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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 230 out of 8,010

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VAERS ID: 1708375 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-06
Onset:2021-09-09
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: PATIENT HAD PFIZER VACCINE Dose 1 date: 01/06/2021, Dose 2 date: 01/27/2021, AND TESTED POSITIVE TO COVID.


VAERS ID: 1708419 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-02-18
Onset:2021-09-09
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: Diagnosed with COVID-19 on 9/9/21.


VAERS ID: 1708477 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Ear pain, Eye pain, Headache
SMQs:, Glaucoma (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: LEXIPRO; BUSPAR; BARIATRIC ADVANTAGE; ZERTEC; FLONASE; FLOVENT
Current Illness: None
Preexisting Conditions: BID; Asthma; Allergies
Allergies: Bananas; pineapple; coconut; pecans; walnuts; egg plant; kiwi
Diagnostic Lab Data: BLOOD WORK; CT SCAN WITH/WITHOUT CONTRAST
CDC Split Type: vsafe

Write-up: SEVERE HEADACHE ON LEFT SIDE OF HEAD STARTED ABOVE LEFT EYE MOVED TO LEFT EAR.


VAERS ID: 1708549 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-03-30
Onset:2021-09-09
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertension, chronic lung disease, high cholesterol
Allergies:
Diagnostic Lab Data: SARS-CoV-2 Antigen specimen collection on 9/9/21
CDC Split Type:

Write-up: hospitalized


VAERS ID: 1708570 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-05-02
Onset:2021-09-09
   Days after vaccination:130
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Decreased appetite, Dyspnoea, Hypokalaemia, Hypotension, Limb discomfort, Malaise, Pain, Pyrexia, SARS-CoV-2 test positive, Tachycardia, Tenderness
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: 9/10/21 PATIENT SEEN IN THE ER REPORTS FEELING SICK X 2 DAYS.SHORTNESS OF BREATH, COUGH, BODY ACHES, REPORTS TESTED POSTIVIE FOR COVID ON HOME TEST 9/9/21. ALSO REPORTS FEVER, CHILLS, ANOREXIA. NOTED TO BE TACHYCARDIC WITH HR 120s. HYPOTENSION 80/60. MILD LEFT CALF TENDERNESS PRESENT WITHOUT SWELLING OR REDNESS. HYPOKALEMIA NOTED. O2 SAT. 99-100%. 9/12/21 DISCHARGED FROM HOSPITAL TO HOME.


VAERS ID: 1708593 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-03
Onset:2021-09-09
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058EZ1A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac flutter, Chest discomfort, Palpitations, Specialist consultation
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine 5mg
Current Illness:
Preexisting Conditions: Hypertension
Allergies: Penicillin
Diagnostic Lab Data: Went to cardiologist on 9/13/2022. Awaiting results of test.
CDC Split Type:

Write-up: Began having palpitations and heart flutters with chest discomfort about a week after vaccine. Comes and goes and has a been up until now.


VAERS ID: 1708612 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-03
Onset:2021-09-09
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cardiac failure congestive, Hypoxia, Oxygen saturation decreased, Pneumonia, SARS-CoV-2 test positive
SMQs:, Cardiac failure (narrow), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: COPD, CORONARY HEART DISEASE
Allergies: NO KNOWN MEDICAITON ALLERGIES
Diagnostic Lab Data: 9/9/21 COVID-19 PCR = DETECTED.
CDC Split Type:

Write-up: 9/9/21 SEEN IN THE ER WITH LOW OXYGEN 88%. SENT FROM PRIMARY CARE MD FOR HYPOXIA ON AMBULATION. ADMITTED TO HOSPITAL DUE TO PNUEMONIA SECONDARY TO COVID. ACUTE CHF.


VAERS ID: 1708636 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-08
Onset:2021-09-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2187 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dysgeusia, Laboratory test, Oral discomfort, Pain, Pyrexia, Taste disorder
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Metamucil Tylenol
Current Illness: Tested positive for COVID 8/20/2021
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Lab drawn
CDC Split Type:

Write-up: Body aches, fever, chills, bad taste in mouth that burns and has a metal taste in mouth


VAERS ID: 1708714 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C212A / 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: Dicyclomine, Fish oil, Juice plus fibre, lisinopril, magnesium, multivitamin, tirosint, vitamin b12, vitamin C
Current Illness: none
Preexisting Conditions: celiac disease, Hemochromotosis, IBS, Thyroidectomy, Post ablative hypothyroidism, GERD, HTN, Fatty Liver
Allergies: sulfacetamide sodium, Gluten
Diagnostic Lab Data: none
CDC Split Type:

Write-up: This Patient came into the office to get the 2nd dose of the covid 19 moderna Vaccine. He came in on 9/9/2021 at 9am. At the time we had a PA student in a rotation and she administered the vaccine to the patient at 9:05am. Later in the day it was noticed that the vial that she used was the same vial that was used the day previous on 9/8/2021. The vial had been punctured for more then 12 hours when administered to the Patient. We informed the patient of this event


VAERS ID: 1708735 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-08
Onset:2021-09-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Movement disorder
SMQs:, Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (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: portigo, diabetic, stroke history, heart history
Allergies: benadryl
Diagnostic Lab Data:
CDC Split Type:

Write-up: chills, couldnt move muscles, couldnt get out of chair


VAERS ID: 1708762 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-04-06
Onset:2021-09-09
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diagnosed and hospitalized for COVID while fully vaccinated


VAERS ID: 1708809 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / 3 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Body temperature increased, Chills, Condition aggravated, Dysphagia, Hemiparesis, Lethargy, Muscular weakness, Pain, Seizure
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: other seizures
Preexisting Conditions: Normal pressure hydrocephalus; polyneuropathy; Acute respiratory failure with hypoxia; Rheumatoid Arthritis; liver transplant status; Nontraumatic subaracnoid hemorrhage, post traumatic seizures; Obstructive sleep apnea; hypothyroidism; hpyerlidipdemia; Acute kidney failure; Vitamin deficieny, dementia, cerebral ischemia
Allergies: ceftriaxone; pentazocine-naloxone; Stadol; Talwin
Diagnostic Lab Data: Resident was sent to the ER for evaluation.
CDC Split Type:

Write-up: At approximately 5:45 pm, staff found patient in an active seizure. His vitals were BP 163/73, SP02 98% Temp 96.9 and RR 16. Patient was given keppra as ordered and noted to have L sided weakness to arms and legs which resolved. Later that evening Patient then had an elevated temperature and was given 1 dose of Apap. The patient continued to have elevated temperature with shivering, increasing pain, lethargy and inability to swallow. His temperature was 102.8.


VAERS ID: 1708835 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Sexual dysfunction (broad)

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

Write-up: Patient states that shes noticed some numbness and less dexterity in 2 fingers on the arm that got the vaccine.


VAERS ID: 1708866 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Back pain, Chills, Cold sweat, Disturbance in attention, Dizziness, Ear pain, Eye pain, Eye swelling, Headache, Hyperhidrosis, Immediate post-injection reaction, Inflammation, Irritability, Lymphadenopathy, Musculoskeletal stiffness, Neck pain, Pain, Paranasal sinus discomfort, Pyrexia, Respiratory tract congestion, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Glaucoma (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: armour thyroid 90 mg, hair skin & nails supplement, vit D
Current Illness: n/a
Preexisting Conditions: Hypothyroidism Hyperparathyroidism Schwannoma of cranial nerve - 3rd Trigeminal Nerve Uveitis - both eyes Primary Lymphedema Praecox Undifferentiated Connective Tissue Disorder PCOS Liver ? hepatic adenomas Lipo-Lymphedema
Allergies: Penicillin, Tdap, aspirin, erythromycin, keflex, clindamycin, neomycin theophylline, advil, ibuprofen, provera, microgestin, percocet, most anti-inflammatory medications, most synthetic and natural progesterones, pravachol (cholesterol), Metformin (pcos), bug bites [especially: ants, bees & spiders]
Diagnostic Lab Data: I have called my doctor''s office & local pharmacy - was told to take decongestant & tylenol.
CDC Split Type:

Write-up: Immediately: injection given in left arm - rt side - headache & swollen glands. stiff neck. stiff shoulder. pain in head, neck & back. fever, chills, clammy. dizzy within 1 day: chills, fever, perfuse sweating. swollen glands & VERY painful under arms, elbows, knees & hips. facial swelling. PAIN IN EYES, EARS & HEAD. Pain in back, hips. Sinus pressure & severe congestion (maybe inflammation). Unable to clear congestion. Broken blood vessels in arms, chest and across rib cage. at 1 week: pain in joints & glands. eyes swollen. headache, irritability, unable to concentrate. pain. inflammation.


VAERS ID: 1708895 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 202A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Muscle contractions involuntary, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Qvar 40mcg Amoxicillin 875 mg albuterol MDI
Current Illness: on amoxicillin for otitis media on the right ear (day 6 on meds when shot given)
Preexisting Conditions: Asthma- mostly exercise induced
Allergies: NKDA
Diagnostic Lab Data: none, seen in office normal exam
CDC Split Type:

Write-up: 3 hours after vaccine patient started feeling muscle fasciculations in the legs, with occasional pins and needles and weakness


VAERS ID: 1708923 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 RA / IM

Administered by: School       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: None on file
Current Illness: None on file
Preexisting Conditions: None on file
Allergies: None on file
Diagnostic Lab Data: None at this time.
CDC Split Type:

Write-up: Moderna was received from deep freezer on 8/6/21. Was placed in refrigerator on 8/6/21. 30 day expiration date was 9/5/21. Moderna was left in refrigerator and used until 9/13/21. On 9/14/21 we realized we were beyond the 30 days and immediately notified the Pharmacy for direction. The Pharmacists are in communication with Moderna to see if the doses are considered valid or invalid. Risk Management is involved to decide on the best course of action and if we notify the patient before we hear back from Moderna.


