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

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



Case Details (Reverse Sorted by Onset Date)

This is page 234 out of 5,069

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VAERS ID: 1378254 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest X-ray normal, Chest discomfort, Dizziness, Full blood count, Laboratory test normal, Troponin normal
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Past medical hx includes stroke (during pregnancy), pre-eclampsia, Dysphagia, Diverticulosis, Diverticulitis, Chronic Diarrhea, abnormal Pap Smear. Past surgical hx hysterectomy, appendectomy.
Allergies: Pt w/ hx of allergy to ammonia (anaphylaxis, SOB), Pollen Extracts (anaphylaxis), Iodinated Contrast Media (Rash), Bleach (SOB - Subjective SOB if smell cleaning products).
Diagnostic Lab Data: In ED, Troponin Negative x1, Panel 7 WNL, Hemogram w/ diff WNL, Chest XR unremarkable.
CDC Split Type:

Write-up: Pt and pt''s daughter were in triage area, post-vaccination (1st dose PFIZER), c/o dizziness and non-radiating chest pressure located in midsection of chest, at approximately 7:50PM. On-site NP and clinic lead notified. Pt denied experiencing SOB or any other new/abnormal sx. Pt denied hx of smoking or taking BP meds. Pt was offered and given water. V/S @ 750PM: BP - 150/102, HR - 86, O2 - 98% V/S @ 758PM: BP - 167/106, HR - 90, O2 - 99% V/S @ 800PM: BP - 160/102, HR - 90, O2% - 99% Continued to monitor pt. Pt denied experiencing improvement to sxs. V/S @ 810PM: BP - 155/95, HR - 97 Pt denied experiencing any improvement to sxs. ED precautions given. Pt was encouraged to see ED. Pt agreed and requested to be transferred to ED via w/c. Pt was accompanied by NP, RN, and pt''s daughter to ED. Report given to ED nurse.


VAERS ID: 1378275 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Unknown  
Vaccinated:2020-06-04
Onset:2021-06-04
   Days after vaccination:365
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Anaphylactic reaction, Hypoxia, Pain, Swelling face
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

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

Write-up: Facial swelling, Mild hypoxia, body aches. Anaphylaxis


VAERS ID: 1378278 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 1 LA / IM

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

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

Write-up: Pt was reported to be "anxious and nervous" about receiving her first dose of Moderna vaccine "all day" by her husband. Pt c/o feeling nauseous 10 minutes after receiving vaccine and vomiting once in restroom after completing the required 15 minute observation period at vaccine site. Pt walked back into POD to be evaluated by writer (clinical lead), pt reported a headache after vomiting, denied any blood in her vomit. Denied any dizziness, chest pain, fever, chills, difficulty breathing, rashes, itching, difficulty speaking or swallowing, abdominal pain, weakness, numbness, tingling, or diarrhea. Pt was given water and evaluated by writer (clinical lead at site, and co-leads) and observed for and additional 30 minutes while obtaining history. Pt tolerated water PO and did not vomit in the presence of writer. Vital signs were stable and pt reported feeling "better". Physical exam was unremarkable: lungs clear, no increased work of breathing or accessory muscle use noted, airway patent, no facial, lip, or tongue swelling noted, no rashes observed, and abdomen soft and non-tender. Pt was discharged home from vaccine POD after evaluation completed. No additional vomiting or new symptoms were reported by pt or husband while still on the vaccine POD premises. Instructions provided to pt were to remain hydrated with clear liquids, advance to BRAT diet as tolerated, and pt instructed to go to ER if any new symptoms arise or anything worsens. Pt and family member emphasized understanding, and all questions were answered.


VAERS ID: 1378317 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-27
Onset:2021-06-04
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None disclosed
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chest pain, elevated troponin, suspected myocarditis


VAERS ID: 1378341 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-06-01
Onset:2021-06-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Angiogram normal, Blindness unilateral, Computerised tomogram head normal, Computerised tomogram neck, Eye pain, Magnetic resonance imaging head normal, Optic nerve cupping, Retinal artery occlusion, Retinal oedema, Retinal pallor, Scan with contrast normal, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Glaucoma (narrow), Optic nerve disorders (narrow), Lens disorders (broad), Retinal disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CT Head and Neck with contrast and MRI/MRA were normal. Ophthalmology Physician diagnosed as arterial occlusion of ophthalmic artery despite patent arteries on imaging
CDC Split Type:

Write-up: Patient developed painful blurry vision in left eye that progressed to painless blurry vision in same eye within 24 hours after onset of symptoms. Patient had edematous and pale retina with swollen optic cup. Patient has had complete vision loss in his left eye since.


VAERS ID: 1378342 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-30
Onset:2021-06-04
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site bruising, Injection site erythema, Injection site induration, Injection site inflammation, Injection site pain, Injection site pruritus
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: No known drug allergies. Allergies: eggs, peanuts, dairy, white beans
Diagnostic Lab Data:
CDC Split Type:

Write-up: Seven days following the immunization my arm began to itch and burn forming a 7cm x 5cm area of induration. This well demarcated area was maroon in color with bruising at 1 o''clock. I applied ice to the area, elevated my arm and took Tylenol 1000mg every 6-8 hours. The visible inflammation has subsided after 60 hours (2.5 days). My arm continues to burn and itch but is no longer indurated, or maroon. I am continuing to have dull headaches, beginning 5 days after immunization. No fever.


VAERS ID: 1378365 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin 500mg bid; duloxetine 60mg qam; simvastatin 40mg qpm, olmesartan 40mg qam; methocarbamol 750mg tid prn; nabumetone 500mg bid prn; omeprazole 40mg qam
Current Illness: none
Preexisting Conditions: diabetes, high blood pressure, fibromyalgia
Allergies: no known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient developed redness on her arm the morning following the vaccine. Patient waited through the weekend and called physician''s office on Monday 6/7/21 and was advised to go to the walk in clinic. Patient was seen by provider and was told cellulitis and given a 10 day course of augmentin 875mg.


VAERS ID: 1378395 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-30
Onset:2021-06-04
   Days after vaccination:66
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Private       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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ASA, CA, Diovan, Fish oil, Gentamicin-prednisolone, Insulin, Metformin, Multivitamin, Omeprazole, rosuvastatin, valsartan Vit C.
Current Illness: unk
Preexisting Conditions: diabetes, HTN, kidney disease
Allergies: none
Diagnostic Lab Data: COVID19 Detection BDMAX
CDC Split Type:

Write-up: breakthrough COVID 19


VAERS ID: 1378396 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-05-25
Onset:2021-06-04
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Retinal migraine, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (narrow), Hypoglycaemia (broad)

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

Write-up: 06-04-2021 developed headache and vision changes. Dx with occular migraine.


VAERS ID: 1378425 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Fall, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (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: B12, Zrytec, Calcium x 4, Curamed, Super Adrenal Stress Formula by Dr. Wilson, Fish Oil, Adrenal C Formula, Tegretol XR 200mg bds, Singulair, DHEA, Strontium, estrogen/progestin combo, selenium 200mcg,
Current Illness: respiratory problems
Preexisting Conditions: Hashimotos Disease, Leaky Gut, Asthma, Allergies,
Allergies: multiple allergies: - oats, orange, walnut, pecan, peanuts, mushrooms, shellfish, egg yolks, - allergy tested- out of 91 needles she is allergic to 69 things - avalox, Biaxin, clarithromycin, doxycycline, erythromycin, Levaquin
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt developed chills and shaking the night after getting the vax. She took tylenol and went to bed. When she woke up she had chills and shaking. She got up to take another tylenol but her body collapsed and she fell to the ground stating she had no control over this. She had to lay and wait a little while before she could get herself up. She was weak the next day but feeling some better today.


