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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 235 out of 5,069

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VAERS ID: 1384335 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Connecticut  
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 1821288 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Blood glucose, Blood pressure measurement, Cardiovascular evaluation, Dehydration, Dizziness, 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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Alcohol use; Blood pressure high; High cholesterol; Stroke (The patient had storke like symptoms but was not diagnosed as stroke because all tests were negative but still had the symptoms.)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210605; Test Name: Blood pressure; Result Unstructured Data: Normal; Test Date: 20210605; Test Name: Cardiovascular evaluation; Result Unstructured Data: Normal; Test Date: 20210605; Test Name: Blood glucose; Result Unstructured Data: Normal
CDC Split Type: USJNJFOC20210613161

Write-up: PASSED OUT; LIGHT HEADED; DEHYDRATED; FELT WEAK; This spontaneous report received from a patient concerned a 59 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included controlled high blood pressure, controlled high cholesterol, stroke like symptoms in MAR-20219, however he was not diagnosed as having stroke because all tests were negative but he still had the symptoms, and alcohol use. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1821288, and expiry: UNKNOWN) 1 total, dose was not reported, administered on left arm on 04-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 04-JUN-2021 after vaccination, the patient felt weak but it was not significant. On 05-JUN-2021, the patient felt weak while doing daily activities. The patient had not felt anything and had breakfast. He got in the sun and got dehydrated as not had water for three hours during the day. Later, he got water. The patient had taken one drink of alcohol, sat down and got light headed then passed out for less than a minute. It was reported that, upon contacting emergency services advised patient to visit emergency room to check him as a precaution but the patient denied. It was reported that, the patient''s heart, blood pressure, and blood glucose were normal. The patient was fine at the time of this report. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from passed out on 05-JUN-2021, and light headed, dehydrated, and felt weak on JUN-2021. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210613161-covid-19 vaccine ad26.cov2.s-passed out. 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: 1384666 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Muscle spasms, Myalgia, Neck pain, Pain, Rash, Somnolence
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: N/A
CDC Split Type:

Write-up: A few hours after getting the 2nd dose, I had the following reactions (I didn''t go to the doctor, I''m just reporting what I experienced): *Slight rash consisting of pen-dot sized raised blisters which only appeared on top of a long-healed tattoo I have *Pain all throughout my right jugular (neck) *Sharp pain behind my right ear *Sleepiness *Dizziness *Muscle aches and muscle cramps Most of these lasted less than 24 hours, but the tattoo rash was progressively becoming worse, I managed to get it under control on day 4 by applying hydrocortisone directly over the immidiate area. I still see a few bumps, but it seems to be healing. I didn''t do anything differently in my daily routine; nothing changed (ie: same soap, same detergent, no contact with dust or etcetera). The tattoo also contains phosphorus, which might be related to the reaction. The muscle aches and cramps are still ongoing; which is weird considering how I never get either and my daily activities haven''t changed.


VAERS ID: 1384776 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Virginia  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chills, Fatigue, Headache, Nausea, Pelvic pain, Peripheral swelling, Proctalgia, Pyrexia, Sensitive skin, Skin burning sensation, Swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TOPIRAMATE; NORETHINDRONE ACETATE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021656601

Write-up: Severe burning of skin over entire body; Hypersensitive to touch including fabric; Swollen neck and hands; Swollen neck and hands; Pain in pelvic area and anus; Pain in pelvic area and anus; Severe lower back pain accompanied with chills; Severe lower back pain accompanied with chills; Headache; Fever; Nausea; Fatigue; This is a spontaneous report from a contactable consumer (patient). A 23-year-old non-pregnant female patient received second dose of BNT162B2 (Pfizer covid-19 vaccine, Solution for Injection, Lot number: EW0202), via an unspecified route in the right arm on 04Jun2021 at 11:00, as a single dose for covid-19 immunization. The patient medical history was not reported. Concomitant medications included topiramate 50mg and norethrindrone 35mg (medications the patient received within 2 weeks of vaccination). Patient previously received first dose of BNT162B2 (Pfizer covid-19 vaccine, Lot number: EW0202), via on an unspecified route in the right arm on 14May2021 at 11:00, as a single dose for covid-19 immunization. Patient has not received any other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination, patient was not diagnosed with COVID-19. Since the vaccination, patient has not been tested for COVID-19. On 04Jun2021 at 22:00, patient experienced severe burning of skin over entire body, hypersensitive to touch including fabric, swollen neck and hands, pain in pelvic area and anus, severe lower back pain accompanied with chills, headache, fever, nausea and fatigue. Patient did not receive any treatment for the events. The clinical outcome of the events was not recovered at the time of this report. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1384787 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021658893

Write-up: Fatigue; Calf muscle pain; Bad headache; This is a spontaneous report from a non-contactable pharmacist reported for a 14-years-old male patient. A 14-years-old male patient received second dose of bnt162b2 (BNT162B2, Pfizer covid vaccine), via an unspecified route of administration on 03Jun2021 (Batch/Lot number was not reported) as single dose for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient received first dose of bnt162b2 (BNT162B2, Pfizer covid vaccine), via an unspecified route of administration on an unknown date (Batch/Lot number was not reported) as single dose for covid-19 immunisation. On 04Jun2021, after second dose of vaccine administration, the patient experienced fatigue, calf muscle pain and bad headache. The outcome of the events fatigue, calf muscle pain and bad headache was unknown. No follow-up attempts are possible and information about lot/batch number cannot be obtained.


VAERS ID: 1384797 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Nebraska  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021659081

Write-up: pain in his feet and pain in his hand; This is a spontaneous report from a contactable consumer (patient''s wife) from a Pfizer-sponsored program. A male patient of an unspecified age received BNT162B2(PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection; Lot Number: ER8736, Expiration date: unknown), dose 2 via an unspecified route of administration on 04Jun2021 as 2nd dose, single dose COVID-19 immunization. patient previously took first dose of BNT162B2(PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection Lot Number: EW0167, Expiration date: unknown) via an unspecified route of administration on an unspecified date as first dose single dose for COVID-19 immunization. The patient medical history and concomitant medications were not reported. On 04Jun2021 after second vaccine, the patient experienced pain in his feet and pain in his hand. Patient is still experiencing a pain in his feet and pain in his hand. The outcome of event was unknown.