VAERS ID: 1708943 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-03
Onset:2021-09-09
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002M20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 2 - / IM

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

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

Write-up: Tested positive for COVID 19


VAERS ID: 1708960 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 RA / IM

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

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

Write-up: Moderna was received from deep freezer on 8/6/21. Was placed in refrigerator on 8/6/21. 30 day expiration date was 9/5/21. Moderna was left in refrigerator and used until 9/13/21. On 9/14/21 we realized we were beyond the 30 days and immediately notified the Pharmacy for direction. The Pharmacists are in communication with Moderna to see if the doses are considered valid or invalid. Risk Management is involved to decide on the best course of action and if we notify the patient before we hear back from Moderna.


VAERS ID: 1708967 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-04
Onset:2021-09-09
   Days after vaccination:97
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arteriosclerosis, Asthenia, C-reactive protein increased, COVID-19, Cerebellar infarction, Computerised tomogram head abnormal, Condition aggravated, Cough, Dysarthria, Echocardiogram normal, Embolic stroke, Endotracheal intubation, Facial paralysis, Fibrin D dimer, Hemiplegia, Hypercoagulation, Intensive care, Ischaemic stroke, Lacunar infarction, Lymphocyte count decreased, Malaise, NIH stroke scale, Oropharyngeal pain, Pneumonia aspiration, Procalcitonin, Rhinorrhoea, SARS-CoV-2 test positive, Serum ferritin, Somnolence, Spinal nerve stimulator implantation, Transient ischaemic attack
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic leukopenia (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hearing impairment (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Outpatient Medications amLODIPine (NORVASC) 5 MG tablet aspirin 325 MG tablet atorvastatin (LIPITOR) 20 MG tablet Calcium-Vitamin D 600-200 MG-UNIT TABS cloZAPine (CLOZARIL) 100 MG tablet cloZAPine (CLOZARIL) 25 MG tablet cloZAPine (CLOZARI
Current Illness: 8.26.21: aspiration pneumonia LLL 9.7.21: COVID symptoms reported 9.9.21: ED to hospital admission; weakness / COVID-19 positive
Preexisting Conditions: Hospital Essential hypertension, benign Chronic obstructive pulmonary disease (HCC) COVID-19 Acute ischemic stroke (HCC) CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min Dysphagia Non-Hospital Avoidant personality disorder (HCC) Schizoaffective disorder (HCC) Dyslipidemia Arthritis Chronic pain disorder Hip pain Low back pain Lumbar spondylosis Pain in limb Urinary tract infection associated with indwelling urethral catheter (HCC) Aspiration pneumonia of left lower lobe, unspecified aspiration pneumonia type (HCC) Weakness Pressure injury of right ankle, stage 2 (HCC) Pressure injury of sacral region, stage 2 (HCC)
Allergies: Peanut [Peanut Oil]Anaphylaxis PenicillinsThroat swelling Antihistamines CodeineRash Cymbalta [Duloxetine]Confusion DiphenhydramineOther Ibuprofen Micronized NsaidsOther Nsaids Sulfa DrugsRash TramadolConfusion
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization (9.10.21); COVID-19 positive (9.9.21); fully vaccinated Chief Complaint/Reason for Admission: Acute ischemic stroke, s/p tPA ASSESSMENT & PLAN: NEURO: Acute ischemic stroke s/p TPA, suspect embolic/atherosclerosis vs hypercoagulable state in the setting of Covid + ; TIA HPI: Patient is a 68 year old with a PMH significant for Schizoaffective disorder, HTN, COPD, Chronic pain, and Covid + that presents today from Big Rapids with concern for acute ischemic stroke. To review, he was recently admitted with aspiration PNA 8/26/2021 and was discharged back to his AFC home and unfortunately requires more assistance then they can provide (requiring 2-3 person assist). He present to Big Rapids ER 9/9 and was admitted for evaluation by PT/OT for recommendations for rehab/placement. He had complaints of cough, nasal drainage, and sore throat. Covid testing was negative 9/8 and repeated on admission which was positive, however, he remains stable on room air with plans for monoclonal antibody treatment. Last evening he was LKW at 2230, upon reevaluation he had acute onset right facial droop, RUE/RLE plegia, and dysarthria at 0044. A stroke code was initiated, 24, BP 142/67. A head CT was negative for acute hemorrhage yet revealed a new acute/subacute lacunar infarct at the left thalamus and small left cerebellar infarct, since 11/7/2020), CTA was significantly degraded by motion vessels visualized were negative for LVO, CTP with no hypoperfusion or core. Accordingly, TPA was administered at 0217 and the patient was transferred to SHBW NICU for further evaluation. Upon arrival to the NICU he was drowsy and dysarthric, followed simple commands. His strength appears generalized, minimally worse on right. Will complete a stroke workup and follow his Covid for potential respiratory compromise. ROS was difficult secondary to dysarthria, he denied chest pain, abdominal pain. Unable to obtain complaints due to dysarthria. Note from 9.16.21: ASSESSMENT / PLAN * Acute ischemic stroke (HCC) Assessment & Plan Stable CT head in Big Rapids showed acute/subacute lacunar infarct at the left thalamus and a small left cerebellar infarction. tPA given with no complications with some improvement of symptoms. Unable to perform MRI brain due to implanted low back stmuilator. Repeat CTHs have been stable with no evidence of bleed or new infarcts. ECHO normal. -continue statin -PT/OT/SLP consulted; recommend SAR and dysphagia diet -normal BP goal -discharge planned to subacute rehab COVID-19 Assessment & Plan Improving. Current oxygen requirement: SpO2: 92 % O2 Flow Rate (l/min): 2 l/min, Lymphocyte count: 0.75, CRP: 28.5, D-dimer: No results found for requested labs within last 720 hours., Ferritin: No results found for requested labs within last 720 hours., Procalcitonin: 0.07 -Dexamethasone 6 mg day 6 -VTE prophylaxis with enoxaparin -Escalating oxygen support up to and including intubation


VAERS ID: 1708981 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 RA / IM

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

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

Write-up: Moderna was received from deep freezer on 8/6/21. Was placed in Student Health refrigerator on 8/6/21. 30 day expiration date was 9/5/21. Moderna was left in Student Health refrigerator and used until 9/13/21. On 9/14/21 we realized we were beyond the 30 days and immediately notified the Pharmacy for direction. The Pharmacists are in communication with Moderna to see if the doses are considered valid or invalid. Risk Management is involved to decide on the best course of action and if we notify the patient before we hear back from Moderna.


VAERS ID: 1709000 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 RA / IM

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

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

Write-up: Moderna was received from deep freezer on 8/6/21. Was placed in Student Health refrigerator on 8/6/21. 30 day expiration date was 9/5/21. Moderna was left in Student Health refrigerator and used until 9/13/21. On 9/14/21 we realized we were beyond the 30 days and immediately notified the Pharmacy for direction. The Pharmacists are in communication with Moderna to see if the doses are considered valid or invalid. Risk Management is involved to decide on the best course of action and if we notify the patient before we hear back from Moderna.


VAERS ID: 1709016 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-06
Onset:2021-09-09
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chills, Condition aggravated, Cough, Decreased appetite, Diarrhoea, Dyspnoea, Hypoxia, Lung infiltration, Oropharyngeal pain, Pain, Pyrexia, SARS-CoV-2 test positive, Tachypnoea
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Outpatient Medications acetaminophen (TYLENOL) 500 MG tablet acyclovir (ZOVIRAX) 200 MG capsule amlodipine (NORVASC) 2.5 MG tablet ascorbic acid (VITAMIN C) 500 MG tablet aspirin 81 MG tablet Biotin (BIOTIN MAXIMUM STRENGTH) 10 MG TABS Calc
Current Illness: 9.9.21: called office to report symptoms (Patient is calling office to report that she is having a cough, runny nose, and fatigue x 1 week that is not going away. ) COVID-19 positive 9.9.21
Preexisting Conditions: Hospital Pneumonia due to COVID-19 virus Non-Hospital Elevated cholesterol GERD (gastroesophageal reflux disease) Gout Post-menopausal Diverticulosis Depression with anxiety Colon polyp DM gastroparesis DM (diabetes mellitus) HTN (hypertension) Normocytic normochromic anemia Enterocele Osteopenia Resting tremor Recurrent cellulitis of left lower leg Vaginal vault prolapse after hysterectomy Vaginal atrophy Herpes simplex infection of skin History of MRSA infection - right groin area - 9/2018
Allergies: BandaidsRash Sulfa Drugs Tramadol Vicodin [Hydrocodone-acetaminophen]Other
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (9.12.21); COVID-19 positive (9.9.21); fully vaccinated History of Present Illness Patient is a 79 y.o. female with a PMHx of DM2, HTN, who presents to hospital with shortness of breath. The patient states that about a week ago she started having some sore throat and fevers and chills. Patient reports some body aches. About 3-4 days after that she started having some cough and shortness of breath. Patient went to get tested for COVID and her test was positive. It took about 3 days for her test results to come back, and by the time she got her test results she was having significant shortness of breath, continued fevers, and severe cough. Patient denies any sick contacts, does not know where she contracted COVID from. Patient denies any vomiting, but has had some diarrhea. Her appetite has been poor. Patient states she has had fever every single day at home. Patient states that given her positive test and her worsening trouble breathing, she came to the ER for evaluation. Patient is fully vaccinated. In the ER the patient was found to be tachypneic, weak, and hypoxic. Chest x-ray was performed and showed bilateral diffuse infiltrate of disease consistent with COVID-19 pneumonia. Patient was placed on high-flow nasal cannula with improvement in her overall work of breathing. Given her significant hypoxic respiratory failure the patient was admitted the hospital for further treatment. Assessment and Plan Acute hypoxic respiratory failure secondary to COVID-19 pneumonia -on HFNC 50% FiO2 -Symptom started on 9/5, day 7 of illness -Hypoxic -received decadron day 1/10 in the ER -remdesivir day 1/5 -would meet criteria for Tociluzumab, but not available -No MAB therapy -patient did receive Moderna x2 back in March/April -VItamin D 10,000 units now - vitamin C 1.5g TID -zinc -wean O2 as able Notes from 9.17.21: Chief complaint Pneumonia due to COVID-19 virus Subjective 08:30 a.m. Patient seen and examined. Patient states she is feeling a lot better today on the nasal canula. Says her shortness of breath seems to be greatly improving.