VAERS ID: 1378446 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Hallucination, Hypoaesthesia, Malaise, Nausea, Pyrexia, Vasoconstriction, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Extreme fever, 104.1 Temporel thermometer, nausea vomiting, malice fatigue, lightheaded dizziness, hallucinations with the fever, Vasoconstriction that included numbness of hands and extremities. Fever exceeds the 48 hour mark only brought down by ibuprofen and acetaminophen alternating Q3 hours then bringing the fever down to 100.1 on average between doses


VAERS ID: 1378514 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-23
Onset:2021-06-04
   Days after vaccination:73
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Appendicitis
SMQs:

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Gabapentin, propranalol, omeprazole, Daisy (birth control), stool softener, Metamucil
Current Illness: none
Preexisting Conditions: lower back pain, knee pain
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Appendicitis appeared 2.5 months after 2nd dose.


VAERS ID: 1378523 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Disturbance in attention, Feeling abnormal, Headache, Hot flush, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Headache, Nausea, hot cold flashes, fever, dizziness, foggy thought and trouble concentrating


VAERS ID: 1378562 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose, Cardiac monitoring, Heart rate decreased, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none known
Diagnostic Lab Data: EMTs checked blood glucose, heart rate, blood pressure. Heart monitor applied due to low heart rate.
CDC Split Type:

Write-up: Patient received vaccine and within 5 minutes he lost consciousness. He came to and was oriented to place and time. Called 911. He was monitored and refused to go to hospital. He left pharmacy about 30-45 minutes later and felt ok.


VAERS ID: 1378573 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-21
Onset:2021-06-04
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Breakthrough COVID


VAERS ID: 1378743 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH #EW0187 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Glossodynia, Injection site induration, Pain, Pain in extremity, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), 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: Simvastatin, Lisinopril-HCTZ, 81 mg Aspirin, Loratadine, Wixela 250, Restasis, Refresh, Vyzulta,
Current Illness: None
Preexisting Conditions: Asthma, hypertension
Allergies: Shellfish, perfumes, different scents/cleaning products,
Diagnostic Lab Data:
CDC Split Type:

Write-up: The left side of my throat started swelling around 2:30 pm, on Friday, ?June 4, although my breathing and swallowing were not impacted. I put a piece of hard candy in my mouth, hoping this would clear up. The area beneath my tongue on the left side began to be painful about 10 minutes later. This was evident whenever I swallowed or moved my tongue, such as in swallowing and speaking. (Note: these continued until 1:30 am; I tried to stay awake until it all dissipated but I felt drained and exhausted.) After 35 minutes I left the ?recovery? area, reported my symptoms and took a bottle of water. In my car I used my inhalant, finished my water and waited another ten minutes. The coolish water helped the swelling feel better. Once home I hydrated a lot with water, and found the cool water eased symptoms only if temporarily. As the night progressed the symptoms eased a little. When I awoke the next morning, Saturday, June 5, the swelling had gone down a lot and the under-tongue pain was much lighter. My arm, though, was achy when I moved my arm around but I did not feel the need to take pain relief medication. I continued to use and move my arm and the pain decreased. By the end of the night there was little discomfort, but the injection site muscles started to harden. Ar3 these all normal currencies?


VAERS ID: 1378754 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-29
Onset:2021-06-04
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram head, Computerised tomogram thorax abnormal, Deep vein thrombosis, Dizziness, Headache, Pain, Pyrexia, Ultrasound Doppler abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: HTN
Allergies: None
Diagnostic Lab Data: CT Scan Head/CT Chest/US Leg
CDC Split Type:

Write-up: Headache, dizziness, pain, aches and fever. DVT in right leg causing extreme, unbearable pain. Has never had history of clotting.


VAERS ID: 1378756 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Feeling abnormal, Headache, Immediate post-injection reaction, Injection site pain, Lymphadenopathy, Pain, Sleep disorder
SMQs:, Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: At time of injection I got an instant headache. Next day felt odd, headache still there, injection site very sore, noticed extremely puffy lymph nodes in left armpit. Took Tylenol 500mg, no help. That night armpit more puffy and noticed lymph?s in left side of neck were puffy, still had headache. Could not sleep on left side because of pressure of body on arm. Next day still had headache and even more puffy lymph?s in arm and sore, took 600mg ibuprofen, eased headache, took 1000mg Vita C. Later took another 600mg ibuprofen, headache went away. Overnight still too puffy and sore to sleep on that side. Next day took 1000mg Vita C, 600mg ibuprofen. Went to work, noticed in the afternoon that the puffy swelling had reduced a little and not tender in the armpit, Neck still the same.


VAERS ID: 1378760 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Pfizer COVID19 vaccine
CDC Split Type:

Write-up: Myocarditis


VAERS ID: 1378781 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: BP taken and was 100/69
CDC Split Type:

Write-up: pt fainted within a couple of minutes and then appeared to have a seizure (brought arms towards body), this was witnessed by patient''s mother. Vaccinator arrived and while talking to pt the same thing happened.


VAERS ID: 1378805 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Headache, Injection site pain, Nausea, Pain in extremity
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Areds capsules 2 capsules daily Eye promise dry eye 2 capsules daily Blink gel eye drops two drops daily
Current Illness: Right eye ulcers
Preexisting Conditions: Dry eyes
Allergies:
Diagnostic Lab Data: No tests and no labs.
CDC Split Type:

Write-up: Headache and nausea at 3:00am on 04jun2021. No treatment given. Drank plenty of water throughout the day. Headache and nausea resolved approximately 8:00pm 04Jun2021. Left arm soreness at time of injection at injection site.


VAERS ID: 1378806 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Injection site erythema, Injection site reaction, Injection site swelling, Rash erythematous, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Supplemental vitamin D
Current Illness: Iron deficiency anemia, low vitamin D
Preexisting Conditions: n/a
Allergies: nkda
Diagnostic Lab Data: 1920 110/66 73bpm 14 99%
CDC Split Type:

Write-up: Patient is a 15 year old female who presents following administration of the second dose of Pfizer COVID19 vaccine in the left deltoid. Patient states that she developed a tender, pruritic, red rash at the site of the injection about 10 minutes following the administration. She relates that she also developed smaller red rashes on the left distal portion of the arm. She states that this did not happen with her first dose of Pfizer vaccine. She states she also feels slightly dizzy, but relates that she only at a grilled cheese for lunch and minimal water intake. She denies a history of anaphylaxis and denies allergies to medications, foods, other vaccines. She affirms a past medical history of low vitamin D (currently treated with supplemental vitamin D gummies) and low iron (untreated). She further relates that she had her tonsils removed about 1 year ago. She denies chest pain, difficulty breathing, swelling of the face/lips/tongue/throat, skin rash/itching, cramping abdominal pain, nausea, and vomiting. Exam (update as needed): GEN: Alert and oriented x 4, NAD. HEAD: NCAT EYES: PERRL, EOMI ENT: Ears normal, Nose normal, OP normal with exception of no tonsils noted, no evidence of angioedema NECK: Supple, without LAD. CV: RRR, no m/r/g PULM: Clear to auscultation bilaterally, no accessory muscle use ABD: Soft, no tenderness. SKIN: Skin warm and dry. 0.5mm ecchymosis noted 2 cm below the AC joint and in the correct anatomical position for IM injection. Roughly 5cm of erythema and edema of the left deltoid injection site. The area is mildly tender to palpation, but nonfluctuant. Two 0.5cm erythematous macules located on the left forearm that are nonfluctuant and nontender to palpation. MSK: FROM, MS 5/5 NEURO: Alert and oriented x 4, CN 2-12 grossly intact, no ataxia, gait steady Clinical Impression/Field Tx: Vaccine site reaction. Vital signs within normal limits. Physical exam otherwise normal. Gave patient 10mg OTC Zyrtec from her personal supply. About 30 minutes following administration, the vaccine site was significantly less erythematous and edematous. Patient did not develop any other symptoms. Patient felt comfortable leaving the site. Advised patient and parent that patient should take 25mg diphenhydramine PO once, once they arrive at home. Instructed patient to consult the patient?s PCP regarding the post-vaccination reaction. Patient instructed to go to emergency department should she develop chest pain, difficulty breathing, swelling of the face/lips/mouth/tongue/throat, worsening skin rash, or cramping abdominal pain with nausea/vomiting. Patient and parent demonstrated understanding of post-vaccination instructions. Medications administered: Patient self administered 10mg of Zyrtec. Disposition: Home