VAERS ID: 1384859 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036CZ1A AND 024 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Myalgia, Pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: can''t afford any tests
CDC Split Type:

Write-up: extreme muscle pain lower back shooting down right leg. Inability to sit,lay down, walk without pain


VAERS ID: 1384880 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Michigan  
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 (MODERNA)) / MODERNA 049C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Confusional state, Dizziness, Erythema, Pruritus, Rash pruritic
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Allergic: Anaphylaxis-Medium, Systemic: Allergic: Itch (specify: facial area, extremeties)-Mild, Systemic: Allergic: Rash (specify: facial area, extremeties)-Mild, Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Medium, Additional Details: Patient noticed redness and itching on chest approximately 20 minutes after injection but no other reported symptoms. Patient had already had a hive like rash on arm prior to injection. Patient was advised to stay in store for further observation. After an hour of observation patient denied any further new symptoms and departed. She was advised to stay near town and to call 911 if she developed any other symptoms. Patient called 911 approximately 2 hours after departure and was taken to ER.


VAERS ID: 1384903 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Kentucky  
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 1808609 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Muscle spasms
SMQs:, Dystonia (broad)

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

Write-up: Chills, muscle cramps mainly in legs, and headache the night of. The next day, extreme fatigue and throbbing headache. Lingering headache still present on fifth day.


VAERS ID: 1385058 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Florida  
Vaccinated:1961-05-16
Onset:2021-06-04
   Days after vaccination:21934
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced a rash on his feet and ankles.


VAERS ID: 1385132 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-31
Onset:2021-06-04
   Days after vaccination:65
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 UN / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, COVID-19, Mechanical ventilation, Pneumonia
SMQs:, Interstitial lung disease (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: case hospitalized due to COVID. Case in the ICU with pneumonia and ARDS and currently on a ventilator.


VAERS ID: 1385215 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B4A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D and Vitamin B12
Current Illness: None
Preexisting Conditions: Congenital CMV Nonfunctional cochlear implant
Allergies: NKMA
Diagnostic Lab Data: None, resolving.
CDC Split Type:

Write-up: Approximately 24 hours after getting immunization she had a reticular rash on the entirety of her left thigh and pain in the inguinal lymph nodes. Nearly resolved 24 hours later.


VAERS ID: 1385235 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Chest pain, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma
Allergies: PCN
Diagnostic Lab Data: troponin elevated to 0.78 CRP elevated to 10.4
CDC Split Type:

Write-up: chest pain thought possibly secondary to pericarditis or myocarditis


VAERS ID: 1385404 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-29
Onset:2021-06-04
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Blood test, Chills, Diarrhoea, Fatigue, Haematochezia, Nausea, Occult blood
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 325mg Bayer Aspirin, Basaglar, Amlodipine Besylate, Lisinopril, Carvedilol, Leflunomide, Folic Acid, Chlorthalidon, Fish Oil, Red Yeast Rice, Calc/Mag/Zinc, Centrum Silver, Probiotic, Vitamin D. As needed: Alprazolam, Clobetasol Propionat
Current Illness:
Preexisting Conditions: Diabetes, Lupus, High Blood Pressure
Allergies: beans
Diagnostic Lab Data: awaiting results of blood tests and stool sample test
CDC Split Type:

Write-up: June 4 onset of diarrhea around 1pm. Took OTC Kaeopectate to stop diarrhea. Stools turned to nothing but blood. Fatigue, abdominal pain, nausea. Same symptoms as my daughter (she has filed a report). Saw Dr. at PCP office on Monday, June 7th. Blood tests requested. Stool Sample requested. Awaiting results. Since my daughter and myself both came down with same symptoms within 24 hours of each other we were instructed to complete this form and we have been discussing possibility of food poisoning with our PCPs. Still have nausea, chills, abdominal pain. Bloody stools have stopped for me.


VAERS ID: 1385427 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Immunisation, Product administration error
SMQs:, Medication errors (narrow)

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

Write-up: RN TRIED TO VACCINATE AND PUNCTURED PT''S LEFT DELTOID AND PT PULLED AWAY. DOSE WAS NOT ADMINISTERED. BHS WAS CALLED AND PT WAS TAKEN TO PRIVACY AREA. FULL DOSE WAS ADMINISTERED TO RIGHT DELTOID WITHOUT COMPLICATIONS.


VAERS ID: 1385510 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: vaccine was administered outside of storage recommendations. Notified pt to return for re-vaccination


VAERS ID: 1385520 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Cough, Dysphonia, Headache, Insomnia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (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: cough, 18 yo, 4/29/21, COVID-19, Moderna
Other Medications: Levothyroxine 100mcg/day, Focalin XR 30mg qd, MVI, Claritin 10mg qd, Singulair 10mg qd
Current Illness: None
Preexisting Conditions: ADHD, allergic rhinitis, autism, hypothyroidism
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe dry cough, temperate max = 99.4, hoarseness, headache, insomnia


VAERS ID: 1385828 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Oregon  
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 (MODERNA)) / MODERNA UNKNOWN / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Arthralgia, Back pain, Chest discomfort, Dizziness, Erythema, Headache, Nausea, Neck pain, Pain in extremity, Pruritus, Stomatitis, Swollen tongue, Tongue geographic, Urticaria, Weight increased, Wheezing
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: reaction to pneumovax shot 2015, age 45 with hives, extreme swelling of vaccination site and arm, shortness of breath and wheezi
Other Medications: Advair, Zyrtec, Singulair, multi vitamin
Current Illness: none
Preexisting Conditions: Asthma, COPD, Allergies, Von Willebrand''s, MVP, IBS, Bronchiectasis, Reynaud''s
Allergies: PCN, sulfa, Terbutaline, Iodine, Norafloxin, Macrobid, ASA, shellfish, strawberries, passionfruit, walnuts, pecans, beef, lactose intolerant, gluten intolerant, venom stings/bites, wool,
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Sore arm, head ache, back and shoulder ache (within 20 minutes), dizziness, extreme nausea and stomachache, wheezing, chest tightening, skin turning red, hives, itchiness, geographic tongue (1 hour 10 minutes after injection), mouth sores internal and external, swollen tongue, water weight around 5 pounds (48 hours after injection). Continued dizziness, headache, neck pain, swollen tongue, mouth sores, and continued itchiness as of today''s date (06/09/21).