VAERS ID: 1709019 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 LA / IM

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

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

Write-up: Moderna was received from deep freezer on 8/6/21. Was placed in refrigerator on 8/6/21. 30 day expiration date was 9/5/21. Moderna was left in refrigerator and used until 9/13/21. On 9/14/21 we realized we were beyond the 30 days and immediately notified the Pharmacy for direction. The Pharmacists are in communication with Moderna to see if the doses are considered valid or invalid. Risk Management is involved to decide on the best course of action and if we notify the patient before we hear back from Moderna.


VAERS ID: 1709047 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 LA / IM

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

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

Write-up: Moderna was received from deep freezer on 8/6/21. Was placed in refrigerator on 8/6/21. 30 day expiration date was 9/5/21. Moderna was left in refrigerator and used until 9/13/21. On 9/14/21 we realized we were beyond the 30 days and immediately notified the facility for direction. The facility pharmacists are in communication with Moderna to see if the doses are considered valid or invalid. One department is involved to decide on the best course of action and if we notify the patient before we hear back from Moderna.


VAERS ID: 1709055 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 LA / IM

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

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

Write-up: Moderna was received from deep freezer on 8/6/21. Was placed in refrigerator on 8/6/21. 30 day expiration date was 9/5/21. Moderna was left in refrigerator and used until 9/13/21. On 9/14/21 we realized we were beyond the 30 days and immediately notified the Pharmacy for direction. The Pharmacists are in communication with Moderna to see if the doses are considered valid or invalid. Risk Management is involved to decide on the best course of action and if we notify the patient before we hear back from Moderna.


VAERS ID: 1709058 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 2 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Amenorrhoea, Menstrual disorder
SMQs:, Fertility disorders (broad)

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

Write-up: Prior to vaccine menstrual cycle day three. Post vaccine menstrual cycle came to an abrupt end and did not continue. Menstrual cycle was incomplete at only three days instead of routine six. After the vaccine menstrual cycle ended and did not pick back up.


VAERS ID: 1709063 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 LA / IM

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

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

Write-up: Moderna was received from deep freezer on 8/6/21. Was placed in Student Health refrigerator on 8/6/21. 30 day expiration date was 9/5/21. Moderna was left in Student Health refrigerator and used until 9/13/21. On 9/14/21 we realized we were beyond the 30 days and immediately notified the Pharmacy for direction. The Pharmacists are in communication with Moderna to see if the doses are considered valid or invalid. Risk Management is involved to decide on the best course of action and if we notify the patient before we hear back from Moderna.


VAERS ID: 1709068 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 LA / IM

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

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

Write-up: Moderna was received from deep freezer on 8/6/21. Was placed in refrigerator on 8/6/21. 30 day expiration date was 9/5/21. Moderna was left in refrigerator and used until 9/13/21. On 9/14/21 we realized we were beyond the 30 days and immediately notified the Pharmacy for direction. The Pharmacists are in communication with Moderna to see if the doses are considered valid or invalid. Risk Management is involved to decide on the best course of action and if we notify the patient before we hear back from Moderna.


VAERS ID: 1709144 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Injection site pain, Injection site pruritus, Injection site swelling, Nausea, Vision blurred
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MEDICAL MARIJUANA
Current Illness: NO ILLNESSES
Preexisting Conditions: NONE
Allergies: LATEX POWDER, MANGOES
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Started on 9/9/21 at around 6pm shortness of breath began. Lasted around 2 day until 9/11/21. Dizziness and nausea began 9/15/21 and continue until present time 9/17/21. Patient is experiencing hard to focus vision. Patient is also experiencing severe swelling, tenderness, and itchiness in injection site that began 9/16/21 and ongoing.


VAERS ID: 1709203 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-01-13
Onset:2021-09-09
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: weakness and somnolence


VAERS ID: 1709433 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-28
Onset:2021-09-09
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: No adverse event
SMQs:

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

Write-up: no symptoms reported


VAERS ID: 1709664 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

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

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

Write-up: vaccine was administered after being improperly. the should have been moved for the freezer on 9/2, but was not removed until 9/8 and was administered to the patient


VAERS ID: 1710055 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-07
Onset:2021-09-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Skin eruptions


VAERS ID: 1710821 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-09-09
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Bedridden, Illness, Lethargy, Lymphadenopathy, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210933069

Write-up: SORENESS IN THE ARM; SWOLLEN GLANDS IN THE NECK; REALLY NAUSEOUS; COULD NOT GET OUT OF BED FOR 3 DAYS; REALLY SICK; VERY LETHARGIC; This spontaneous report received from a parent 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 (suspension for injection, route of admin not reported, batch number: 201A21A, expiry: UNKNOWN) dose was not reported, administered on 08-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 09-SEP-2021, the patient experienced could not get out of bed for 3 days. On 09-SEP-2021, the patient experienced really sick. On 09-SEP-2021, the patient experienced very lethargic. On 09-SEP-2021, the patient experienced swollen glands in the neck. On 09-SEP-2021, the patient experienced really nauseous. On 10-SEP-2021, the patient experienced soreness in the arm. The action taken with covid-19 vaccine was not applicable. The patient recovered from could not get out of bed for 3 days, really sick, very lethargic, soreness in the arm, swollen glands in the neck, and really nauseous on SEP-2021. This report was non-serious. This case, from the same reporter is linked to 20200314674.


VAERS ID: 1711119 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-27
Onset:2021-09-09
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 1 - / OT

Administered by: Unknown       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: Comments: Medical history was not provided.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: 1st dose Moderna, 2nd dose Janssen; This spontaneous case was reported by a nurse and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (1st dose Moderna, 2nd dose Janssen) in a 38-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 046A21A) for COVID-19 vaccination. No Medical History information was reported. On 27-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 milliliter. On 09-Sep-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (1st dose Moderna, 2nd dose Janssen). At the time of the report, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (1st dose Moderna, 2nd dose Janssen) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. The Janssen Covid-19 vaccine was administered at 0.5ml, intramuscular on the right deltoid. Lot number 204A21A The action taken with mRNA-1273 in response to the event was not applicable. No concomitant medication reported. No treatment was provided. Reporter did not allow further contact


VAERS ID: 1711124 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Hot flush, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: That night and the next morning I had hot flashes severe enough to cause me to change tshirts.; Since then, even sminimal exercise has also brought unusual amount of perspiration; This spontaneous case was reported by a consumer and describes the occurrence of HOT FLUSH (That night and the next morning I had hot flashes severe enough to cause me to change tshirts.) and HYPERHIDROSIS (Since then, even sminimal exercise has also brought unusual amount of perspiration) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 09-Sep-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 09-Sep-2021, the patient experienced HOT FLUSH (That night and the next morning I had hot flashes severe enough to cause me to change tshirts.) and HYPERHIDROSIS (Since then, even sminimal exercise has also brought unusual amount of perspiration). At the time of the report, HOT FLUSH (That night and the next morning I had hot flashes severe enough to cause me to change tshirts.) and HYPERHIDROSIS (Since then, even sminimal exercise has also brought unusual amount of perspiration) outcome was unknown. Concomitant medications were not reported No treatment information was provided.


VAERS ID: 1711178 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-01-26
Onset:2021-09-09
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042220A / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: USMODERNATX, INC.MOD20213

Write-up: very high temperatures/101.6; shakes; This spontaneous case was reported by a consumer and describes the occurrence of PYREXIA (very high temperatures/101.6) and TREMOR (shakes) in a 76-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 048F21A, 042220A and 031220A) for COVID-19 vaccination. No Medical History information was reported. On 26-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 23-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 07-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 09-Sep-2021, the patient experienced PYREXIA (very high temperatures/101.6) and TREMOR (shakes). At the time of the report, PYREXIA (very high temperatures/101.6) and TREMOR (shakes) outcome was unknown. Concomitant product usage were not provided. Treatment details were not provided.