VAERS ID: 1379010 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling abnormal, Head discomfort, Headache, Impaired work ability, Pain, Pain in extremity
SMQs:, Dementia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin zinc, potassium, K-2, magnesium, and COQ-10
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Head ace the next day could not work, had to go home. Felt like my head had a lot of pressure. Body was aching really bad and my legs were also in pain. Got home and just took a nap, but felt like if I was not all there. Head was hurting so I took Advil every 8hrs on Friday. Saturday was better and head pressure went down, but most of Saturday I was recovering


VAERS ID: 1379024 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

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

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

Write-up: Patient was administered 2nd dose on day 16. earliest date should be day 17


VAERS ID: 1379067 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dyspepsia, Electrocardiogram, Epigastric discomfort, Laboratory test, Troponin normal, X-ray normal
SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

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

Write-up: 64-year-old female with history of angina nitrates presents from vaccine clinic with chest pain slightly different than her classic chest pain. Also has history of fibromyalgia and chronic neck pain. Initial complaint was of epigastric discomfort and burning however given her history EKG obtained initial enzymes. EKG with some flipped T waves that have flipped back and forth in prior EKGs as well. She had a negative troponin. During her stay she had that pain resolved and that her chronic pain returned, this improved as well with nitro and morphine, EKG did not change on repeat and repeat troponin continued to be negative. Given patient''s history she is already on significant risk factor modification, is requesting to be discharged and I believe that close follow-up with her cardiologist is a reasonable plan given serial negative troponins. Low suspicion for PE dissection or other acute pathology. X-ray unremarkable.


VAERS ID: 1379529 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Feeding disorder, Feeling abnormal, Headache, Insomnia, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: prozac magnesium vitamin b complex
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 6/4/21 at 9:20pm
CDC Split Type:

Write-up: symptoms: fever (up to 102) chills headache dizziness naesous body aches treatment: ibuprofen outcome: miserable, couldn?t sleep or eat and the fever wouldn?t break. the ibuprofen made the headache go away


VAERS ID: 1379530 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Cardiac imaging procedure abnormal, Chest pain, Dyspnoea, Echocardiogram normal, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Fatigue, Headache, Hyperhidrosis, Myocardial oedema, Pyrexia, Troponin increased, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (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? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Not applicable
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 6/1/2021, EKG showed diffuse ST elevations. Echo done was normal . Troponin was intially 4.63 and trended up to 18.80. Cardiac MRI was done 6/5/21 which revealed edema.
CDC Split Type:

Write-up: Patient started having generalized weakness, fatigue, fever and headache after the second dose of his Moderna Covid-19 vaccine. These symptoms persisted throughout the next day. However, two days after the second Covid-19 shot patient developed severe chest pain that resulted in presentation in the ED. There was associated shortness of breath and diaphoresis. He was treated with Colchicine and Ibuprofen. He was also started on metoprolol because he had an 11-beat run of non-sustained ventricular tachycardia. He was discharged home on the fourth day to follow up with cardiology as outpatient.


VAERS ID: 1379720 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Full blood count normal, Heart rate increased, Metabolic function test normal, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Keflex 500mg BID
Current Illness: None
Preexisting Conditions: None
Allergies: Augmentin
Diagnostic Lab Data: Only CBC and CMP in ER which came back normal.
CDC Split Type:

Write-up: Nausea and vomiting started just after midnight, every 30 minutes, then increased to constant every 5 minutes by 0500. 0630 intractable and heart rate in 130s. Taken to ER where 2 boluses of fluids and Zofran given. 1200 she still could not get an ice chip down without vomiting and heart rate remained between 110-140. Admitted to pediatric floor for observation and fluids. About 1600 she was able to hold down spoonful of fluids. By 1900 she was totally back to feeling good and was able to hold down mac-n-cheese, ice cream, crackers with no nausea.


VAERS ID: 1379727 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-28
Onset:2021-06-04
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amitriptyline 25mg, Topiramate 25mg, Sumatriptan 50mg, and Alprazolam 1mg
Current Illness:
Preexisting Conditions: Migraine headache, depression, anxiety
Allergies: no known drug allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s husband reported that patient noticed on 6/4/2021 bumps and itchy rash on her stomach , side of torso, and back (not as prominent on back). Bumps and rash have grown in size and seem pustule and "zit-like". Patient will continue to monitor rash size and temperature. If any drastic changes in temperature or rash size/status, patient will seek medical attention.


VAERS ID: 1379741 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-29
Onset:2021-06-04
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Injection site bruising
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: I felt pain on the right side of my abdomen on June 4th. I see a bruise on the site on June 7th.


VAERS ID: 1379747 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Immediate post-injection reaction, Injection site pain, Wrong technique in product usage process
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Arthritis (broad), Medication errors (narrow)

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

Write-up: Shot was placed too high on arm. Shot was given too high/too deep. Experience immediate intense injection pain. Likely pierced bursa. Improper and poor technique. Reported to administrator of shot and emt on site. 3 days later having shoulder pain.


VAERS ID: 1379750 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Chest pain, Electrocardiogram ST segment elevation, Laboratory test, Nasopharyngitis, Nausea, Red blood cell sedimentation rate increased, Troponin increased, Vomiting
SMQs:, Acute pancreatitis (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: mild cold symptoms started the day after the vaccine given-lasted for 2 days
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 6/7/2021: Troponin- 30; ESR- 35; CRP- 3.5; EKG- ST elevation; other labs from ER in process
CDC Split Type:

Write-up: Pt started with mild cold sxs the day after the vaccine. Then 2 days after the vaccine in the evening developed chest pain - mid sternal - when going to bad. Vomited x1 and pain resolved and fell asleep. Next day also with an episode of chest pain in the pm but more severe and also with n/v; took to ER but left before evaluation done bc pain resolved. The following day 2 more episodes of chest pain less severe. 5 days later sought care for follow up- EKG and labs abnormal so sent to ER for further evaluation.


VAERS ID: 1380226 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Headache, Insomnia, Nervousness, Oropharyngeal discomfort, Pain, Pain in extremity, Paraesthesia oral, Pharyngeal hypoaesthesia, Pyrexia, Throat tightness, Tongue disorder
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamin E, Fish oil
Current Illness: None
Preexisting Conditions: Psoriasis on my feet=was not taking any oral medication, only topical and lotions
Allergies: Penicillin, amoxicillin, shellfish
Diagnostic Lab Data: None taken
CDC Split Type:

Write-up: A couple of hours or so after the second vaccine my body felt achy and feverish. Also started to get the chills and then a headache. The symptoms gradually got worse over the course of time, took a couple of Advil and went to bed. It was difficult to sleep as my legs ached so badly I could not get into a comfortable position. As the night progressed and and fell in and out of sleep, the pain and especially the chills and headache were unbearable. I woke up around 10-11 pm with my throat numb, feeling tight, my tongue was numb at the back and the front area of my tongue was numb and tingling. I was nervous and scared to go back to sleep. My family all asleep and did not want to unnecessarily awaken them. I put myself into an upright position for fear of anaphylaxis. Considered calling 911= but we live in a quiet community and waited to see if it got worse. I did not sleep all night, finally got some rest while sitting upright. The following day all the symptoms were there and fever, chills and body aches worsened. My temp was around 101. Drank a lot of water. Today, my throat does not feel the same. Feels like something is there but cannot describe the feeling. Have been tired these past couple of days. Not usual for me but cannot say it is due to the vaccine. I will comment in that I never had the chills so bad as I had experience with actually being sick. Was horrible.