VAERS ID: 1385929 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-01-27
Onset:2021-06-04
   Days after vaccination:128
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Diarrhoea, Infection, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic kidney disease, coronary artery disease, type 2 diabetes, hypertension, h/o DVT, h/o atrial flutter
Allergies: 1,4-diaminobenzene (reaction not specified), codeine (hallucinations), sulfa antibiotics (unknown reactiion)
Diagnostic Lab Data: SARS-CoV-2 PCR detected by SARS-CoV-2 PCR on 6/8/21
CDC Split Type:

Write-up: Patient had breakthrough COVID-19 infection requiring hospitalization, presenting with 4 day history of cough and diarrhea.


VAERS ID: 1385945 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Kentucky  
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 (MODERNA)) / MODERNA 001C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

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

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

Write-up: pt presented for 2nd covid vaccine without vaccine card, reported hx of Pfizer vaccination. Later presented to have card filled out and noted hx of moderna-1st dose, Pfizer-2nd dose. reports feeling well, no adverse reactions per patient on 6/9/21


VAERS ID: 1385988 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-23
Onset:2021-06-04
   Days after vaccination:73
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram thorax abnormal, Deep vein thrombosis, Pulmonary embolism, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad)

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: right leg ultrasound, CT chest
CDC Split Type:

Write-up: DVT and PE thought provoked after long care ride


VAERS ID: 1386005 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Nausea, Vertigo, Vision blurred
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (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: PfizerBioNTech COVID19, 5/11/2012, Dizziness 5/28/2021
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nausea, dizziness, light headed, head spinning, blurred vision. Lasted 3 days.


VAERS ID: 1386017 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Kansas  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Confusional state, Delirium, Diplopia, Headache, Lethargy, Pain, Pain in extremity, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ocular motility disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Projectile vomiting, double vision, confusion/ delirium No treatment just gave her time. All symptoms cleared within 6 hours of onset. Approximately 9 hours after vaccine administration. Other more expected immune response followed, sore arm, headache, body aches and lethargy. Theses all resolved 36 hours after vaccine administration.


VAERS ID: 1386027 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-27
Onset:2021-06-04
   Days after vaccination:69
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: levotyroxine
Current Illness:
Preexisting Conditions: Hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bells Palsy with no apparent reason.


VAERS ID: 1386051 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-22
Onset:2021-06-04
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO175 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, C-reactive protein, Full blood count, Metabolic function test, Red blood cell sedimentation rate, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Basic Metabolic Panel C-Reactive Protein CBC Sedimentation Rate We weren''t given the results
CDC Split Type:

Write-up: She broke out in hives on June 4, they haven''t cleared up yet. She was experiencing intense joint pain this morning (June 9) and we had to take her to the ER. They did blood tests, stated that her blood test for inflamation was mildly high.


VAERS ID: 1386103 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Arizona  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: vaccine was administered outside of storage recommendations.


VAERS ID: 1386119 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: vaccine was administered outside of storage recommendations. Notified pt to return for re-vaccination


VAERS ID: 1386145 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Washington  
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 (MODERNA)) / MODERNA 047C21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Eye pruritus, Face injury, Pruritus
SMQs:, Anaphylactic reaction (broad), Accidents and injuries (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:
Current Illness: Stomach pain and diarrhea, seasonal allergies
Preexisting Conditions:
Allergies: Codeine, Levothyroxine sodium, Penicillin G, Sulfamethoxaole, trimethoprim
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt experiencing intense itching on eye and on body. Pt said symptoms began after vaccination (June 4, 2021-4 days), has been taking Benadryl nightly since but has had no relief. No reaction was noted during 30 minute period after vaccine and pt stated that itching began at home that night. Pt unsure if eye itching is associated with hitting face on rope by accident, but entire body itching continues. Pt told to go to clinic and advised to make appointment with PCP. Pt refused referral for prompt care due to cost of care.


VAERS ID: 1386195 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Wisconsin  
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 (MODERNA)) / MODERNA - / 2 LA / IM

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

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, sertaline, blood sugar monitor
Current Illness: n/a
Preexisting Conditions: type 2 diabetes, anxiety, obestiy, tobacco use disorder
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Fatigue after second dose of Moderna vaccine- sleeping 12 hour or more at one time , soreness that has improved


VAERS ID: 1386219 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
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 (MODERNA)) / MODERNA - / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient does remember a medication given for anxiety
Current Illness: None
Preexisting Conditions: None
Allergies: Apple, dry cherry, peach
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient has hives all over her body after receiving her vaccine.


VAERS ID: 1386279 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Eczema, Fatigue, Nausea, Psoriasis, Rash, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (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: Patient went to MD 6/7/21 who diagnosed her with psoriasis/eczema. The patient wasn''t receptive to this diagnosis as they believe the COVID vaccine caused these reactions.
CDC Split Type:

Write-up: Patient developed chills, fatigue, nausea, and a generalized rash (inflammed and red).


VAERS ID: 1386342 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Unknown  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: It is suspected that the patient received an inadequate dose at this administration. They presented and were potentially injected with an empty syringe (no air, just empty vanish-point). The care team has attempted to contact the patient to determine if they have had any symptoms after injection, but have not been able to get in touch with the patient. We will continue to try to contact the patient.


VAERS ID: 1386353 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: 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: It is suspected that the patient received an inadequate dose at this administration. They presented and were potentially injected with an empty syringe (no air, just empty vanish-point). The care team talked with the patient and they stated they had no signs or symptoms of a reaction and had no pain at the injection site. They stated they had some symptoms after their first dose. The patient was told that they will be rescheduled for their 2nd dose.


VAERS ID: 1386362 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 2 LA / IM

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

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

Write-up: It is suspected that the patient received an inadequate dose at this administration. They presented and were potentially injected with an empty syringe (no air, just empty vanish-point). The care team has attempted to contact the patient to determine if they have had any symptoms after injection, but have not been able to get in touch with the patient. We will continue to try to contact the patient.