VAERS ID: 1711204 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: USMODERNATX, INC.MOD20213

Write-up: Received a 1st dose of the Moderna COVID 19 vaccine that was beyond use date.; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Received a 1st dose of the Moderna COVID 19 vaccine that was beyond use date.) in a 45-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 007B21A) for COVID-19 vaccination. No Medical History information was reported. On 09-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 09-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Received a 1st dose of the Moderna COVID 19 vaccine that was beyond use date.). On 09-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Received a 1st dose of the Moderna COVID 19 vaccine that was beyond use date.) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment medications were reported


VAERS ID: 1711941 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Unknown  
Location: California  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH BA30130 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Insomnia, Poor quality product administered
SMQs:, Arthritis (broad), Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101182796

Write-up: They should be like cloudy you know like off white and was completely clear; Mild pain in my shoulder; I am just like, I can''t sleep its been 2 hours that I am here thinking about reading about.; This is a spontaneous report from a contactable nurse (patient). A 40-years-old patient of an unspecified gender received first dose of bnt162b2 (BNT162B2, solution for injection) via an unspecified route of administration on 09Sep2021 (Batch/Lot Number: BA30130) (at the age of 40-years-old) as SINGLE for covid-19 immunization. The patient medical history and concomitant medications were not reported. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. On 09Sep2021, the patient took the vaccine and found the appearance as like cloudy like off white and was completely clear and had mild pain in her shoulder and patient was wondering about the appearance of the vaccine and wanted to make sure that she got the thing and was done in right way that''s all. It was reported that patient couldn''t slept for 2 hours. The patient did not received any treatment for the events. The outcome of events was unknown. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1711957 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-08
Onset:2021-09-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Nausea, Vision blurred
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101183044

Write-up: Vision blurry/foggy all morning; Very nauseas; This is a spontaneous report from a contactable consumer, the patient. A 25-year-old male patient received second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FA7485) via an unspecified route of administration in the left arm on 08Sep2021 at 13:00 (at the age of 25-years-old) as a single dose for COVID-19 immunisation. The patient had no medical history. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient had not received any other vaccines within four weeks prior to the vaccination. The patient did not receive any concomitant medications. The patient previously received BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number : FC3184) via an unspecified route of administration on 17Aug2021 at 1200 (at the age of 25-years-old) as a single dose for COVID-19 immunisation. On 09Sep2021 at 10:00, the patient reported vision was blurry/foggy all morning and got better in the afternoon and felt very nauseas but could not puke. The events did not result in a doctor or other healthcare professional office/clinic visit, and emergency room/department or urgent care. Since the vaccination, the patient had not been tested for COVID-19. Therapeutic measures were not taken as a result of the reported events. The clinical outcome of the events vision blurry/foggy all morning and very nauseas were resolving at the time of this report.


VAERS ID: 1711991 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101190945

Write-up: muscle aches; over did not feel well; joint aches; headache; This is a spontaneous report from a contactable consumer (patient). A male patient of an unspecified age received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, formulation: solution for injection, lot number was not reported, expiration date was not reported), via an unspecified route of administration on 09Sep2021 as dose 1, single for covid-19 immunization. The patient medical history and concomitant medications were not reported. Patient reports that he received his first dose of the Pfizer Biontech covid 19 vaccine around 10:15-10:30 yesterday. Last night (on 09Sep2021) he experienced muscle aches, joint aches, headache and over did not feel well. Patient seeking information about how long these side effects typically last. The outcome of the events was unknown. Follow-up activities closed. Batch/lot number not available for vaccine/BNT162B2.


VAERS ID: 1712034 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-08
Onset:2021-09-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dental paraesthesia, Dizziness, Fatigue
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101192918

Write-up: Fatigue; Tingling of teeth; Heaviness in chest; Dizzy; This is a spontaneous report from a non-contactable consumer, the patient. A 14-year-old non-pregnant female patient received second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration on 08Sep2021 (at the age of 14-years-old) as a single dose for COVID-19 immunisation. Medical history was not reported and the patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the COVID-19 vaccine. The patient did not receive any concomitant medications. The patient previously received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration on an unknown date in Aug2021 (at the age of 14-years-old) as a single dose for COVID-19 immunisation. On 09Sep2021, 24 hours after the vaccination, the patient experienced fatigue, tingling of teeth, heaviness in chest and dizzy. The events did not result in a visit to the doctors or other healthcare professional office/clinic visit, and emergency room/department or urgent care. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events fatigue, tingling of teeth, heaviness in chest and dizzy was resolved on an unknown date in Sep2021. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1712058 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-08
Onset:2021-09-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary mass, Myalgia, Pain, 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: ESTROGEN; AMBIEN
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101197624

Write-up: 28 hours after shot High fever; Muscle aches on entire side of body as the shot; Large lump under shot arm; Extremely painful; This is a spontaneous report from a non-contactable consumer, the patient. A 48-year-old non-pregnant female patient received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FC3184) via an unspecified route of administration in the right arm on 08Sep2021 at 14:00 (at the age of 48-year-old) as a single dose for COVID-19 immunisation. The patient had no medical history. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. Concomitant medications included estradiol (ESTROGEN) and zolpidem tartrate (AMBIEN) from unknown dates for unknown indications and unknown if ongoing. On 09Sep2021 at 16:00, 28 hours after the shot, the patient experienced high fever, muscle aches on entire side of her body as the shot and a large lump under the shot arm and extremely painful. Therapeutic measures were not taken for the reported events. Since the vaccination, the patient was not tested for COVID-19. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. The clinical outcome of the events 28 hours after the shot high fever, muscle aches on entire side of body as the shot, large lump under the shot arm and extremely painful were recovering at the time of this report. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1712077 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Fatigue, Headache, Pain, SARS-CoV-2 test
SMQs:, Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210913; Test Name: Nasal swab; Result Unstructured Data: Test Result:Pending
CDC Split Type: USPFIZER INC202101198736

Write-up: Light headed; Fatigued; Headache; Body ache; Diarrhea; This is a spontaneous report from a contactable healthcare professional, the patient. A 26-year-old non-pregnant female patient received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 09Sep2021 at 12:00 (at the age of 26-years-old) as a single dose for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within 4 weeks prior to the COVID-19 vaccine. On 09Sep2021 at 18:00, the patient felt light headed, fatigued and experienced headache, body ache and diarrhea. The events resulted in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Therapeutic measures were taken as a result of events and included treatment with ibuprofen. On 13Sep2021, the patient underwent nasal swab test and the result was pending. The clinical outcome of the events light headed, fatigued, headache, body ache and diarrhea was unknown at the time of this report. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1712091 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-07
Onset:2021-09-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Nasal congestion, Oropharyngeal pain, Pain, Pyrexia, Sinus headache
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101204833

Write-up: Body aches; Congestion; Sore throat; Sinus headache; Fever; This is a spontaneous report from a contactable other healthcare professional, the patient. A 61-year-old male patient received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 07Sep2021 (at the age of 61-years-old) as a single dose for COVID-19 immunisation. The patient had no medical history and no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the COVID vaccine. The patient did not receive any concomitant medications. On 09Sep2021, the patient experienced fever, body aches, congestion, sore throat, and sinus headache. Since the vaccination, the patient had not been tested for COVID-19. Therapeutic measures were not taken as a result of the events. The clinical outcome of the events fever, body aches, congestion, sore throat, and sinus headache was not resolved at the time of this report. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1713256 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dizziness, Dysstasia, Fall, Fatigue, Feeling of body temperature change, Gait disturbance, Headache, Hyperhidrosis, Laboratory test, Malaise, Myalgia, Ocular hyperaemia, Pain, Scan, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flu vaccine resulted in 3 weeks of severe illness spent in bed.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Penecillin, Latex, Flu Vaccine
Diagnostic Lab Data: The ER conducted labs, xrays, scan. We don''t know the exact results as they weren''t given to us. We were told they were ok. All tests done on September 16th, 2021 at Hospital Emergency Room.
CDC Split Type:

Write-up: Feeling unwell day one of vaccine. Continue to feel worse every day with muscle aches, pains, severe headaches, light headed dizzy, difficulty walking standing, feeling freezing cold, feeling hot and sweaty, total exhaustion. Tried going to work and collapsed into a co-workers arms and ended up going to the emergency room. Could not walk or stand without assistance. Severe headache, red eyes, chest pain/discomfort started a couple of days after the vaccine.


VAERS ID: 1713280 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysarthria, Exposure during pregnancy, Foetal monitoring normal, Headache, Hypotension, Visual impairment
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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: Prenatal vitamin Aspirin 81 mg
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: Fetal monitoring- normal 9/9/21
CDC Split Type:

Write-up: 10/25/21 was 33.3 weeks pregnant on day of vaccine administration Within 15-20 minutes of vaccine administration patient began experiencing slurred speech, vision changes, headache, and low blood pressure. Was evaluated in ER. Resolved in 3 hours.


VAERS ID: 1713391 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-03
Onset:2021-09-09
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A214 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Costochondritis, Pain
SMQs:

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

Write-up: Catastrophic Costochondritis onset during exercise, 6 days after vaccination. Pain gradually increasing since event.


VAERS ID: 1713397 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-03
Onset:2021-09-09
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood test normal, Cardiac monitoring, Dizziness, Dyspnoea, Electrocardiogram normal, Fatigue, Feeling abnormal, Heart rate increased, Pallor, Palpitations, Thyroid function test normal, Troponin normal
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Bananas
Diagnostic Lab Data: Troponin 9/9/21 normal Thyroid 9/9/21 normal Blood chems 9/9/21 normal EKG 9/9/21 unremarkable Holster monitor placed 9/17/21 for 30 days
CDC Split Type:

Write-up: On 9/8/2021, PT started to feel not right. He was complaining of feeling lightheaded and fatigued and weak. On the morning of 9/9/2021, PT was woken from his sleep with a heart rate of 203 beats per minute, he was pale, short of breath and lightheaded. He could feel his heart race and felt like it was going to beat out of his chest. He was brought to the Emergency Department. After a 15 minute wait, his heart rate began to normalize. His ER doctor said that pt. could have a heart monitor to wear at home but said he wouldn?t recommend it as it probably won?t show anything so Jayson felt like he shouldn?t get one. Since that day, pt. heart rate has been higher than usual with any activity and his resting heart rate is higher than normal for him. PT has seen a primary care physician 9/15/21 and was referred to cardiology


VAERS ID: 1713661 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-27
Onset:2021-09-09
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, C-reactive protein increased, Gastrointestinal disorder, Immunoglobulin therapy, Lymphopenia, Multi-organ disorder, Multisystem inflammatory syndrome in children, Neutrophilia, Red blood cell sedimentation rate increased, Skin disorder
SMQs:, Haematopoietic leukopenia (narrow), Systemic lupus erythematosus (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Toxic-septic shock conditions (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

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

Write-up: Atypical MIS-C: multiple organ involvement (skin, GI), elevated ESR, CRP, lymphopenia, neutrophilia Symptoms started approx 7 days prior to admission Treated w/ IVIG, steroids, ASA


VAERS ID: 1713663 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Bone pain, Injected limb mobility decreased, Nausea, Palpitations, Pruritus, Pyrexia, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Osteonecrosis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderral 20mg daily omelrazole 40mg daily
Current Illness:
Preexisting Conditions: GERD
Allergies: Latex penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: 3 hours after the shot I ran a fever, nausea, vomiting, bone pain, and hives and itching all over my body. The itching and hives lasted over a week.I could not lift my left arm for 4 days. I also experienced palpitations within 48hrs of getting the vaccine that re-occurred for several days.