VAERS ID: 1380687 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-06-04
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia oral, Nausea, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Breast cancer (Diagnosed in 2019, in remission since 2020)
Preexisting Conditions: Comments: no known allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210611869

Write-up: DIZZY; TINGLY ALL OVER BODY; LITTLE NUMBNESS IN TONGUE; NAUSEA; This spontaneous report received from a patient concerned a 40 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included in remission breast cancer, and other pre-existing medical conditions included no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A, and expiry: UNKNOWN) dose was not reported, administered on 03-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 04-JUN-2021, the subject experienced dizzy. On 04-JUN-2021, the subject experienced tingly all over body. On 04-JUN-2021, the subject experienced little numbness in tongue. On 04-JUN-2021, the subject experienced nausea. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from dizzy, tingly all over body, little numbness in tongue, and nausea. This report was non-serious.


VAERS ID: 1381358 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-06-04
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 201A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Haemorrhage
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: SERTRALINE
Current Illness: Abstains from alcohol; Non-smoker; Penicillin allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210612348

Write-up: EXCESSIVE BLEEDING; This spontaneous report received from a patient concerned a other, Hispanic or Latino male of unspecified age. The patient''s height, and weight were not reported. The patient''s concurrent conditions included no alcohol, non-smoker, penicillin allergy. The patient experienced drug allergy when treated with clarithromycin for drug used for unknown indication. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 201A21A, expiry: unknown) dose was not reported, 1 total dose was administered on 04-JUN-2021 to right arm for prophylactic vaccination. Concomitant medications included Sertraline (100 mg once daily) used for unknown indication. On 04-JUN-2021, the patient experienced excessive bleeding when he tried to cut his nails and scratch his beard but the bleeding did not stop. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from excessive bleeding. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0.20210612348-Covid-19 vaccine ad26.cov2.s -excessive bleeding . This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


VAERS ID: 1381668 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-03
Onset:2021-06-04
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Anaemia, Arthralgia, Blood albumin decreased, Blood culture negative, Blood fibrinogen increased, C-reactive protein increased, Complement factor normal, Culture throat negative, Culture urine negative, Fibrin D dimer increased, Haemoglobin, Joint swelling, Mycoplasma test negative, Peripheral swelling, Pyrexia, Rash, Respiratory viral panel, Sterile pyuria, Streptococcus test, Urticaria, White blood cell count increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Tubulointerstitial diseases (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: CRP elevated to 74, elevated D dimer, elevated fibrinogen, anemia from Hgb 14-$g10, albumin 2.7, sterile pyuria 25 WBC, normal complements, ASO titer, negative blood, urine, and throat cultures, negative respiratory panel for 15 pathogens, including mycoplasma (6/6-$g6/8/21 for all testing)
CDC Split Type:

Write-up: Fever, urticarial rash to face, neck trunk, and extremities, arthralgias and swelling to hands, feet, ankles, left knee and left elbow occurring 4 weeks after vaccine lasting for 4 days in hospital after 2 days at home. still resolving slowly


VAERS ID: 1381720 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood urine present, Micturition urgency, Pyrexia, Renal pain, Urine analysis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Estrogen, progesterone, vitamins D and B, fish oil, turmeric, calcium
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Urine test at 6:00 PM on 6/4/21 showed blood in urine. Waiting for culture to show if infection was present
CDC Split Type:

Write-up: Approximately 48 hours after my second Covid vaccine, I spiked a fever of 101.5 and had extreme kidney pain. Frequent urge to urinate. I ended up going into the doctor to have a urine test checking for a bladder infection. Blood was found in my urine. My doctor put me on an antibiotic. I have not had a bladder infection in over 20 years and I have never had kidney pain.


VAERS ID: 1381764 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / UNK - / IM

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

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

Write-up: patient misrepresented her age twice, once on registration then again when verbally asked.


VAERS ID: 1381807 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-04-13
Onset:2021-06-04
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

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

Write-up: Patient received first dose of COVID-19 vaccine (Moderna) on 4/13/21. The second dose of COVID-19 vaccine was Pfizer-BioNTech, which was administered on 6/4/21.


VAERS ID: 1381816 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-25
Onset:2021-06-04
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Blood triglycerides increased, Injury
SMQs:, Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Lipodystrophy (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: Lo loestrin, Paroxetine, Losartin, Lovastatin, Atomoxetine, Topamax, Melatonin, Omeprezole,
Current Illness: None
Preexisting Conditions: Elevated BP, Elevated triglycerides, Anxiety
Allergies: Oxycodone
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Continuous pain in joints and areas with old injuries


VAERS ID: 1381854 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-05
Onset:2021-06-04
   Days after vaccination:60
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 AR / IM

Administered by: Public       Purchased by: ?
Symptoms: C-reactive protein increased, Cardiac imaging procedure abnormal, Catheterisation cardiac normal, Chest pain, Dyspnoea, Dyspnoea exertional, Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Myocarditis, Red blood cell sedimentation rate increased, SARS-CoV-2 antibody test, Troponin increased, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: ESR -42 6/8/21 CRP 82 6/8/21 Troponin 2.23 6/8/21 Covid Spike Protein Domain Antibody $g250 6/7/21 Echo: 1. Normal global left ventricular systolic function. 2. Left ventricular ejection fraction, by visual estimation, is 55 to 60%. 3. Trivial pericardial effusion.
CDC Split Type:

Write-up: Chest pain, SOB, DOE Pt presented to hospital - transferred to university hospital - underwent LHC which was clean - Troponin rose to 2.23 - ESR, CRP elevated - active chest pain, EKG w/ diffuse ST elevation - myopericarditis - Cardiac MRI - colchicine/ibuprophen - developed NSVT, required beta blockade


VAERS ID: 1381895 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / N/A RA / IM

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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prednisone 10 mg- 3 tabs X 3 days. 2 tab X 3 days, 1 tab X 3 days Benadryl OTC- 1-2 tablets every 4-6 hours Subutex 8mg- 1/2 tab every day
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash


VAERS ID: 1381939 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dysphagia, Fatigue, Flushing, Headache, Hyperhidrosis, Incorrect dose administered, Lethargy, Respiratory symptom, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (broad), Medication errors (narrow), Hypoglycaemia (broad)

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

Write-up: Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Mild, Systemic: Chills-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: respiratory symptoms-Mild, Systemic: Flushed / Sweating-Medium, Systemic: Headache-Medium, Error: Wrong Dose of Vaccine - Too High


VAERS ID: 1381963 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0049C21A / 2 LA / IM

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

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

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


VAERS ID: 1381969 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Anal incontinence, Blood test, Cardiac monitoring, Dizziness, Echocardiogram, Electrocardiogram, Heart rate increased, Loss of consciousness, Pyrexia, Slow response to stimuli, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: EKG, Echocardiogram, Blood Work, Heart Monitor 6/4/2021
CDC Split Type:

Write-up: Fever the following morning. Then, 38 hours after shot: abdominal cramping, rapid heart beat, dizziness while laying in bed. Then, upon standing, passing out with loss of bowels and bladder and a tonic response.


VAERS ID: 1382003 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Chills, Pyrexia, Rash, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Complaining of chest tightness in the morning, then it progressed to pain, subjective fever, chest, rashes on arm and face, shivering. Feels throat is tightening.


VAERS ID: 1382008 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Muscle spasms, Nausea
SMQs:, Acute pancreatitis (broad), Dystonia (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: growth hormone pentaza
Current Illness:
Preexisting Conditions: crohns disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: arms and legs are cramping feels nauseous, Tylenol 4:30am


VAERS ID: 1382028 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Impaired work ability, Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Patient had severe left shoulder/arm pain around the site of injection that continued after injection, worsened by his physical job as a custodian, he had to miss work due to this for several days, still moderate/severely painful to complete physical tasks using the left arm 5 days later (today, 6/8/21)


VAERS ID: 1382035 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Patient denied.
Diagnostic Lab Data: Unknown.
CDC Split Type:

Write-up: Patient reported intermittent chest pain and numbness in her extremities that began approximately 12 hours after receiving the vaccine and ceased after 24 hours.