VAERS ID: 1386389 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Michigan  
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 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cellulitis
SMQs:

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

Write-up: Pt presented with cellulitis 2 days after injection. I sent her to urgent care for an antibiotic


VAERS ID: 1386831 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-01
Onset:2021-06-04
   Days after vaccination:64
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045B21A / 2 LA / SYR

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

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

Write-up: Shingles


VAERS ID: 1386850 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-02
Onset:2021-06-04
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LOTENSIN 10 MG PO QD, HYDROCHLOROTHIAZIDE 25 MG PO QD, WARFARIN AS INSTRUCTED BY CLINIC, SPIRONOLACTONE 25 MG PO QD,
Current Illness: NONE KNOWN
Preexisting Conditions: HYPERTENSION
Allergies: NONE KNOWN
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient noticed redness and itchiness on the arm where he received the vaccination starting two days after the vaccination. He used a steroid cream he had at home and the itchiness decreased. He thought the area of redness increased slightly on the third day after the vaccination. He had not sought treatment at the time of reporting.


VAERS ID: 1386867 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Chills, Dizziness, Fatigue, Full blood count, Headache, Metabolic function test, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Meteprolol Metformin
Current Illness: None
Preexisting Conditions: Pcos Depression Anxiety PVT Obesity
Allergies: None
Diagnostic Lab Data: CBC Comprehensive No results yet
CDC Split Type:

Write-up: 06/04/2021- fever, chills, fatigue, dizzy 06/05/2021- fatigue, dizzy 06/06/2021- fatigue, nausea, headache, stomach pain 06/07/2021-06/09/2021- nausea, stomach pain, headache


VAERS ID: 1387211 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Palpitations, Pericarditis
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Apparent percarditis. Heart palpitations, chest pain, trouble breathing ( due to chest pain). Worse when lying down. NSAIDs helped. Waited in ER lobby for an hour ( approx hour 6 after onset of symptoms when symptoms began to dissipate). Only intake triage performed at hospital. 10 hours duration


VAERS ID: 1387348 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-06
Onset:2021-06-04
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Vaccination site bruising, Vaccination site pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Currently presents a bruise with pain when touched in the area where the vaccine was placed. A little headache in the temple area.


VAERS ID: 1387349 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-05-07
Onset:2021-06-04
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Chills, Headache, Influenza like illness, Menstrual disorder, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Initial side effects were as expected. Sore arm and feeling like I had a mild flu the next day. Very sore mid back pain, headache, chills and a fever of 101. I am now 6 days late for my period ( neg pregnancy test). This never happens. I am like clockwork. I had not received any warning about this side effect but I came across a Reddit forum where other women were reporting menstrual problems after the vaccine also. This needs to be listed as a side effect. And it needs to be studied further in case it impacts fertility.


VAERS ID: 1387361 (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: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: grass, trees, almonds, corn, Tylenol (hives occasionally)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever 102 day of vaccination Fever 101 day 2 +3 post vaccination Fever 100 day 4+5 post vaccination


VAERS ID: 1387840 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia
SMQs:, Taste and smell disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021655792

Write-up: She lost the sense of taste this morning; This is a spontaneous report received from a contactable consumer (Patient mother) via medical information team. A 17-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, Batch/Lot number was not reported), dose 2 via an unspecified route of administration on an unspecified date in Jun2021 as single dose for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient previously took first dose of BNT162B2 (solution for injection, Batch/Lot number was not reported), dose 1 via an unspecified route of administration on an unspecified date as single dose for covid-19 immunisation. No adverse events reported with the first dose. On 04Jun2021, the patient had lost the sense of taste. The consumer stated that "My adult daughter received the second dose of the Pfizer COVID-19 vaccine two days ago. She lost the sense of taste this morning. I have seen people reported a loss of taste but along with a metallic taste in the mouth. But my daughter doesn''t have a metallic taste in her mouth". The reporter has been reading some of the questions and articles and none of them talk about a loss of a sense of taste. They talk about a metallic taste, but her daughter doesn''t have a metallic taste. The reporter wanted to know that if loss of a sense of taste was common after the Covid vaccine and if this was a side effect reported. Information on lot/batch number has been requested.


VAERS ID: 1388000 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

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


VAERS ID: 1388004 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Confusional state, Dizziness, Fatigue, Gait disturbance, Lethargy, Muscle tightness, Pain
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Body Aches Generalized-Medium, Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Weakness-Medium, Additional Details: Patient reports weakness, leg muscle tightness, difficulty walking, and dizziness. Started post vaccine and has continued. Patient was advised to go to local urgent care for examination on 6/9.


VAERS ID: 1388154 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 RA / IM

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

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

Write-up: Vaccine given at 5:19 pm. After the vaccine, mom took pt and walked around the store rather than stay in the waiting area. They returned at approximately 5:45 pm, because pt was complaining of a bad headache rating pain 6/10. He denied any other symptoms. We had him sit down in the waiting area and gave him a bottle of water. He started feeling lightheaded a few minutes later and was moved to an exam room. I had him lay down on the exam table. At approx. 5:55pm, I checked his BP while he was laying down and it was 104/62. He reported feeling a little better, so I had him sit up. Rechecked BP and it was 108/70. He reported dizziness had resolved and headache was now 5/10. At some point while I was not with the pt, mom gave him some Aleve, but I don''t know what time. Mom decided to take him home at that point.


VAERS ID: 1388225 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-01
Onset:2021-06-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Feeling abnormal, Injection site pain
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: D-3; Omega-3; vitamin C
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: symptom: chest pain, pain in my left arm approximately 4 inches from my arm pit (injection side), shortness of breath, heart felt as though rhythm was off a bit. This happened about three days after my first dose for about 4 days. Starting to feel better now though. I didn''t know what was happening and was tempted to go to the emergency room a couple of times but didn''t. I''m just finding out about this from an article I''m just reading about 30 minutes ago and thought I should report this. I''ve only had my first dose and now I''m very concerned about the second due June 22nd.


VAERS ID: 1388302 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 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? 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: Patient received the second dose of the Moderna Vaccine at 21 days after the first shot


VAERS ID: 1388317 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 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? 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: Ptnn received second dose of Moderna vaccine at a 21 days interval not 28


VAERS ID: 1388331 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 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? 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: Ptn received second dose of Moderna Vaccine at a 21 day interval not 28.