VAERS ID: 1713689 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-08-25
Onset:2021-09-09
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstrual disorder
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Menstrual cycle came 4 days early and much, much heavier than normal. It lasted 2 extra days. I have never taken birth control and have had regular periods since age 14. Even after having my children, my period came back the month after birth and was regular. I have date on my phone of the last 6 years of cycles showing they come every 28 days and last 4-5 days. This was definitely not a normal cycle for me. I just received my 2nd vaccine this week. I will send another report after my next period if it is abnormal again. I just wanted to add this to your records. Thank you.


VAERS ID: 1713980 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939901 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Crying, Ear pain, Eye pain, Gingival pain, Loss of personal independence in daily activities, Myalgia, Pain, Pain of skin, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gingival disorders (narrow), Glaucoma (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Full body pain (muscles, joints, skin, ears, eyes, gums) began around 9:00 pm on 9/9/21 and increased in severity over the next 24 hours. By the morning of 9/10/21, a fever of 103 degrees accompanied the severe body pain. Cried from the pain. Needed assistance to get out of bed. Pain and fever gradually lessened throughout the day on 9/11/21 and into 9/12/22.


VAERS ID: 1714018 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-09-07
Onset:2021-09-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Exposure during pregnancy, Ultrasound foetal, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderal taken at 6:30am. Been on this medicine since 18 years old
Current Illness: None
Preexisting Conditions: Mirgraines .
Allergies: Bactrim
Diagnostic Lab Data: Lab test, ultrasounds, and physical exam
CDC Split Type:

Write-up: At the time of the vaccine I did not know I was pregnant. I was due to get my period Saturday September 11.. I started bleeding Thursday as to what I thought was my period. My period only last 3 days maximum. I have had 2 abortions when I was a teen and I have two children. I know my body. As the bleeding started it wasn?t my normal flow of my period as the days went on I knew something is not right. I stopped needing a tampon or pad but I bleed and have chuncks come out every time I pee. This has been going on since Thursday Sept 9. The bleeding has not stopped. I called my OB bc this is not normal. I told them I have had sexual relations but I have my period. Never have I ever continued getting my period any of the other 4 times I?ve been pregnant. This is not a period blood. I cannot get the bleeding to stop. The doctors told me I need to wait one more week then they will do an ultrasound. They said they will send me to get pregnancy levels because of the chance. It comes to find out I am pregnant 4 weeks 4 days. My pregnancy levels are rising and they sent me to the emergency department because of this weird bleeding. They cannot tell what the bleeding is form nor stop it. The pregnancy is not yet identified through ultrasound. But bleeding will not stop. This is not normal for my body.


VAERS ID: 1714166 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Public       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: The patient received Pfizer on 01/16/21 and 02/06/21, Moderna on 06/09/21 and Janssen on 09/09/21


VAERS ID: 1714259 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-08
Onset:2021-09-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Blood test, Dizziness, Headache, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (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? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: prazosin, trazodone, lithium
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: no known allergies
Diagnostic Lab Data: Patient was hospitalized from 9/13/21 to 9/18/21, but unsure of bloodwork of medical tests done during stay.
CDC Split Type:

Write-up: Patient was given first Pfizer vaccine dose on 9/8/21. Starting feeling symptoms of dizziness and slight nausea on 9/9/21. On 9/10/21, patient was very nauseous and vomiting. Vomiting continued to get worse in the next few days ending in a hospitalization on 9/13 - 9/18. Vomiting was as bad as 30 times per hours (per patient). She also reported that she had an increase in blood pressure during her hospitalization, but unsure of what day that occurred. Headache was a side effect that was reported starting on 9/9/21, but unsure of when that subsided.


VAERS ID: 1714388 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-01
Onset:2021-09-09
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Cardiac flutter, Loss of personal independence in daily activities, Menstruation irregular, Migraine
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Guillain-Barre syndrome (broad), Tachyarrhythmia terms, nonspecific (narrow), Fertility disorders (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamictal, vyvanse, naltrexone
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: dairy, gluten, shelfish, penicillin and Septra
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heart flutters when going up stairs or walking at a faster pace, pissed period first time ever always regular, ongoing migraine, weakness ache in joints impacting daily living.


VAERS ID: 1714610 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-08
Onset:2021-09-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Haematochezia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Bloody stool with mucous/ change in bowel habits for 5 days; This spontaneous case was reported by a consumer and describes the occurrence of HAEMATOCHEZIA (Bloody stool with mucous/ change in bowel habits for 5 days) in a 37-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 062E21A) for COVID-19 vaccination. No Medical History information was reported. On 08-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 09-Sep-2021, the patient experienced HAEMATOCHEZIA (Bloody stool with mucous/ change in bowel habits for 5 days) (seriousness criterion medically significant). On 13-Sep-2021, HAEMATOCHEZIA (Bloody stool with mucous/ change in bowel habits for 5 days) had not resolved. Not Provided No concomitant medications were reported. No treatment information was provided. Company comment- This case concerns a 37 year-old, female subject with no relevant medical history, who experienced the unexpected event of Haematochezia. The event occurred approximately 1 day after the second dose of Spikevax. The rechallenge was unknown as there''s no information available about the first dose. The benefit-risk relationship of Spikevax is not affected by this report. Event Haematochezia was automatically upgraded as a Serious event as per IME list and kept as serious as per medical judgement, despite it was reported as non-serious.; Sender''s Comments: This case concerns a 37 year-old, female subject with no relevant medical history, who experienced the unexpected event of Haematochezia. The event occurred approximately 1 day after the second dose of Spikevax. The rechallenge was unknown as there''s no information available about the first dose. The benefit-risk relationship of Spikevax is not affected by this report. Event Haematochezia was automatically upgraded as a Serious event as per IME list and kept as serious as per medical judgement, despite it was reported as non-serious.


VAERS ID: 1714686 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-01-11
Onset:2021-09-09
   Days after vaccination:241
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Chills, Headache, Nausea, Off label use, Vaccination site mass
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Big knot at injection site; Weakness; Shooting pain inside her head; Chills; Nausea; Extra dose administered; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE MASS (Big knot at injection site), ASTHENIA (Weakness), OFF LABEL USE (Extra dose administered), HEADACHE (Shooting pain inside her head) and CHILLS (Chills) in a 57-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 062E21A and 015M20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 11-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 05-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 09-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 09-Sep-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced OFF LABEL USE (Extra dose administered). On 10-Sep-2021, the patient experienced VACCINATION SITE MASS (Big knot at injection site), ASTHENIA (Weakness), HEADACHE (Shooting pain inside her head), CHILLS (Chills) and NAUSEA (Nausea). On 09-Sep-2021, OFF LABEL USE (Extra dose administered) outcome was unknown. On 11-Sep-2021, HEADACHE (Shooting pain inside her head), CHILLS (Chills) and NAUSEA (Nausea) had resolved. At the time of the report, VACCINATION SITE MASS (Big knot at injection site) and ASTHENIA (Weakness) had not resolved. No concomitant medication reported. No treatment medication reported.


VAERS ID: 1714870 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-24
Onset:2021-09-09
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 01ES12V0CF25F84 / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Feeling abnormal
SMQs:, Dementia (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: Zebinix 800Mg (0-0-1)
Current Illness: Epilepsy
Preexisting Conditions: Epilepsy
Allergies: None
Diagnostic Lab Data: The night of 13 and 14 in the facility, and the night of the 18 and 19 in the facility.
CDC Split Type: 01ES12V0CF25F8487E54F06B2

Write-up: Thursday 09/09 after a year of being diagnosed and without any crisis. 12 days after the vaccination, I have a crisis like the previous ones, and I have a continuous beeping and dazed that does not stop after modifying the treatment as I was in the emergency twice.


VAERS ID: 1714924 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

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

Write-up: Hives on the arms, legs, butt, lower back, chest. Treated with steroid injections and topical creams with no improvement to rash.


VAERS ID: 1715014 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Burning sensation, Dizziness, Dyspnoea, Fatigue, Hyperhidrosis, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Recieced 1st vaccine on 9-9-21 I did not go through any worksheets of what could happen of if I had any problems . After 1 hour I was sweating profusely had shortness of breath, dizzzyness and had spots all over my legs that were burning with pain. I was exhausted and had no energy.


VAERS ID: 1715040 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-01
Onset:2021-09-09
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dizziness, SARS-CoV-2 test
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), COVID-19 (broad)

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

Write-up: Patient presents to the emergency department for evaluation of weakness and dizziness; COVID test for d/c to subacute rehabilitation


VAERS ID: 1715064 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-08
Onset:2021-09-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Electrocardiogram normal, Heart rate increased, Pyrexia, Sinus tachycardia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Presented to ED complaining of abnormally fast heart rate. Patient had second COVID vaccine on 9/8/21. Also running a fever, feeling shaky. Temperature in ED was 101.8 F and she had taken some Tylenol prior to arriving at ED. No chest pain or shortness of breath. Patient was observed in ED and patient started to feel better and was discharged home.