VAERS ID: 1382037 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-30
Onset:2021-06-04
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypersensitivity, 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: NONE
Current Illness: NONE
Preexisting Conditions: ALLERGIES
Allergies: HE HAS A HISTORY OF ALLERGIES, AND food products also. but not to medications. ALLEGIC TO NSAIDS
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PT SAID HE GOT THE SHOT ON 5.30.21, HIS 2ND DOSE, THEN IN 6.4.21,, EARLY IN THE MORING, HE WAS FULL OF HIVES ON HIS ARMS ONLY. BOTH ARMS, THE PT TOOK SOME BENADRYL AND CORTISONE CREAM. IT RELIEF THE ITCHING. HE CAME TO THE PHARMACY ON 6.7.21, TO LET ME KNOW WHAT HAPPEN. HE SHOW ME HIS ARM AND IT WAS AL CLEAR. I TOLD HIM IF HE HAS A BREAK OUT TO FOLLOW WITH HIS DR IF THESE FLAIRS UP AGAIN. HE IS GETTING ALLERGY TESTED, HE SAID HE DINT CHANGED ANYTHING IN HIS DIET, OR NEW MEDICATIONS. ITS SEEMS IT WAS DELAYED HYPERSENSITIVITY REACTIONS TO COVID VACCINE


VAERS ID: 1382039 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Military       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram PR segment depression, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Myocarditis, Pericarditis, Troponin I increased, Troponin increased
SMQs:, Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Troponin I (initial): 0.519 ng/mL (6/4/21, 1021) (ref range <.034) Troponin I (peak): 31 ng/mL (6/4/21, 2321) EKG: Diffuse ST elevations w/ PR depression in aVR
CDC Split Type:

Write-up: Acute myopericarditis: chest pain, presenting w/ EKG findings of pericarditis and elevated troponins; improved w/ pain medications and supportive care; no significant complications at time of report (patient remains admitted for care coordination)


VAERS ID: 1382041 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Erythema, Fatigue, Hypoaesthesia, Pain, Paraesthesia, Pruritus, Pyrexia, Skin warm, Tenderness
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Chills, fatigue. fever(100.9), bodyaches. Redness, warmth, tenderness, itching, tingling and numbness in right arm and fingers.


VAERS ID: 1382048 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-22
Onset:2021-06-04
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood lactate dehydrogenase normal, Blood uric acid normal, Differential white blood cell count normal, Full blood count normal, Lymph node pain, Lymphadenopathy, Metabolic function test normal
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: MMR - 6 months old; rash
Other Medications: Budesonide nasal spray 2 sprays each nostril once daily Miralax prn
Current Illness: none
Preexisting Conditions: Allergic rhinitis Asthma
Allergies: EGGS
Diagnostic Lab Data: CMP, CBC with diff, LDH, uric acid obtained 6/7/21; all labs normal
CDC Split Type:

Write-up: Day 13 after Pfizer vaccine, patient felt a lump below clavicle on R side Saw Dr. 6/5 - per prescriber, ~ 1.5 cm lymph node subclavicle; tender, discrete, moveable No other lymph nodes of concern As of 6/8 - lymph node still same size


VAERS ID: 1382051 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Head injury, Hypoxia, Seizure, Vomiting
SMQs:, Acute pancreatitis (broad), Asthma/bronchospasm (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

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

Write-up: While giving a Pfizer Covid vaccine today, a patient appeared to be fine but after a few minutes suddenly passed out and had a short 3-4 second seizure on the ground. He did hit his head and appeared to be hypoxic. We called 911 immediately and informed store management. The paramedics asked him to walk off on his own power, but they did offer to escort the family to Hospital which I believe was accepted. His mother and sister were present too.


VAERS ID: 1382054 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

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

Write-up: RAPID HEARTBEAT. LASTED FROM 7PM TO 6:45 AM NEXT DAY


VAERS ID: 1382059 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Epistaxis, Headache
SMQs:, Haemorrhage terms (excl laboratory terms) (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: Covid 19 (pfizer brand)-Febr. 1, 2021- severe diarrhea (lasted week), Caught covid 3 weeks later.
Other Medications: 81 mg Aspirin, thyroxine, metoprolol succinate, glipizide xl, folic acid, multi-vitamin, calcium supplement, diazepam 10 mg, nifedipine ER 90 mg, leflutamide 20 mg, (arava), methotrexate 2.5 mg tablet, allopurinol 300 mg, simponi infusion e
Current Illness: none
Preexisting Conditions: rheumatoid arthritis, high blood pressure, thyroid condition, osteoporosis, gout, restless leg syndrome, diabetes,
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Headache for 2 days and nose bleed that lasted 25 minutes in left nostril. Nose bleed started the evening that vaccine was given. Patient had received Pfizer vaccine (one dose) on February first and then caught Covid-19 three weeks later. Her doctor at emergency room told her to start the series over again. She wanted to then get Moderna since she had such bad side effects with Pfizer brand.


VAERS ID: 1382087 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Electrocardiogram, Hypoaesthesia, Intervertebral disc protrusion, Magnetic resonance imaging, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Bloodwork, EKG and MRI on Monday June 7th
CDC Split Type:

Write-up: Tingly feeling and numbness throughout my body since the vaccine shot. No other symptom but it is constant. Visited the ER on Monday June 7th - testing only revealed a bulging disc in the neck. Doctors do not believe it is related to the vaccine


VAERS ID: 1382117 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immunisation, No adverse event, Syringe issue, Underdose
SMQs:, Medication errors (broad)

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

Write-up: WHILE ADMINISTERING THE VACCINE, THE MAJORITY OF THE VACCINE LEAKED OUT OF THE SYRINGE AT THE NEEDLE JUNCTION. THE NEEDLE IS NOT SUPPOSED TO COME APART FROM SYRINGE OR NEED TO BE TIGHTENED AS THEY ARE SEALED, SO THE SYRINGE MALFUINCTIONED. SINCE MOST OF THE VACCINE WAS NOT ADMINISTERED, PT MOM DECICED TO RE-VACCINMATE AFTER DISCUSSING WOTH THR RPH THROUGH SHARED CLINICAL DECISION MAKING. NO ADDITION ADVERSE EVENT HAVE BEEN REPORTED SINCE


VAERS ID: 1382128 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / SYR

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

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

Write-up: Break out and swollen left arm. Extremely itchy


VAERS ID: 1382131 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

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

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

Write-up: Patient received dose of Jannsen vaccine as 17 years old, when agency indication was 18 years old. Event reported to state authorities as well. Patient did not experience any side effects and is now considered vaccinated by the state.


VAERS ID: 1382150 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Chills, Cough, Oropharyngeal pain, Pyrexia, Rhinorrhoea, Sneezing
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: ON 6/4/2021 AROUND 1:00 AM, CLIENT STARTED WITH CHILLS AND FEVER. SYMPTOMS PROGRESSED TO INCLUDE JOINT PAIN, SORE THROAT, COUGH, SNEEZING AND RUNNY NOSE. ADVISED CLIENT TO GO TO PCP. CLIENT STATES THAT SHE DOES NOT HAVE A PCP, DOES NOT HAVE INSURANCE AND DOES NOT HAVE A JOB. AVISED TO GO TO NEAREST HOSPITAL ER TO BE CHECKED OUT.


VAERS ID: 1382182 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE REPORTED
Current Illness: NONE REPORTED
Preexisting Conditions: NONE REPORTED
Allergies: NONE REPORTED
Diagnostic Lab Data: NONE
CDC Split Type: TX29

Write-up: 3:17 PM-DIZZNESS AND NAUSEA AFER GETTING VACCINE. PATIENT WAS GIVEN WATER AND GATORADE. BP:120/72 PR:65


VAERS ID: 1382190 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-05
Onset:2021-06-04
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Malaise, 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? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Proventil Flonase Neurontin Robaxin Ultram
Current Illness: None known
Preexisting Conditions: Lymphoma COPD
Allergies: PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: This is a 60 y.o. patient with a past medical history significant for DLBCL, hypogammaglobulinemia, anemia, COPD, peripheral neuropathy, chronic back pain, and tobacco abuse who presented to ED for symptoms of fevers, chills, malaise. Pt states that she has been fevering since the beginning of April, when she was diagnosed with COVID.