VAERS ID: 1388334 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 3 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin 81 mg daily, Atorvastatin 10 mg daily, Cramp tabs 2 daily PRN, losartan 50 mg, omeprazole 20 mg daily
Current Illness: HTN, hyperlipidemia
Preexisting Conditions: See above.
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Phone call from patient''s daughter on 06/07/21 - patient saw doctor last Friday for a complete physical. Order sent to pharmacy for Tdap vaccine. Patient went to pharmacy and received COVID vaccine. Pharmacy staff thought patient requested COVID vaccine. Tdap order was not yet received at pharmacy. Patient had already gotten COVID Pfizer vaccine on 01/28/21 and 02/18/21. Pharmacy states patient did fill out a general consent for vaccine - questions such as do you have a fever or feel ill today? Have you had a reaction to any vaccine before? Consent was not COVID specific. Phone call from Pharmacy staff on 06/07/21 acknowledging wrong vaccine was given.


VAERS ID: 1388346 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 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? 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: Patient was given second dose of Moderna vaccine at 1 21 day interval not 28


VAERS ID: 1388374 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 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? 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: Pineapple
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Patient was given second dose of Moderna vaccine at a 21 day interval not 28


VAERS ID: 1388386 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 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? 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: Patient was given second dose of Moderna vaccine at a 21 day interval not 28


VAERS ID: 1388400 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 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? 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: Patient was given second dose of Moderna vaccine at a 21 day interval not 28


VAERS ID: 1388404 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Lip swelling, 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? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Calcium, Vitamin D3, Omega 3
Current Illness: Sprained Wrist
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: There were no medical tests done at either Emergency Room.
CDC Split Type:

Write-up: Extreme Hive Break Out for three days. Extreme Lip Swelling. I have plenty of pictures if you want them. We went to Emergency room on Friday and they gave her an IV with Antihistamine and Steroids and Pepcid. She got better and we went home. She broke out again all over her body on Saturday and this time we went to Emergnecy room. They observed her and basically told us when they discharged us to keep her on Benadryl every four hours for the next 48 hours. I think it''s important to note that she did test positive for COVID 19 on December 11, 2020 and had a fairly mild case of the virus. ALso, that she has never had this reaction to anything ever before.


VAERS ID: 1388420 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014C21A / 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 given second dose of Moderna vaccine at a 21 day interval not 28


VAERS ID: 1388470 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Headache, Mobility decreased, Nausea, Pain, Pyrexia, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Advair 100 Diskus, Iron and multi-vitamin
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Bacitracin Allergy
Diagnostic Lab Data: None - just reported to her physician
CDC Split Type:

Write-up: Woke up exactly 12 hours after vaccine with the following symptoms: Fever 99.5-100, red cheeks, shaking, body aches, nausea, headache, couldn''t lift her arms much. Symptoms lasted 24hours and as fast as they came on, they went away the same. A severe headache remained the second day.


VAERS ID: 1388814 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Muscle contractions involuntary
SMQs:, Dystonia (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: Influenza vaccines-she experienced similar muscle tetany
Other Medications: Claritin 10mg, Flonase nasal spray, Depo-Provera IM injection
Current Illness: Amplified pain syndrome
Preexisting Conditions: Amplified pain syndrome, IBS, migraines, exercise induced asthma, obesity
Allergies: Compazine, sulfa, influenza vaccines (developed muscle tetany)
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Within 30 minutes of the injection she developed forceful, involuntary muscle contractions to her abdomen and B. hands. Had less severe muscle contractions to jaw. She has had similar reactions to compazine and to influenza vaccines.


VAERS ID: 1388849 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016CZIA / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036CZIA / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Eye swelling, Headache, Injection site pain, Lymphadenopathy, Pain, SARS-CoV-2 test negative, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), 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: None.
Current Illness: None.
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data: The NP tested my breathing with a stethoscope, checked my eyes for reactivity, and had me read from the letter chart to ensure my vision was fine. He gave me a rapid COVID-19 test that came back negative. I told him I had been taking one Zyrtec every morning since 06/04/2021 and Benadryl before bed just in case the reaction rapidly worsened while I slept. On 06/06/2021, I began using Alaway allergy eye drops as well. The NP told me that I was doing everything that he would recommend and that my symptoms were likely due to the COVID Vaccine I received on 06/03/2021. He told me that he would normally prescribe/give prednisone to treat the reaction but that studies have found the steroid to reduce the efficacy of the vaccine so he would not recommend it. My visit was on 06/09/2021 at 8:30 am CT, 6 days after my vaccine , and 5 days after my reaction began.
CDC Split Type:

Write-up: Starting the day after the vaccine, 06/04/2021, I had severe body aches, severe headache, pain on my arm where the shot was given, and severely swollen eyes but no vision problems. The body aches, headache, and arm pain lasted until 06/06/2021. The swollen eyes are still swollen today, 06/10/21, 7 days after the vaccine. On 06/09/2021 my lymph nodes in my right arm pit and on my left pectoral muscle swelled up, became red, and had an aching pain without touch and a moderate pain when touched. As of today, 06/10/2021, my lymph nodes are still swollen but with very minor pain with touch.


VAERS ID: 1388865 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Unknown  
Vaccinated:2020-12-23
Onset:2021-06-04
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid Swab 6/4/2021 positive
CDC Split Type:

Write-up: Employee reported to Health Services that she tested Positive for Covid on 6/4/2021, after having 2 doses of Covid Vaccine. 12/23/2020 & 1/13/2021


VAERS ID: 1388875 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-06-04
   Days after vaccination:58
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient tested Positive For Covid -19


VAERS ID: 1388887 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-04-22
Onset:2021-06-04
   Days after vaccination:43
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Injection site nerve damage, Neuralgia, Phantom limb syndrome
SMQs:, Peripheral neuropathy (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: Flomax, Zyrtec
Current Illness: Spinal stenosis
Preexisting Conditions: Spinal stenosis, service injuries to spine
Allergies: None
Diagnostic Lab Data: None to date
CDC Split Type:

Write-up: Nerve damage Pain at time of injection by nurse. Currently experiencing pain and phantom shot replication.