VAERS ID: 1715070 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-07
Onset:2021-09-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac flutter, Heart rate increased, Palpitations, Toothache
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Mild asthma
Allergies:
Diagnostic Lab Data: Dr appointment 9/20/21
CDC Split Type:

Write-up: Heart palpitations, rapid heart rate, heart fluttering, intense teeth pain


VAERS ID: 1715101 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-09
Onset:2021-09-09
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Exposure to SARS-CoV-2
SMQs:, COVID-19 (narrow)

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

Write-up: Covid positive household member


VAERS ID: 1715118 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-02
Onset:2021-09-09
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA C37F21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Exercise tolerance decreased, Injected limb mobility decreased, Injection site joint pain, Injection site muscle weakness, Pain, Pain in extremity, X-ray limb
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol; Valsartan; Norvasc; Vitamin B12; Vitamin D3; Low-Dose Aspirin.
Current Illness: None.
Preexisting Conditions: High Blood Pressure; Heart Disease.
Allergies: Coconut; Possibly penicillin.
Diagnostic Lab Data: X-ray of shoulder 9/17/21, I haven''t received results yet.
CDC Split Type: vsafe

Write-up: Started with soreness in the arm I received my shot about 6-7 days after. It progressed from soreness to pain in shoulder joint and weakness. Hard to do weightlifting and hard to sleep on it. Difficultly raising arm. The pain has not gone away at all, it fluctuates from bad to worse and back. Now it also radiates to just above the elbow in my arm.


VAERS ID: 1715187 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-07
Onset:2021-09-09
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

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

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

Write-up: hives and itching like similar allergic reactions, self treated with benadryl


VAERS ID: 1715303 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Itchy throat treated with Benadryl po 50 mg


VAERS ID: 1715362 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-08
Onset:2021-09-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Computerised tomogram head normal, Headache, Pain, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: zyrtec, vit D3,flexeril, magnesium, maxalt, immitrex,
Current Illness: none
Preexisting Conditions: migraines
Allergies: gabapentin, nortriptyine, propranolol, topiramate.
Diagnostic Lab Data: ssing a nuerologist. CT of head normal
CDC Split Type:

Write-up: 9-9-2021 upperbody aches headache and chills. 9-10 blurry vision and upperbody aches as of today headache is gone upper body ache persisst and vision is improving.


VAERS ID: 1715388 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-26
Onset:2021-09-09
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Lung disease, cardiovascular disease, high blood pressure
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient is fully vaccinated and hospitalized due to Covid.


VAERS ID: 1715444 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-01-01
Onset:2021-09-09
   Days after vaccination:251
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Oxygen saturation decreased, Pneumonia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: unknown
Preexisting Conditions: BPH, Insomnia, chronic back pain, hypertension
Allergies: Unknown
Diagnostic Lab Data: COVID positive 9/14/21
CDC Split Type:

Write-up: cough, congestion, desaturation, pneumonia


VAERS ID: 1715494 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-09
Onset:2021-09-09
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Computerised tomogram thorax, Fatigue, Muscular weakness, Pain in extremity, Pyrexia, Ultrasound scan normal
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: magox, zofran,topamax, effexor xr. maclizine
Current Illness: none
Preexisting Conditions: unknown
Allergies: latex, cipro, bee stings
Diagnostic Lab Data: CT of chest and US of legs neg Blood clots.
CDC Split Type:

Write-up: bilateral leg weakness, fatigue hours after vaccine. next day pain in legs with feeling feverish and general fatigue. pain focused to the back of knees and calves. legs still feel weak and sore.


VAERS ID: 1715551 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-03-18
Onset:2021-09-09
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Yes
Current Illness: No
Preexisting Conditions: Asthma, heart condition, stage 2 kidney disease
Allergies: Ragweed, seasonal allergies
Diagnostic Lab Data: COVID test.
CDC Split Type: vsafe

Write-up: Contracted the COVID virus after being fully vaccinated. I went in to hospital and had the antibiotic infusion on 09/15/2021.


VAERS ID: 1715660 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Erythema multiforme, Injection site erythema, Injection site urticaria, Rash, Rash papular, Skin plaque
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, bupropion HCL, cetirizine, levonorgestrel-ethinyl estradiol
Current Illness:
Preexisting Conditions: Anxiety, ectopic kidney, allergic conjunctivitis/rhinitis, Vitamin D deficiency, asthma, shoulder/neck pain, urticaria
Allergies: Dust, dust mites
Diagnostic Lab Data:
CDC Split Type:

Write-up: Erythema multifore, diffuse erthematic pinpoint papular rash on hands, arms, legs, thighs, trunk, back. Erythematic plaques bilateral cheeks, right ear lobe. 8 cm circular erythematic wheal with central clearing on left deltoid at site of injection. Erythematic plaque on left elbow.


VAERS ID: 1715675 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-26
Onset:2021-09-09
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Headache, Nasal congestion, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: hydrochlorothiazide, estrace, multi vitamins, Vit C & E, calcium, lansoprazole, omega-3, probiotics, turmeric
Current Illness: none
Preexisting Conditions:
Allergies: Flexeril, soma, Lodine
Diagnostic Lab Data: over the counter COVID test at home = Positive nasal swab test = Positive
CDC Split Type:

Write-up: 9/9/2021 Sore throat, headache, nasal congestion, loss of smell & taste. Used over the counter cold liquid and ibuprofen. Symptoms subsided about 6 days later


VAERS ID: 1715710 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: received 2nd dose of Pfizer covid vaccine 2 weeks after 1st dose


VAERS ID: 1715717 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-03
Onset:2021-09-09
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deep vein thrombosis, Pain in extremity, Ultrasound Doppler
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: vit D, fluoxetine, melatonin, sertraline, trazamine, trazadone,
Current Illness:
Preexisting Conditions: depression, crohns
Allergies: no known allergies
Diagnostic Lab Data: Doppler on 9/13/21
CDC Split Type:

Write-up: Present to ED on 9/13/21 with pain in right calf and back of leg x 4 days 9/13/21: No current chest pain or shortness of breath. Normal vital signs 97% O2 sat. She was found to have DVT acute from Doppler ultrasound from triage. She has no history of blood clots in the past. No chest pain or shortness of breath. - complains of minimal swelling (but states has been swollen since surgery on ankle fracture 5/21/21) - discharged on 9/13/21 on apixaban


VAERS ID: 1715806 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-26
Onset:2021-09-09
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Hyponatraemia, Pulmonary mass, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol HFA 108 (90 Base) MCG/ACT inhaler alendronate (FOSAMAX) 70 MG tablet Ascorbic Acid (VITAMIN C) 500 MG tablet Calcium Carbonate Antacid 1000 MG tablet Cholecalciferol (VITAMIN D) 2000 UNITS CAPS Clotrimazole 10 MG troche dilTIAZem
Current Illness: Hyponatremia; SIADH r/t underlying lung mass; Atrial fibrillation
Preexisting Conditions: Cardiovascular and Mediastinum Paroxysmal atrial fibrillation (CMS/HCC) Respiratory Allergic rhinitis Asthma OSA on CPAP Musculoskeletal and Integument Osteoporosis Onychomycosis Genitourinary BPH (benign prostatic hyperplasia) Other Neck pain Hyperlipidemia Lower back pain Hyponatremia
Allergies: Penicillins Rash
Diagnostic Lab Data: COVID-19 +
CDC Split Type:

Write-up: Breakthrough case and hospitalized with hyponatremia r/t lung mass


VAERS ID: 1716585 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site urticaria, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (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: Tetnus, young child, entire body swelled up
Other Medications: Levothyroxine, Bupropion, Lithium, Atenolol, Kurvelo, Quetiapine, Lorazepam, Prazosin, and b-12 injection
Current Illness: None
Preexisting Conditions: Pernicious Anemia, hypothyroidism, neurocardiogenic syncope
Allergies: Raspberries and tetanus
Diagnostic Lab Data:
CDC Split Type:

Write-up: My entire body broke out in hives mostly around my chest and right arm (where I was vaccinated) which lasted throughout the evening and into the next day. My legs then went numb for just over 30 minutes.


VAERS ID: 1717365 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-08
Onset:2021-09-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Pain, Skin warm, 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: Venlafaxine 150mg caps and Buspar 7.5mg tabs
Current Illness:
Preexisting Conditions:
Allergies: Penicillin, Sulfa and Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling; soreness; warm-to-touch; red. Went away for 4 days then came back and started to itch. After taking Motrin, swelling went down but still sore and the red patch has grown.


VAERS ID: 1717828 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-09-01
Onset:2021-09-09
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination complication
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Got my 2nd dose yesterday and now I am feeling really bad; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION COMPLICATION (Got my 2nd dose yesterday and now I am feeling really bad) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In September 2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 09-Sep-2021, the patient experienced VACCINATION COMPLICATION (Got my 2nd dose yesterday and now I am feeling really bad). At the time of the report, VACCINATION COMPLICATION (Got my 2nd dose yesterday and now I am feeling really bad) outcome was unknown. Concomitant medication were not reported. Treatment information was not reported.


VAERS ID: 1717949 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F71A / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Chills, Fatigue, 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: LISINOPRIL
Current Illness:
Preexisting Conditions: Comments: No medical history was provided by the reporter
Allergies:
Diagnostic Lab Data: Test Name: Body temperature; Result Unstructured Data: 101,2 ?F
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Fever (102,1 ?F); Chills; Fatigue; This spontaneous case was reported by a consumer and describes the occurrence of PYREXIA (Fever (102,1 ?F)), CHILLS (Chills) and FATIGUE (Fatigue) in a 57-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 048F71A) for COVID-19 vaccination. No medical history was provided by the reporter. Concomitant products included LISINOPRIL for Hypertension. On 09-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 09-Sep-2021, the patient experienced PYREXIA (Fever (102,1 ?F)), CHILLS (Chills) and FATIGUE (Fatigue). At the time of the report, PYREXIA (Fever (102,1 ?F)), CHILLS (Chills) and FATIGUE (Fatigue) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: 101.2 (High) 101,2 ?F. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown.