VAERS ID: 1382197 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: No immediate adverse events witnessed. Patient received 2 doses of Janssen vaccine. Duplication of dosage was discovered upon billing insurance. Patient received 1st dose on 5/3 at pharmacy. Second dose was given on 6/4 at different pharmacy. Upon initial interview of patient before administration, no mention was made of previous vaccine doses. After vaccine was administered the patient remained on site for 15 minutes for observation and no adverse reactions were noted. There has been no contact made with the patient since.


VAERS ID: 1382214 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Periorbital swelling, Rhinorrhoea, Swelling face, Throat irritation, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydroxychloroquine and Allegra
Current Illness:
Preexisting Conditions:
Allergies: Do have some slight to moderate food and seasonal allergies
Diagnostic Lab Data: I did not take a medical test after the incident however I made an appointment with an allergist on June 12th and my clinic on June 10th before taking the second dose of the Pfizer vaccine.
CDC Split Type:

Write-up: Was fine before the COVID19 vaccine shot. After 15 minutes of observation, I experienced a runny nose which I was told was fine. About an hour later, I experienced slight swelling under my left eye and cheek. A few minutes after, my throat began to have a scratchy feeling and a slight wheezing which was concerning. As soon as I experienced this feeling, I took one Benadryl immediately. After about a half an hour, the swelling under my eye and cheek gradually went down, my runny nose stopped after a few minutes , and my throat itching stopped after about 15 to 20 minutes. I felt fine afterwards.


VAERS ID: 1382224 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Desloratadine, Vitamin D3, MVI
Current Illness: None
Preexisting Conditions: Personal hx of melanoma, vitamin D deficiency, nontoxic goiter
Allergies: Doxycycline, lacrilube, ibuprofen, penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: COMES IN FOR ACUTE VISIT FOR RASH REACTION AFTER HER SECOND COVID VACCINE. HAD FATIGUE X 2 DAYS, NO OTHER SX FROM VACCINE EXCEPT REACTION AT ARM THAT SHE IS CONCERNED ABOUT SINCE IT IS MOVING DOWN AND AROUND HER ARM. STARTED WITH REDNESS DAY AFTER VACCINE, LEFT UPPER ARM AT SHOULDER AREA. THEN NEXT DAY MOVED DOWN TO MID ARM AND THEN YESTERDAY AND TODAY MORE AT MID ARM EXTENDING TO MEDIAL ARM. THE REDNESS AT SHOULDER AREA AND NEAR SHOULDER HAS RESOLVED. NOT REALLY PAINFUL, MORE JUST A LITTLE IRRITATED/ A LITTLE ITCHY. NO PAIN IN MUSCLE, GOOD ROM SHOULDERS. NO LUMP NOTICED AT ARMPIT.


VAERS ID: 1382238 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Abdominal pain lower, Abdominal pain upper, Appendicitis perforated, Chills, Lymphocyte count increased, Nausea, Neutrophil count increased, Pyrexia, Vomiting, White blood cell count increased
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal perforation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin and tree nuts.
Diagnostic Lab Data: Available if needed. Elevated neutrophils, lymphocytes and WBC counts.
CDC Split Type:

Write-up: 17 hours post dose, pt started with low grade fever, chill and nausea. 22 hours post dose she began vomiting and complaining of on and off stomach pain. 36 hours later on Sat June 6, she presented with severe lower right quadrant pain and we went to ER. Diagnosis was perforated appendix requiring emergency appendectomy and treatment for 72 hours with IV Cipro and Flagyl. She was discharged from hospital on Tues, June 7th on Cipro 500 mg BID po for 3 days.


VAERS ID: 1382254 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 2 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Abdominal pain upper, Diarrhoea, Dyspnoea, Hypoaesthesia, Impaired work ability, Malaise, Paraesthesia, Pyrexia, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: -Thursday 6/3, received 2nd Moderna vaccine here in clinic before lunch -Friday 6/4, reported to work but left within an hour on sick leave -Saturday 6/5, severe malaise, SOB, numbness/tingling hands, fever (would not reduce), diarrhea/stomach cramps reported to ER approx.. 1600 ? given IV fluids, potassium, discharged approx. 2300 with diagnosis probable severe vaccine reaction OTC meds. -Sunday 6/6, malaise and diarrhea/cramps, NO SOB, NO fever, NO hand numbness/tingling -Monday 6/7, still has malaise and stomach cramps, but they are improving


VAERS ID: 1382281 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Computerised tomogram thorax normal, Echocardiogram normal, Exposure during pregnancy, Inappropriate schedule of product administration, Myocarditis, Troponin increased
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Prenatal Vitamin
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKA
Diagnostic Lab Data: 24 yo G2P1001 at 34w5/7 with EDD 7/9/21 received TDAP vaccination and Janssen COVID vaccination on 6/2/21. Presented to hospital 6/4/21 complaining of squeezing chest pain. Elevation of troponins. CT chest negative for pulmonary embolism or other pathology. Maternal echocardiogram negative for cardiomyopathy or structural heart disease. Leading diagnosis myocarditis with patient treated with IV steroids and hospital observation. Discharged home safely 24 hours following admission.
CDC Split Type:

Write-up: 24 yo G2P1001 at 34w5/7 with EDD 7/9/21 received TDAP vaccination and Janssen COVID vaccination on 6/2/21. Presented to hospital 6/4/21 complaining of squeezing chest pain. Elevation of troponins. CT chest negative for pulmonary embolism or other pathology. Maternal echocardiogram negative for cardiomyopathy or structural heart disease. Leading diagnosis myocarditis with patient treated with IV steroids and hospital observation. Discharged home safely 24 hours following admission.


VAERS ID: 1382286 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: was vaccinated six days before she should have received her second dose. Her first dose of Moderna was administered on May 13, 2021 and her second dose was administered on June 4, 2021. Her second dose was administered on Day 22.


VAERS ID: 1382287 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea, Myalgia, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), 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: escitalopram, HCT, vit D, MV, Naproxen
Current Illness: unknown
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 8 hour later sudden onset fever 103, vomiting, diarrhea, myalgia, lasting 4 days.


VAERS ID: 1382315 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 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? 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: Dose was administered 1 hour after dose expiration. Dose expired at 1425 and he was given an expired dose of Pfizer Covid Vaccine at 1530. Contacted Pfizer as well as Dept. of Health. Pfizer had no recommendations to repeat the dose. The state contacted CDC and responded with "Here is what current guidance states: Dose administered after improper storage and handling (e.g., temperature excursion, more than allowed time after first vial puncture) Contact the manufacturer for guidance. If the manufacturer provides information supporting that the dose should be repeated, the repeated dose may be given immediately (no minimum interval) in the opposite arm. Pfizer does not give guidance to repeat dose so dose was not repeated.


VAERS ID: 1382352 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Chest pain, Dizziness, Electrocardiogram normal, Feeling abnormal, Limb discomfort, Lymphadenopathy, Monoplegia, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), 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), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Flonase; Claritin
Current Illness: no
Preexisting Conditions: ADHD; PTSD; and Autism
Allergies: no
Diagnostic Lab Data: 4th - evening - ER - hospital - EKG - normal; listened to his lungs and heart and those seemed okay. No bloodwork or other tests.
CDC Split Type: vsafe

Write-up: On the 4th - woke up weak; light headed; and a lot of discomfort - his arm really hurt. General body achiness. After a little while, he got up and was able to take some Tylenol and attend his video school day with frequent breaks. In afternoon, he started to feel worse. 102. 6 fever - we called Tele-doc appt. His throat was sore and he had some chest pain. The doctor recommended that we go to ER to have him fully evaluated. Pain and fever got better with the Tylenol. He took another couple of dose. Next morning, he had a lot better but continued to have a low fever 100.2 - on and off that day. His lymph nodes under his left arm were quite swollen and painful. The fever did not continue yesterday but the swelling has and the pain has. He was very light-headed and brain fogged on Sunday and Monday. Seems to be better today - the lymph nodes have gone down a lot but are still swollen today. He is in process of recovering.