VAERS ID: 1389064 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthma, Blood pressure increased, Chills, Coagulation factor, Cough, Decreased appetite, Epistaxis, Full blood count, Heart rate increased, Hyperhidrosis, Lethargy, Pulmonary function test, Pyrexia, X-ray
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol, concerts, methylphenidate, advair
Current Illness:
Preexisting Conditions: Asthma
Allergies: Augmentin, Zithromax
Diagnostic Lab Data: X-rays, CBC, clotting factor tests, pulmonary function test,
CDC Split Type:

Write-up: Coughing, fever, chills, sweating, lethargy, decreased appetite, SEVERE nose bleeds lasting 20+ minutes, increased blood pressure and heart rate. Induced an asthmatic flare which required increased breathing treatments, steroids, and antibiotics. **Maternal grandmother had severe reaction. VAERS NUMBER 1182545


VAERS ID: 1389088 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-29
Onset:2021-06-04
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022B21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Chest pain, Injection site mass, Injection site pain
SMQs:, Peripheral neuropathy (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Patient was experiencing arm pain around injection site with a lump where moderna was given. She mentioned that she has burning of the chest/sternum area radiating down to left arm with little to no effect when using ibuprofen for relief. It has been continuous since when she has reported having symptoms


VAERS ID: 1389100 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-16
Onset:2021-06-04
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Trismus
SMQs:, Dystonia (narrow), Hearing impairment (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: multivitamin, vitamin D
Current Illness: none
Preexisting Conditions: none
Allergies: shellfish
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 6/3/21: started having left eye watering with the inability to close the eyelid 6/6/21: received 2nd covid vaccine 6/8/21: Developed inability to close his mouth and to smile which has persisted 6/10/21: Seen in clinic and diagnosed with left Bells Palsy and prescribed prednisone


VAERS ID: 1389156 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Arthralgia, Chills, Diarrhoea, Erythema, Fatigue, Headache, Nausea, Pain, Palpitations, Peripheral swelling, Pyrexia, Rash, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Vaccine administered at 11am. By 11:30am, I was severely nauseous. Abdominal cramping. Nausea until 2:30pm. By 3:30pm, head ache, body aches, chills, joint paint, fatigue, fever of 100.8 By 6:00pm, my hands and feet became red, swollen, and hot. Rash on my legs. Racing heart rate of 115bpm. Continued body aches and joint pain. No more fever. By 9:30pm, 25mg Benadryl taken. By 10:30pm, redness and swelling reduced, heart rate decreases to 85bpm. 06/05/2021: diarrhea and continued fatigue and body aches, residual swelling of extremities. Currently, it?s 6/10/2021, and fatigue and body aches/joint pain are continuing.


VAERS ID: 1389203 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Patient received 2nd dose of pfizer covid vaccine on 06/03/2021, next day noted supraclavicular lymph node.


VAERS ID: 1389227 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-28
Onset:2021-06-04
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blister, Diarrhoea, Rash, Rash maculo-papular, Urticaria
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 50mg, gemmily (OCP), B12 lozenge, probiotics
Current Illness: None
Preexisting Conditions: Neurocardiogenic syncope
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 6 days after, I developed a rash on my thighs, hands, forearms, elbows, upper arms, low back, and some on my lower interior stomach. The rash ranged from welt/hive-like to macule/papule type. The ones on my hands felt more like blisters. I had no anaphylaxis... Mild loose stool. Breathing fine. I still have the rash on my hands, elbows, and upper thighs, but it has started to go down as of today.


VAERS ID: 1389303 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Flank pain, Headache, Nausea, Pain, Pyrexia, SARS-CoV-2 test, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Migraines, depression
Allergies: None
Diagnostic Lab Data: PCR COVID pending, collected on 6/10/2021
CDC Split Type:

Write-up: severe headache, body aches, fever (highest 102.3), and flank pain (right) for 7d. As well as, milder nausea/vomiting. Mild cough after 6d of vaccination (#2).


VAERS ID: 1389334 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-05-11
Onset:2021-06-04
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

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

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

Write-up: Shingles (herpes zoster) first signs occured on 6/4/21 and diagnosed on 6/9/21. Prescribed Valacyclovir HCL 1 gram tablet twice a day for 7 days, and Prednisone 50mg tablet once per day for 5 days.


VAERS ID: 1389523 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-26
Onset:2021-06-04
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Fatigue, Hypertension, Pain in extremity
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (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: None
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: Allergies to grass pet dander , dust
Diagnostic Lab Data:
CDC Split Type:

Write-up: Feel pain in back of calves legs still fatigue still blood pressure raised higher


VAERS ID: 1389531 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pain, Paraesthesia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin ,Jardiance
Current Illness: Nothing
Preexisting Conditions: Diabetic
Allergies: Pencyllin,Sulphur
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling pain Redness and sensation


VAERS ID: 1389532 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site urticaria, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: large rash on neck area initially; rash spread to back and legs; hives on arm of injection in the middle of the night Took Benadryl which seemed to clear it up but rash came back in morning. Threw up in morning. Went to urgent care. No respiratory issues and rashes cleared up. Instructed to monitor and continue Benadryl as needed. If hives come back and Benadryl does not clear it up then go to urgent care or ER. Benadryl did seem to work but rashes continued for several days.


VAERS ID: 1389563 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-06-01
Onset:2021-06-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 064C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Inflammation, Injection site erythema, Injection site inflammation, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: PATIENT REPORTED PAIN AND INFLAMMATION IN HER ARM 10 DAYS AFTER 1ST SHOT OF MODERNA. SITE ON LEFT ARM WAS RED AND INFLAMMED. PATIENT REPORTED HER ARM WAS STILL VERY SORE (SCORE 4 ON 1-10 SCALE) BUT REPORTED SHE FELT HIGHER PAIN 2-3 DAYS AFTER INJECTION WAS GIVEN. PATIENT ALSO REPORTED THAT SHE HAS BEEN TAKING TYLENOL FOR THE PAIN. SHE HAS ALSO BEEN HAVING HEADACHES THAT STARTED AFTER RECEIVING THE VACCINE. SHE REPORTED THIS IS ABNORMAL FOR HER AND USUALLY DOES NOT HAVE HEADACHES. SHE HAS BEEN DRINKING LOTS OF WATER SO THE HEADACHES ARE UNRELATED TO DEHYDRATION.


VAERS ID: 1389572 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

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

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

Write-up: This is just to report that Nurse gave the patient a Pfizer vaccination instead of his second Moderna. Patient is aware and experienced no side effects


VAERS ID: 1389758 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 RA / SYR

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

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

Write-up: He had the 2nd Pfizer covid vaccine on Thursday late afternoon. By Friday evening, he was complaining of chest pain and shortness of breath. He was also running a fever. Called the advice line for his dr and were told to monitor him. Saturday early morning, took him to urgent care due to no improvement. They did an x-ray and other tests to rule out myocarditis. His symptoms eventually resolved on Monday.