VAERS ID: 1717957 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-09-09
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Pallor
SMQs:, Hypotonic-hyporesponsive episode (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: USMODERNATX, INC.MOD20213

Write-up: Im pale after receiving the vaccination; This spontaneous case was reported by a consumer and describes the occurrence of PALLOR (Im pale after receiving the vaccination) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 09-Sep-2021, the patient experienced PALLOR (Im pale after receiving the vaccination). At the time of the report, PALLOR (Im pale after receiving the vaccination) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication was reported. No treatment information was provided. Reporter did not allow further contact


VAERS ID: 1717961 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 04721A / UNK - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: USMODERNATX, INC.MOD20213

Write-up: expired dose; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a physician and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (expired dose) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 04721A) for COVID-19 vaccination. No Medical History information was reported. On 09-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 09-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (expired dose). At the time of the report, EXPIRED PRODUCT ADMINISTERED (expired dose) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No Concomitant medication was reported No treatment Drug was reported


VAERS ID: 1717967 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: New York  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Accidental overdose
SMQs:, Drug abuse and dependence (broad), 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: USMODERNATX, INC.MOD20213

Write-up: Administered a 1 mL dose instead of 0.5 mL; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by an other health care professional and describes the occurrence of ACCIDENTAL OVERDOSE (Administered a 1 mL dose instead of 0.5 mL) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 09-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 ml. On 09-Sep-2021, the patient experienced ACCIDENTAL OVERDOSE (Administered a 1 mL dose instead of 0.5 mL). On 09-Sep-2021, ACCIDENTAL OVERDOSE (Administered a 1 mL dose instead of 0.5 mL) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication were reported. No treatment information was provided by the reporter.


VAERS ID: 1718023 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B21A / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: USMODERNATX, INC.MOD20213

Write-up: received a dose of an expired vial/The dose was administered 22 hours after first puncture; This spontaneous case was reported by a health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (received a dose of an expired vial/The dose was administered 22 hours after first puncture) in a 66-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 033B21A) for COVID-19 vaccination. No Medical History information was reported. On 09-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 09-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (received a dose of an expired vial/The dose was administered 22 hours after first puncture). On 09-Sep-2021, EXPIRED PRODUCT ADMINISTERED (received a dose of an expired vial/The dose was administered 22 hours after first puncture) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were provided by the reporter. No treatment medications were provided by the reporter.


VAERS ID: 1718055 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Body temperature, Chest discomfort, Chest pain, Chills, Feeling cold, Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: PROAIR HFA; SPIRIVA
Current Illness: Asthma; Immunocompromised (not specified)
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19; Heart rate abnormal (irregular heart beat)
Allergies:
Diagnostic Lab Data: Test Date: 20210909; Test Name: Body Temperature; Result Unstructured Data: Fever 102F
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Back pain is bad and waking her up last night, radiating pain; Chest hurts after 3rd shot; Chest feels tight after 3rd shot; Feel cold after 3rd shot; Chills after 3rd shot; Body Aches after 3rd shot; Fever 102F after 3rd shot; Headache after 3rd shot; This spontaneous case was reported by a consumer and describes the occurrence of BACK PAIN (Back pain is bad and waking her up last night, radiating pain), CHEST PAIN (Chest hurts after 3rd shot), CHEST DISCOMFORT (Chest feels tight after 3rd shot), FEELING COLD (Feel cold after 3rd shot) and CHILLS (Chills after 3rd shot) in a 57-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Heart rate abnormal (irregular heart beat) and COVID-19 in January 2021. Concurrent medical conditions included Asthma and Immunocompromised (not specified). Concomitant products included SALBUTAMOL SULFATE (PROAIR HFA) and TIOTROPIUM BROMIDE MONOHYDRATE (SPIRIVA) for Asthma. On 09-Sep-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 09-Sep-2021, the patient experienced BACK PAIN (Back pain is bad and waking her up last night, radiating pain), CHEST PAIN (Chest hurts after 3rd shot), CHEST DISCOMFORT (Chest feels tight after 3rd shot), FEELING COLD (Feel cold after 3rd shot), CHILLS (Chills after 3rd shot), MYALGIA (Body Aches after 3rd shot), PYREXIA (Fever 102F after 3rd shot) and HEADACHE (Headache after 3rd shot). The patient was treated with PARACETAMOL (TYLENOL) for Fever, at an unspecified dose and frequency. At the time of the report, BACK PAIN (Back pain is bad and waking her up last night, radiating pain), CHEST PAIN (Chest hurts after 3rd shot), CHEST DISCOMFORT (Chest feels tight after 3rd shot), FEELING COLD (Feel cold after 3rd shot), CHILLS (Chills after 3rd shot), MYALGIA (Body Aches after 3rd shot), PYREXIA (Fever 102F after 3rd shot) and HEADACHE (Headache after 3rd shot) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 09-Sep-2021, Body temperature: 102 (High) Fever 102F. This case was linked to MOD-2021-315546, MOD-2021-315706 (Patient Link).


VAERS ID: 1718085 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-10
Onset:2021-09-09
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 2 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: USMODERNATX, INC.MOD20213

Write-up: Patient received dose from punctured vial after 12 hours; This spontaneous case was reported by a health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Patient received dose from punctured vial after 12 hours) in a 47-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 939902 and 037F21A) for COVID-19 vaccination. No Medical History information was reported. On 10-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 09-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 09-Sep-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced EXPIRED PRODUCT ADMINISTERED (Patient received dose from punctured vial after 12 hours). At the time of the report, EXPIRED PRODUCT ADMINISTERED (Patient received dose from punctured vial after 12 hours) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments.


VAERS ID: 1718099 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-25
Onset:2021-09-09
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 RA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: USMODERNATX, INC.MOD20213

Write-up: Right arm was swollen/ woke up with whole arm swollen where got the shot, on the right side; This spontaneous case was reported by a consumer and describes the occurrence of PERIPHERAL SWELLING (Right arm was swollen/ woke up with whole arm swollen where got the shot, on the right side) in a 57-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 006C21A) for COVID-19 vaccination. No Medical History information was reported. On 25-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 09-Sep-2021, the patient experienced PERIPHERAL SWELLING (Right arm was swollen/ woke up with whole arm swollen where got the shot, on the right side). At the time of the report, PERIPHERAL SWELLING (Right arm was swollen/ woke up with whole arm swollen where got the shot, on the right side) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant medications included sugar pill and cholesterol pill (unspecified). Patient did not take medication to treat symptoms.


VAERS ID: 1718100 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Florida  
Vaccinated:2021-08-27
Onset:2021-09-09
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210909; Test Name: SARS-CoV-2 test; Test Result: Positive ; Result Unstructured Data: Positive
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: tested positive for COVID-19; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of SARS-COV-2 TEST POSITIVE (tested positive for COVID-19) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 27-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 09-Sep-2021, the patient experienced SARS-COV-2 TEST POSITIVE (tested positive for COVID-19). At the time of the report, SARS-COV-2 TEST POSITIVE (tested positive for COVID-19) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 09-Sep-2021, SARS-CoV-2 test: positive (Positive) Positive. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant medication were not provided. Treatment information was not provided. The patient will take second shot on 24-Sep-2021


VAERS ID: 1718146 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination site erythema, Vaccination site pain, Vaccination site swelling
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: I got the vaccine last Thursday but it''s still swollen, red, and hurting; I got the vaccine last Thursday but it''s still swollen, red, and hurting; I got the vaccine last Thursday but it''s still swollen, red, and hurting; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE SWELLING (I got the vaccine last Thursday but it''s still swollen, red, and hurting), VACCINATION SITE ERYTHEMA (I got the vaccine last Thursday but it''s still swollen, red, and hurting) and VACCINATION SITE PAIN (I got the vaccine last Thursday but it''s still swollen, red, and hurting) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 09-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 09-Sep-2021, the patient experienced VACCINATION SITE SWELLING (I got the vaccine last Thursday but it''s still swollen, red, and hurting), VACCINATION SITE ERYTHEMA (I got the vaccine last Thursday but it''s still swollen, red, and hurting) and VACCINATION SITE PAIN (I got the vaccine last Thursday but it''s still swollen, red, and hurting). At the time of the report, VACCINATION SITE SWELLING (I got the vaccine last Thursday but it''s still swollen, red, and hurting), VACCINATION SITE ERYTHEMA (I got the vaccine last Thursday but it''s still swollen, red, and hurting) and VACCINATION SITE PAIN (I got the vaccine last Thursday but it''s still swollen, red, and hurting) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were reported. No treatment medications were reported. Reporter did not allow further contact


VAERS ID: 1718318 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-08
Onset:2021-09-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Influenza like illness, Neck pain, Nervousness
SMQs:, Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101192090

Write-up: Bad sore neck on the left side; exact side that she had the vaccine arm, she had on the left side; she can hardly move her neck; Flu like symptoms; Chills really bad; real shaky; Chills really bad; real shaky; This is a spontaneous report from a contactable consumer (parent). A 16-years-old female patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Batch/Lot number was not reported, patient was 16-year-old at the time of vaccination), via an unspecified route of administration, administered in Arm Left on 08Sep2021 as DOSE 2, SINGLE for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. Historical vaccine included first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Batch/Lot number was not reported), on an unspecified date as DOSE 1, SINGLE for covid-19 immunisation. On 09Sep2021 at 03:30, the patient experienced flu like symptoms, chills really bad; real shaky, on 10Sep2021, the patient experienced bad sore neck on the left side; exact side that she had the vaccine arm, she had on the left side; she can hardly move her neck. The outcomes of events (Flu like symptoms, Bad sore neck on the left side; exact side that she had the vaccine arm, she had on the left side; she can hardly move her neck) were unknown and the outcomes of events (Chills really bad; real shaky) were recovered on an unspecified date in Sep2021. The lot number for the vaccine [BNT162B2] was not provided and will be requested during follow up.