VAERS ID: 1382357 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039A21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fatigue, Headache, Migraine, Pain, Periorbital swelling, Pyrexia, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: suboxone, levothyroxine
Current Illness: None
Preexisting Conditions: History of thyroid cancer Substance Use Disorder Migraine Depression Arthritis, Shoulder Pain
Allergies: Ibuprofen, NSAIDS, EGGS
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Had her second dose of the Moderna Vaccine 6 days ago. On day 2 she had a headache, fatigue and fever of 100.9 which went away after 24 hours. The fever was proceeded by eye puffiness and a rash on day 3 in all flexure surfaces, buttocks, bikini line and axillary area included. Rash with sunburn appearance. Called nurse when rash occurred and advised to take benedryl which made her more tired but helped symptoms. Rash went way after 24 hours. Puffy eyes still remain but less pronounced. Patient has picture of rash with her today. Since that time feeling body aches, migraine and fatigue.


VAERS ID: 1382379 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Arteriogram coronary normal, Computerised tomogram thorax normal, Echocardiogram normal, Myocarditis, Troponin I increased
SMQs:, Myocardial infarction (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Echocardiogram showed normal left ventricular systolic function. CTA showed normal coronary arteries. CT PE protocol did not show pulmonary embolism. Troponin I peaked at 47 and then down trended.
CDC Split Type:

Write-up: The patient developed myocarditis several days after receiving the vaccine. He was admitted to hospital and observed for several days before discharge in stable condition.


VAERS ID: 1382423 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 1 LA / IM

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

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

Write-up: 1st dose of Moderna was inadvertently given to an adolescent age 15. Client did not have and noted adverse reactions during time spent immediately after vaccination and within the post-vaccination observation period.


VAERS ID: 1382432 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-03-31
Onset:2021-06-04
   Days after vaccination:65
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Cardiac disorder, Eye swelling, Lung disorder, Pharyngeal swelling, Pulmonary function test, Rash, SARS-CoV-2 test, Sinus disorder, Urticaria, X-ray
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: been back and forth to the doctor many times, but on steroids, antibiotics, and a hand full of other meds. Pulmonary testing, covid testing, x-rays, and set-up to see a specialist about my lungs the 16th.
CDC Split Type:

Write-up: Broke out in hive and a rash, throat swelled, eyes swelled, problems with heart and lungs and sinus issues really bad... lasted over 3 months and still having some effects.


VAERS ID: 1382506 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Agonal respiration, Alanine aminotransferase normal, Blood albumin decreased, Blood calcium decreased, Blood creatinine increased, Blood glucose increased, Blood lactic acid, Blood urea increased, Cerebral atrophy, Cold sweat, Computerised tomogram head abnormal, Cyanosis, Diarrhoea, Discoloured vomit, Full blood count abnormal, Haematocrit decreased, Haemoglobin decreased, Heart rate irregular, Laboratory test, Metabolic function test abnormal, Oxygen saturation decreased, Pallor, Procalcitonin, Protein total decreased, Pulse absent, Red blood cell count decreased, Snoring, Troponin, Unresponsive to stimuli, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiac arrhythmia terms, nonspecific (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pantoprazole 40mg daily; Synthroid 50mcg daily; ASA 325mg daily; MVI daily; Simvastatin 20mg daily; Coreg 12.5mg 2 times day; Gabapentin 600mg 3 times day; Dicyclomine 10mg 3 times day; Celexa 10mg daily; Lorazepam 0.5mg 2 times day; Humal
Current Illness:
Preexisting Conditions: IDDM; OA; CHF; CAD; HTN; HLD; hypothyroidism; dementia
Allergies: none
Diagnostic Lab Data: 6/4/21--troponin 0.05; procal 0.07; lactate 3.1; cmp Ca 8.4, Gluc 136; Alb 3.3; SGPT/ALT 9, CR 2.9 BUN 26; Total protein 6.2 CBC--RBC 3.63; HGB 7.3 HCT 27.8; CT HEAD --persistnet chronic atrophy no acute intracranial pathology.
CDC Split Type:

Write-up: On 6/4/21 at 10:40, res became unresponsive with agonal/snoring respirations, no palpable pulse, but audible apical pulse with irregular rhythm, general pallor nd cyanosis, cool and clammy skin. BP92/58 manual, R 4 initially sats low 90''s. Accucheck 181. required heavy tactile sternal rub; Res vomited large amt of yellow/white vomitus and had large diarrhea episode. She became responsive after sternal rub but shortly thereafter became unresposnive again. MD notified with new orders for labs and head CT.


VAERS ID: 1382552 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0190 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect product formulation administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)


VAERS ID: 1382555 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None as per patient
Preexisting Conditions: Hypertension and Obesity
Allergies: No as per patient
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient, a homebound patient received the COVID19 Pfizer vaccine 0.3 mL IM on 6/4/2021 at 3:07PM. The COVID19 Pfizer vaccine was prepared on 6/4/2021 at 8:20AM. Patient received the his second dose of Pfizer vaccine 47 minutes outside of the required 6 hours window after reconstituting the vaccine. Patient did not have any adverse reactions to the Pfizer vaccination. Follow-up call 6/8/2021, no issues as per patient.


VAERS ID: 1382556 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-19
Onset:2021-06-04
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac failure congestive, Dyspnoea
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Shortness of breath, Congestive heart failure.


VAERS ID: 1382587 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023C21A / 1 RA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Naproxen, Atorvastatin, Flovent, Levothyroxine, lisinopril, Claritin, metformin, sertraline, omeprazole, spironolactone, Ventolin, Imitrex
Current Illness: dysmetabolic syndrome, glucose intolerance, hypothyroid, obesity, depression, GERD, asthma, hyperlipidemia, migraine
Preexisting Conditions: see above
Allergies: cimetidine, ampicillin,
Diagnostic Lab Data:
CDC Split Type:

Write-up: red swollen upper arm, swollen axillary lymph nodes, very painful to touch


VAERS ID: 1382601 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Balance disorder, Chills, Decreased appetite, Dizziness, Fatigue, Headache, Mobility decreased, Nausea, Night sweats, Pain, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Symptom: Sore arm. Pain when lifting. Unable to lift above shoulder height. Began: Within 10 hours of receiving shot Duration: 2 days Symptom: Fever, chills, headache, night sweat, dizziness, fatigue, loss of appetite, nausea, lightheadedness, inability to balance while walking Began: Within 24 hours of receiving shot Duration: 3 days


VAERS ID: 1382665 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-06-01
Onset:2021-06-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / SYR

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

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

Write-up: Itching all over the body. lasted all night. Took some benadryl the next morning and the itching gradually went away.


VAERS ID: 1382916 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Feeding disorder, Feeling abnormal, Headache, Hyperhidrosis, Hypersomnia, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C, zinc, msm, vitamin D, vitamin B Nuerontin, Abilify, Omeprazole, Cymbalta
Current Illness: Chronic Parasite infestation since November 2018 after a tick bite in June 2018
Preexisting Conditions: GERD, Depression, Anxiety, Bi-Polar
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Starting Friday, June 4th I had Chronic fatigue, muscle weakness, headache, sweats, and chills for 4 days. I couldn''t eat or drink anything. All I did was sleep and get up to go pee. I really felt like I was dying.


VAERS ID: 1382945 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-04-30
Onset:2021-06-04
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / UNK LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, SARS-CoV-2 test, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Simvistatin 20mg 1/day
Current Illness: None
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: Covid19 rapid test 6/8/2021
CDC Split Type:

Write-up: Itching over entire body, hives like spots in some areas nothing in other areas, usually, but not always shortly after eating. Some relief from Benedryl throughout day not always lasting 4 hours between doses. Have no past history of hives, food allergies or food intolerance known.