VAERS ID: 1390057 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO185 / 2 LA / SYR

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

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

Write-up: Hives started on my abdomen on day 3 and are spreading to upper arms and legs. Tried Benedryll first then Zyrtec. Went to see doctor on day 6 and was given a Solu-Medrol injection and prescription for a Medrol dose pack. On day two of dose pack currently.


VAERS ID: 1390349 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Blood pressure increased, Chest pain, Constipation, Decreased appetite, Diarrhoea, Dry mouth, Eye pain, Headache, Injection site pain, Lymphadenopathy, Muscle spasms, Nasal dryness, Nausea, Neck pain, Otorrhoea, Pain, Thirst
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Hypertension (narrow), Cardiomyopathy (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Sore arm where shot was given
Other Medications: None were taken.
Current Illness: Hypothyroidism & Hypertension
Preexisting Conditions: N/A
Allergies: Allergies to: Penicillin, Ampicillin, Betadine, and Sulfur.
Diagnostic Lab Data: None at this time
CDC Split Type:

Write-up: Chest pains, sore left arm where shot was given, painful swollen lymph nodes under left arm pit, bad head pain, eye pain from the head pain, elevated blood pressure (even after medication), body pain everywhere, diarrhea, nausea, lost of appetite, neck pain from the head pain, constipation, left/right side stomach pain, left/right muscle spasms in both calves, dry mouth, thirsty, dry nostrils, and ear drainage from right ear.


VAERS ID: 1390688 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New York  
Vaccinated:0000-00-00
Onset:2021-06-04
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A 21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure measurement, Face oedema, Hypersensitivity, Hypotension, Hypoxia, Nausea, Oxygen saturation decreased, Pharyngeal oedema, Tongue oedema, Vomiting, Wheezing
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal allergic conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (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: THC DROPS STENOCARE
Current Illness: Alcoholic (rarely about two (2) drinks per month.); Allergy to antibiotic (Allergic to cipro, doxycycline, flagyl and cephalosporins); Antihemophilic factor; Arthritis; Asthma; Endometriosis; Non-smoker; Penicillin allergy (Allergy to penicillin, amoxicillin.); Post-traumatic stress disorder; Slipping rib syndrome; Vesicoureteral reflux with reflux nephropathy, bilateral
Preexisting Conditions: Medical History/Concurrent Conditions: Food allergy (Allergic to tree nuts, almonds, peanuts and legumes.); Comments: No illicit drug use or drug abuse.
Allergies:
Diagnostic Lab Data: Test Date: 20210604; Test Name: Oxygen saturation low; Result Unstructured Data: 92%, 92%; Test Date: 20210604; Test Name: Blood pressure; Result Unstructured Data: 62/80, 62/80
CDC Split Type: USJNJFOC20210611762

Write-up: OXYGEN WAS AT 92%; BLOOD PRESSURE 62/80; EDEMA OF FACE; EDEMA OF THROAT; EDEMA OF TONGUE; EMESIS; WHEEZING; ALLERGIC REACTION; NAUSEA; This spontaneous report received from a patient concerned a 23-year-old white, Not-Hispanic/ Latino female. The patient''s weight was 230 pounds, and height was 64 inches. The patient''s concurrent conditions included non-smoker, alcoholic, penicillin allergy, anti-biotic allergy, food allergy, factor VIII (a), endometriosis, bilateral urinary reflex, arthritis, slipping rib syndrome, asthma, and PTSD (Post-traumatic Stress Disorder), and other pre-existing medical conditions included no illicit drug use or drug abuse. The patient was previously treated with Leuprorelin acetate for 10 years which was ended on FEB-2020 and 2 rounds of Intravenous chemotherapy for 6 months apart ending 22-NOV-2019, for drug used for unknown indication; and experienced drug allergy when treated with acetylsalicylic acid, gabapentin, ethinylestradiol/ferrous fumarate/norethisterone acetate, meloxicam, ibuprofen, paroxetine hydrochloride, topiramate, ketorolac tromethamine, venlafaxine, and sertraline hydrochloride for drug used for unknown indication. The patient mentioned that she had also taken 2 oral chemotherapy drugs of which names she did not remembered. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 202A 21A and expiry: 23-JUN-2021) dose was not reported, frequency of 1 total, administered on 04-JUN-2021 18:10 for prophylactic vaccination on right deltoid. Concomitant medications included cannabis sativa flower for arthritis. The patient reported that after vaccination on 04-JUN-2021 at 18:15 she began experiencing allergic reactions with symptoms of nausea, vomiting, wheezing, and swelling of face, throat and tongue. She also mentioned that her oxygen was at 92% and blood pressure was 62/80. Laboratory data included: Blood pressure (NR: not provided) 62/80 62/80, and Oxygen saturation low (NR: not provided) 92% 92%. On 04-JUN-2021 18:20, treatment medications included: epinephrine. On 04-JUN-2021 18:20, treatment medications included: Epinephrine, 2 doses had been administered. The patient had visited the emergency department for monitoring. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from oxygen was at 92%, blood pressure 62/80, emesis, and nausea on 04-JUN-2021, was recovering from wheezing, edema of face, edema of throat, and edema of tongue, and the outcome of allergic reaction was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: 20210611762-COVID-19 VACCINE AD26.COV2.S-OXYGEN WAS 92%,BLOOD PRESSURE 62/80,EDEMA OF FACE,EDEMA OF THROAT,EDEMA OF TONGUE,EMESIS,WHEEZING. 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).20210611762-COVID-19 VACCINE AD26.COV2.S-ALLERGIC REACTION,NAUSEA. This event(s) is labeled per RSI and is therefore considered potentially related.


VAERS ID: 1390701 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2021-06-04
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210614695

Write-up: VACCINE ADMINISTERED AFTER THE 6 HOUR MARK AFTER FIRST PUNCTURE IN REFRIGERATED CONDITIONS; INCORRECT STORAGE OF DRUG; This spontaneous report received from a pharmacist concerned a 20 year old of unspecified sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, intramuscular, batch number: 205A21A, and 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 after the 6 hour mark after first puncture in refrigerated conditions. On 04-JUN-2021, the subject experienced incorrect storage of drug. The action taken with covid-19 vaccine was not applicable. The outcome of the vaccine administered after the 6 hour mark after first puncture in refrigerated conditions and incorrect storage of drug was not reported. This report was non-serious.