VAERS ID: 1718328 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-04
Onset:2021-09-09
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, SARS-CoV-2 test
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210909; Test Name: COVID; Test Result: Positive ; Comments: she tested positive
CDC Split Type: USPFIZER INC202101197384

Write-up: tested positive; tested positive; This is a spontaneous report from a contactable consumer (patient). This 40-Year-old female patient received the first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE) on 04Sep2021 as single dose for covid-19 immunisation. Medical history and concomitant medications were not reported. The reporter asked how long she needed to wait before getting her second COVID vaccine dose after having COVID. She received her first COVID vaccine dose on 04Sep2021. Her son came home with COVID and she tested positive on 09Sep2021. She was scheduled to get her second vaccine dose on 25Sep2021 and asked if she still keep that appointment or if she need to change it. She has heard from her doctor to wait 30 days, then somewhere else she heard to wait 90 days and she calls now to obtain clarification. This case was reported as Non-Serious. The outcome of the event was unknown. The lot number for [BNT162B2] was not requested and will be requested during follow up.


VAERS ID: 1718335 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-04
Onset:2021-09-09
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: KLONOPIN; VITAMIN C [ASCORBIC ACID]; ZINC; VITAMIN D [COLECALCIFEROL]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anxiety; Cardiac ablation; Supraventricular tachycardia
Allergies:
Diagnostic Lab Data: Test Date: 20210909; Test Name: COVID-19 test/nose swab test; Result Unstructured Data: Test Result:Positive for COVID-19; Comments: nose swab test
CDC Split Type: USPFIZER INC202101198529

Write-up: Tested positive for COVID-19; This is a spontaneous report from contactable consumer (patient) via Pfizer sponsored program. A 40-year-old female patient received bnt162b2 (PFIZER BIONTECH COVID-19 MRNA VACCINE Solution for injection Lot Number: FC3183) via an unspecified route of administration in arm left on 04Sep2021 16:00 as dose 1, single (age at vaccination: 40 years) for COVID-19 immunisation. Medical history included heart ablation from 2020 to 2020 This was done a year ago for SVT-supraventricular tachycardia because when she was pregnant with her last baby, she had all that so they decided to do the heart ablation after she had the baby, supraventricular tachycardia, anxiety, both from an unknown date and unknown if ongoing. Concomitant medications included clonazepam (KLONOPIN) 0.5 mg as needed taken for anxiety from an unspecified start date and ongoing; vitamin c [ascorbic acid] (VITAMIN C [ASCORBIC ACID]) 7.5 mL, daily taken for an unspecified indication from an unspecified start date and ongoing; zinc (ZINC) 15mL liquid taken for an unspecified indication from an unspecified start date and ongoing; cholecalciferol (VITAMIN D [COLECALCIFEROL]) chewable gummy taken for an unspecified indication from an unspecified start date and ongoing. History of all previous immunization with the Pfizer vaccine considered as suspect (or patient age at first and subsequent immunizations if dates of birth or immunizations are not available) was none. Additional Vaccines Administered on Same Date of the Pfizer Suspect, all vaccines administered on same date with the Pfizer vaccine considered as suspect was none. Prior Vaccinations (within 4 weeks) any other vaccinations within four weeks prior to the first administration date of the suspect vaccines was none. The adverse events following prior vaccinations was none. Other relevant medical history including but not limited to these conditions: diagnosed allergies, compromised immune status, respiratory illness, genetic/chromosomal abnormalities, endocrine abnormalities (including diabetes) and obesity was none. The culture, serotyping was not performed. The predisposing factors (e.g., immunosuppression, contact with other infected persons) was son came home from school with COVID. No antipyretic was used (around the date(s) of Vaccination). On 09Sep2021 10:30, the patient experienced tested positive for COVID-19. Mom had COVID-saw how bad she struggled with it made her say she does not want to struggle like that. She heard if she gets vitamin-C, vitamin-D, zinc in COVID this will help her immune system. She explained that her son came home from school with COVID. She verified she had a couple of questions in terms of whether it is a good idea to get her second dose of Pfizer-BioNTech Covid-19 Vaccine within the 21 days, or if she should wait. She was scheduled for second dose on 25Sep2021. The adverse event did not result in emergency room/physician Office. The product complaint includes consumer is patient who was administered first dose of Pfizer-BioNTech Covid-19 Vaccine on 04Sep2021. On 09Sep2021 they tested positive for COVID-19 on COVID-19 nose swab test. Patient explained that their child came home from school with COVID. The patient underwent lab tests and procedures which included sars-cov-2 test resulted as positive for covid-19 on 09Sep2021 nose swab test. The clinical outcome of the event was unknown.


VAERS ID: 1718347 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-20
Onset:2021-09-09
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PL3183 / UNK LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: XELJANZ.
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Celiac disease (known allergies: gluten: celiac disease); Gluten intolerance (known allergies: gluten: celiac disease); Myasthenia gravis; Rheumatoid arthritis.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101206573

Write-up: Shingles; This is a spontaneous report from a contactable consumer (patient). A 47-years-old non-pregnant female patient received unknown dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Batch/Lot Number: PL3183, patient was not pregnant at the time of vaccination), via an unspecified route of administration, administered in Arm Left on 20Aug2021 at 05:00 PM as DOSE NUMBER UNKNOWN, SINGLE for COVID-19 immunisation. Medical history included myasthenia gravis, rheumatoid arthritis, Known Allergies with Gluten and Celiac disease. No other vaccine received in four weeks, no covid prior vaccination, not tested covid post vaccination. Concomitant medication(s) included tofacitinib citrate (XELJANZ) taken within two weeks. The patient experienced shingles. Ae resulted in doctor or other healthcare professional office/clinic visit. Therapeutic measures were taken as a result of shingles with Valacyclovir HCL. The outcome of event was not recovered.


VAERS ID: 1718776 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 2 LA / IM

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

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

Write-up: Metalic taste 10 mins after receiving the vaccine ( 2nd dose moderna lot# 040c21a)


VAERS ID: 1718830 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-18
Onset:2021-09-09
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Fatigue, Headache, Impaired work ability, Nasal congestion, Pain, Pyrexia, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Amoxicillin
Diagnostic Lab Data: COVID-19 test - 9/11/2021 - Negative.
CDC Split Type: vsafe

Write-up: On Sept. 9 2021, around 4 pm, I picked my children up from daycare. My youngest had a stuffy nose and a cough. I was dealing with him, and around 6 pm I felt very rundown myself. I was very achy and had a slight headache. On the 10th, I kept my kids home from daycare. I had a severe headache, a cough and fever. I had body aches still. Same thing on Saturday the 11th, so I went and did a drive thru COVID-19 test. The symptoms continued for over a week. I just called in sick today as well 9/21/2021.


VAERS ID: 1718939 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-09
Onset:2021-09-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Dysgeusia, Fatigue, Gait disturbance, Headache, Heart rate increased, Insomnia, Joint swelling, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: I got a metal taste right away after getting the shot. My joints and muscles got sore starting that night. I also experienced headaches, trouble sleeping, fatigue, and increased heart rate. It was beating fast like it was trying to beat out of my chest, so I guess my blood pressure was high. Those symptoms lasted for about a week. Probably until 9/16/2021. The night of 09/16/221 I woke up in the middle of the night and my right knee was incredibly sore. I could not walk. It woke me up at about 4 am. It was incredibly painful. On Friday morning I went to the doctor to get that knee checked up. They did not do any medical tests. They just checked the structure of my knee. There was nothing physically wrong with it so they could not do any determinations. It was also swollen behind my knee. There was no visible clotting issue or anything. They just told me to take some Aleve for the joint pain. My knee is a little sore but its gotten better, it does not hurt. Not even close to that night.


VAERS ID: 1718949 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-26
Onset:2021-09-09
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / UNK - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Hyponatraemia, Pulmonary mass
SMQs:, Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol HFA 108 (90 Base) MCG/ACT inhaler alendronate (FOSAMAX) 70 MG tablet Ascorbic Acid (VITAMIN C) 500 MG tablet Calcium Carbonate Antacid 1000 MG tablet Cholecalciferol (VITAMIN D) 2000 UNITS CAPS Clotrimazole 10 MG troche dilTIAZem
Current Illness:
Preexisting Conditions: Cardiovascular and Mediastinum Paroxysmal atrial fibrillation (CMS/HCC) Respiratory Allergic rhinitis Asthma OSA on CPAP Musculoskeletal and Integument Osteoporosis Onychomycosis Genitourinary BPH (benign prostatic hyperplasia) Other Neck pain Hyperlipidemia Lower back pain Hyponatremia
Allergies: Penicillins: Rash
Diagnostic Lab Data: COVID-19+
CDC Split Type:

Write-up: 77 y/o male with hx of PAF on Eliquis and who was vaccinated against COVID-19 earlier this month, was admitted to NBH for + COVID-19 and a lung mass. See below for details of his hospitalization: Hyponatremia Sodium 121 on admission Treated with IV fluids initially Labs suggest SIADH from underlying lung mass Stopped fluids and gave a dose of Samsca x 1 Sodium 139 today Recommend close monitoring of his sodium by PCP in 1-2 weeks Lung mass IR unable to perform biopsy today due to patient being COVID-19 + Since he was already vaccinated, this appears to be a breakthrough case If he continues to do well from a respiratory standpoint with no oxygen requirements, he should be ok to have biopsy in 10 days 9/21/2021 from a medical standpoint Seen by Dr who plans for additional work-up for the lung mass as an outpatient He will also help arrange the lung biopsy as an outpatient He will need to hold his Eliquis 48 hours prior to the biopsy COVID-19 + No clear infiltrates on CXR/CT chest Patient has been vaccinated earlier this year Not requiring oxygen sats No additional treatment at this time PAF Continue Cardizem, flecainide, and Eliquis Patient is medically stable for discharge home today.


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