VAERS ID: 1383119 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Unknown  
Location: Washington  
Vaccinated:2021-05-30
Onset:2021-06-04
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthritis, Asthenia, Fatigue, Injection site pain, X-ray
SMQs:, Systemic lupus erythematosus (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (narrow), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Patient reported pain through left shoulder area after exersise. Went to urgent care. Xray was taken. Provider advised patient showed arthritis and thought possibly due to vaccine. Patient also experiencing fatigue and weakness


VAERS ID: 1383398 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Patient received vaccination and was told to sit in waiting area for observation. Patient chose to sit in car in parking lot. Family member ran inside to alert pharmacy staff that patient had passed out and might be having seizure. Patient was unconscious for approximately a minute. Patient was awake when staff went outside. Patient requested an ambulance be called. Family believed it might have been because she hadn''t eaten since breakfast. Paramedics arrived and took patient to hospital.


VAERS ID: 1383773 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram normal, Contusion, Full blood count, Headache, Injection site erythema, Magnetic resonance imaging normal, Pain, Platelet count decreased, Pyrexia, Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: B12.
Current Illness: None
Preexisting Conditions: Migraine.
Allergies: None
Diagnostic Lab Data: CBC, CAT, vMRV and various other blood tests. I will receive more blood tests tomorrow to determine if counts are stabilized of not. I was treated at the Hospital.
CDC Split Type:

Write-up: After second injection on 6/3/2021, I felt fine. Upon waking on 6/4, I had a fever of 101, severe headache and body pain. On 6/5, I developed a 5? x 5? irritated red patch on my injection arm. On 6/6 I awoke to no fever. I then noticed sores in my mouth and busies on my abdomen, left leg and left foot. I went to urgent care. They ran a CBC. My platelet count was down 30% since ,my last test a few months ago. My average was about 180,000 for the last 6 years. My test number was 127,000. I have no history of a low platelet count. This appeared within days of the 2nd vaccination along with the sores and spontaneous bruising. A CAT and v,MRI were performed that same day. Those tests were normal.


VAERS ID: 1383774 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

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

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

Write-up: A rash on my left arm that was visibly red, warm to the touch, hurt when touched, and itched.


VAERS ID: 1383796 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Acid reflux
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Left arm swollen and red and in pain the size of a softball for 5+ days


VAERS ID: 1383805 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-26
Onset:2021-06-04
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deep vein thrombosis
SMQs:, Embolic and thrombotic events, venous (narrow), Thrombophlebitis (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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Deep venous thrombosis, pt was treated with blood thinners at Hospital emergency room and is being followed up by pt''s primary care provider.


VAERS ID: 1384292 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Alaska  
Vaccinated:0000-00-00
Onset:2021-06-04
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203 21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hypertension
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210611796

Write-up: EXPIRED PRODUCT USED; This spontaneous report received from a patient concerned a 69 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included hypertension. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 203 21A, expiry: UNKNOWN) dose was not reported, administered on 03-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 04-JUN-2021, the subject experienced expired product used. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of expired product used was not reported. This report was non-serious.


VAERS ID: 1384294 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Indiana  
Vaccinated:0000-00-00
Onset:2021-06-04
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Patient had no known allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210611838

Write-up: VACCINATION ADMINISTERED FROM A VIAL AFTER POST PUNCTURE TIME PERIOD; POOR QUALITY DRUG ADMINISTERED; This spontaneous report received from a health care professional concerned an elderly male. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A expiry: 23-JUN-2021) dose was not reported, administered on 04-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 04-JUN-2021, the subject experienced vaccination administered from a vial after post puncture time period. On 04-JUN-2021, the subject experienced poor quality drug administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the vaccination administered from a vial after post puncture time period and poor quality drug administered was not reported. This report was non-serious. This case, from the same reporter is linked to 20210613154.


VAERS ID: 1384300 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-06-04
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210611923

Write-up: PRESSURE ON THE HEAD (WOULD NOT CALL IT HEADACHE); RED DOT ON UPPER THIGH; RASH ALL OVER BODY; This spontaneous report received from a patient concerned a 25 year old female. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 204A21A, and expiry: UNKNOWN) dose was not reported, administered on 01-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 04-JUN-2021, the subject experienced pressure on the head (would not call it headache). On 04-JUN-2021, the subject experienced rash all over body. On 04-JUN-2021, the subject experienced red dot on upper thigh. The action taken with covid-19 vaccine was not applicable. The outcome of the rash all over body, pressure on the head (would not call it headache) and red dot on upper thigh was not reported. This report was non-serious.


VAERS ID: 1384306 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-06-04
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Non-smoker
Preexisting Conditions: Medical History/Concurrent Conditions: Heart valve replacement; Comments: The patient had no known allergies. The patient has history of no drug drug abuse or illicit drug usage. The patient was taking blood thinning medications
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210611981

Write-up: WOKE UP WITH PAIN AND BODY ACHES IN BACK AND LEFT SIDE AND FEELS LIKE THE PAIN IS ENLARGING; FEELING BAD; FELT FEVERISH; DIZZINESS; This spontaneous report received from a patient concerned a 44 year old male. The patient''s height, and weight were not reported. The patient''s past medical history included heart valve replacement, and concurrent conditions included abstains from alcohol, and non-smoker, and other pre-existing medical conditions included the patient had no known allergies. the patient has history of no drug drug abuse or illicit drug usage. the patient was taking blood thinning medications. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 207A21A, expiry: UNKNOWN) dose was not reported, administered on 04-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 04-JUN-2021, the subject experienced dizziness. On 04-JUN-2021, the subject experienced feeling bad. On 04-JUN-2021, the subject experienced felt feverish. On 05-JUN-2021, the subject experienced woke up with pain and body aches in back and left side and feels like the pain is enlarging. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from felt feverish, dizziness, and woke up with pain and body aches in back and left side and feels like the pain is enlarging, and the outcome of feeling bad was not reported. This report was non-serious.


VAERS ID: 1384311 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-06-04
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210612026

Write-up: BODY ACHES; This spontaneous report received from a patient concerned a 62 year old female. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 205A21A, expiry: UNKNOWN) dose was not reported, administered on 03-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 04-JUN-2021, the subject experienced body aches. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from body aches. This report was non-serious.


VAERS ID: 1384312 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Georgia  
Vaccinated:0000-00-00
Onset:2021-06-04
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210612045

Write-up: EXPIRED VACCINE USED; MEDICATION ERROR; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 01-JUN-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 04-JUN-2021, the subject experienced expired vaccine used. On 04-JUN-2021, the subject experienced medication error. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the expired vaccine used and medication error was not reported. This report was non-serious The Product Quality complaint number: 90000181971


VAERS ID: 1384326 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2021-06-04
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210612702

Write-up: PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE; OFF LABEL USE; This spontaneous report received from a pharmacist concerned a 14 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 203A21A expiry: UNKNOWN) dose was not reported, administered on 04-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 04-JUN-2021, the subject experienced product administered to patient of inappropriate age. On 04-JUN-2021, the subject experienced off label use. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the product administered to patient of inappropriate age and off label use was not reported. This report was non-serious.


VAERS ID: 1384328 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Indiana  
Vaccinated:0000-00-00
Onset:2021-06-04
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Patient had no known allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210612869

Write-up: VACCINE ADMINISTERED FROM THE OVERNIGHT REFRIGERATED PUNCTURED VIAL; This spontaneous report received from a health care professional concerned a 71 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A expiry: 23-JUN-2021) dose was not reported, administered on 04-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 04-JUN-2021, the subject experienced vaccine administered from the overnight refrigerated punctured vial. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of vaccine administered from the overnight refrigerated punctured vial was not reported. This report was non-serious. This case, from the same reporter is linked to 20210613154.


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