
Onset:2021-10-07
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Feeling hot, Injection site rash, Pruritus, Rash, Rash erythematous
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: rosuvastatin
Current Illness: none
Preexisting Conditions: high cholesterol
Allergies: none
Diagnostic Lab Data: I went to the emergency room on October 10th and doctor told me to watch it and if the rash gets worse to see the PCP. no tests were done
CDC Split Type:

Write-up: I woke up with a severe rash on the left arm from the top of the deltoid down through the triceps area all the way to the elbow. Rash was red and bumpy, itchy, and warm to the touch. treated with OTC oral Benadryl and hydrocortisone ointment.


VAERS ID: 1775293 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

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

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

Write-up: called today with itching all over her body starting early afternoon the day after the covid shot as of saturday afternoon was still having itching, has been taking zyrtec or claritin and has had improvement in symptoms


VAERS ID: 1775305 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Electrocardiogram, Palpitations
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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: None
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Vital signs EKG
CDC Split Type:

Write-up: Patient received her covid vaccine and 10 minutes following the vaccine she stated she was feeling light headed. She was already sitting down so the nurse took a set of vital signs at 6:14pm: oxygen saturation 98%, heart rate 104, respiration?s 18. She attempted to get a BLood Pressure on the patient?s forearm due to patient?s upper arm being too large to fit the Blood pressure cuff. The patient stated her heard was racing like it did when her asthma starts t act up. Nurse called the paramedics at 6:18pm. The paramedics arrived at 6:22pm and took vital signs and placed an EKG pads on the patient to monitor her heart. The patient continued to feel light headed. She stated that she has not had much water in the past days and often forgets to eat. She had a sandwich with morning and a muffin at 4:00pm. The paramedic did not feel like the patient needed to be taken to the ER unless the patient wanted to go. Shy patient attempted to stand up with the help of 2 paramedics and she started to sway. The patient decided to go the the ER vis ambulance. Her husband mark was waiting in his car and was altered to the news that patient would be going to the ER.


VAERS ID: 1775323 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Blood pressure increased, Chest pain, Injection site bruising, Injection site haemorrhage, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), 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: Daily multi vitamin
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Bruising at the injection site for 3+ days, heavy bleeding from injection site, fever, deep chest pain, elevated blood pressure (180/90).


VAERS ID: 1775389 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-29
Onset:2021-10-07
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deep vein thrombosis, Ultrasound scan
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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: ultrasound
CDC Split Type:

Write-up: on 10/7/21, pt developed developed spontaneous DVT left leg. no PE. no other obvious cause.


VAERS ID: 1775394 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Palpitations, Tinnitus
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hearing impairment (narrow)

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

Write-up: Immediate and ongoing ringing in ears, very bad headache, heart palpitations.


VAERS ID: 1775419 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-01
Onset:2021-10-07
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstruation delayed
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

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

Write-up: Extremely heavy period . Late period.


VAERS ID: 1775441 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 1 LA / SYR

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

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

Write-up: -Sharp pain in my head when sneezing or coughing, still today 10/10/2021 -Oxygen levels dropped to 92% 2 days after shot.


VAERS ID: 1775466 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-10-05
Onset:2021-10-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal pain upper, Back pain, Headache, Musculoskeletal chest pain, Myalgia, Nausea, Oesophageal pain, Somnolence
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Naproxen sodium, tums, daily multivitamins, elderberry supplements
Current Illness:
Preexisting Conditions: Asthma
Allergies: Latex
Diagnostic Lab Data: Currently trying to find somewhere to go aside from the ER
CDC Split Type:

Write-up: Horrible shooting/stabbing pains at the base of my esophagus/rib cage. Constant stOmach cramps and nausea. Almost like heartburn or acid reflux but not quite. Back pain from the middle of my back and up. Drowsiness, headaches. Sore muscles. All of this started either in the day after or two days after, it''s hard to remember.


VAERS ID: 1775515 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-18
Onset:2021-10-07
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1775519 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-03
Onset:2021-10-07
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asymptomatic COVID-19, COVID-19, Cardiac failure congestive, Cardiomegaly, Chest X-ray abnormal, Condition aggravated, Lung opacity, Oedema, Pulmonary congestion, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Interstitial lung disease (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin, APAP, fluticasone, gabapentin, lidocaine cream, lisinopril, mobic, oxycodone, tizanidine, torsemide
Current Illness: no
Preexisting Conditions: Chronic Diastolic Heart Failure, HTN, HLD, Lymphedema, Morbid Obesity, chronic pain
Allergies: nka
Diagnostic Lab Data: CXR: Cardiomegaly with increased pulmonary vascular congestion and perihilar ground-glass opacity consistent with edema in the setting of congestive heart failure. PCR + 10/7/2021
CDC Split Type:

Write-up: breakthrough covid, asymptomatic, hospitalized for acute exacerbation of CHF


VAERS ID: 1775526 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / IM

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

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

Write-up: Covid arm: swelling and redness at site of injection spread approximately 3 1/2 inches down my left arm, felt sore and hot to the touch.


VAERS ID: 1775564 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-24
Onset:2021-10-07
   Days after vaccination:136
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1775581 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-20
Onset:2021-10-07
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1775583 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 3U358A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: zoloft, prilosec, lipitor, vitamin d, claritin, furosimide
Current Illness:
Preexisting Conditions: Chronic Bronchitis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever 102.5, for 1 day...then 99.8 for 1 day...very achy joints and tired. I took Ibuprofen. Was better after a couple of days


VAERS ID: 1775590 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-24
Onset:2021-10-07
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1775593 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 RA / IM

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

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

Write-up: Systemic: Allergic: Itch (specify: facial area, extremeties)-Medium, Systemic: Allergic: Itch Generalized-Medium, Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Systemic: Allergic: Rash Generalized-Medium


VAERS ID: 1775671 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose increased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (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: Vitamin D3, Haloperidol, Mirtazapine, Pramipexole, Cosentyx
Current Illness:
Preexisting Conditions: Ankylosing Spondylitis
Allergies: Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Spike in blood sugar and im nondiabetic. Blood sugar of 219.


VAERS ID: 1775683 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-13
Onset:2021-10-07
   Days after vaccination:236
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1775688 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-19
Onset:2021-10-07
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


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