VAERS ID: 1391029 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-21
Onset:2021-06-04
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Cough, Headache, Insomnia, Malaise, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021655185

Write-up: headache/Headache, excruciating, which caused trouble sleeping; Feeling weak, after second vaccine; not feeling well; Vomiting/ sensation of vomiting; coughing; headache/Headache, excruciating, which caused trouble sleeping; This is a spontaneous report received from a contactable consumer (patient). A 25-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, lot number EW0186), via an unspecified route of administration in left arm on 21May2021 at 14:50 (age at vaccination 25 year) as second dose, single dose for COVID-19 immunisation. The patient had received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, lot number EW0167), via an unspecified route of administration into left arm on 30Apr2021 at 14:50 (Age at vaccination: 25 year) as a single dose for COVID-19 immunisation. Patient did not had any Medical History. No Family Medical History Relevant to AE. No additional vaccines were administered on same date of the Pfizer vaccine. Patient previously took tylenol. No prior Vaccinations within four weeks to the first administration date of the suspect vaccine. Concomitant medication was not reported. Patient Stated she had some vomiting after second vaccine. Vomiting, occurred on two separate occasions, after second vaccine. She stated that she reacted strongly, for about 24 hours, and had vomiting, and a headache and she had trouble sleeping. She stated she got through that and felt fine, in the days that followed. She stated that last night, about two weeks after her second vaccine, she had similar events of headache and vomiting, that mimicked those initial symptoms. Patient was concerned that maybe she had food poisoning. She stated vomiting returned yesterday (03Jun2021) along with a headache. Described also as sensation of vomiting, coughing on 04Jun2021. On 04Jun2021 01:00 am, she experienced headache, excruciating, which caused trouble sleeping, she woke up and felt weak after second vaccine. Caller states that she had the sensation of vomiting, similar to coughing, and this was identical to the first experience, but milder. She then thought that it was not food poisoning. Caller stated she was healthy, and that is why these reactions were concerning to her. She reported that compared to other people, she felt her effects a little stronger. She later reclarified, from earlier in report, that after the second vaccine, she initially did not have a headache until later. She stated she had vomiting initially after the second vaccine that was stronger last time. She stated the vomiting lasted the first time for about 23 hours. She stated the vomiting that occurred, again, the second time at 3 am on an unspecified date in 2021, was milder. She stated she still felt a little weak, which could be from the vomiting, and she was still not feeling well, and taking it easy and not working today. She stated she did not take anything and a couple of hours went by and she took some Tylenol for headache. Caller stated the Tylenol, did not help her headache. She stated she had taken Tylenol before and it had been effective. Regarding feeling weak, patient stated when she woke up this morning at 7:18 am, she felt better now than earlier today. The outcome of the event "headache/Headache, excruciating, which caused trouble sleeping" with PT ''Insomnia'' was recovered on 04Jun2021; Feeling weak, after second vaccine was recovering; Event Vomiting/ sensation of vomiting, "headache/Headache, excruciating, which caused trouble sleeping" with PT ''Headache'' was not recovered; coughing and not feeling well was unknown.


VAERS ID: 1391042 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Work       Purchased by: ?
Symptoms: SARS-CoV-2 antibody test, Vaccination site pain, Vaccination site rash, Vaccination site swelling
SMQs:, Hypersensitivity (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Appendectomy (Appendectomy in Feb2019, otherwise healthy boy)
Allergies:
Diagnostic Lab Data: Test Date: 20201005; Test Name: Nasal Swab; Result Unstructured Data: Test Result:Negative; Test Date: 20210307; Test Name: Nasal Swab; Result Unstructured Data: Test Result:Negative
CDC Split Type: USPFIZER INC2021656745

Write-up: left arm deltoid injection site with red circular rash with well defined border; There was general swelling (puffy/boggy) of upper arm centered around the injection site that extended under the rash 4 inches in diameter with diffuse/tapered border.; The injection site was very tender to palpation w/ pain raising or using arm.; This is a spontaneous report from contactable consumer (patient). A 13-year-old male patient received BNT162b2 (PFIZER BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Lot number- UNKNOWN) via an unspecified route of administration in left arm on 03Jun2021 at 10:30 as 2nd dose, single dose for COVID-19 immunization. Medical history included appendectomy in Feb2019, otherwise healthy boy. Patient previously took Amoxicillin and experienced full body rash. Concomitant medications were not reported. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Patient did not receive any other medications the patient received within 2 weeks of vaccination. On 05Oct2020, patient had been tested for COVID-19 via Nasal Swab and resulted negative. Prior to vaccination, patient was not diagnosed with COVID-19. Historical vaccine included BNT162b2 (PFIZER BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Lot number- unknown) via an unspecified route of administration in left arm on 13May2021 at 09:15 AM as 1st dose, single dose for COVID-19 immunization. It was reported that, patient experienced on left arm deltoid injection site with red circular rash with well defined border that was not raised and about 2 inches in diameter. Does not itch. There was general swelling (puffy/boggy) of upper arm centered around the injection site that extended under the rash 4 inches in diameter with diffuse/tapered border. The injection site was very tender to palpation w/ pain raising or using arm. This was only a day following the 2nd injection (On 04Jun2021 at 14:00). No treatment was received for the adverse events. Since the vaccination, the patient had been tested for COVID-19 via Nasal Swab. On 07Mar2021, patient tested COVID-19 and resulted negative. The device date was 05Jun2021. The outcome of the events was recovering. Information about batch/ lot number has been requested.


VAERS ID: 1391046 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Ear pain, Feeling abnormal, Malaise, Pain, Pain in extremity, Pyrexia, Vertigo
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Vestibular disorders (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Temperature; Result Unstructured Data: Test Result:101
CDC Split Type: USPFIZER INC2021658025

Write-up: Head spinning; Body ache/Intense body ache; Aching or having such an intense ache that even her thumbs and ears on the inside hurt and she did not want to touch her thumbs; Felt horrible; Aching or having such an intense ache that even her thumbs and ears on the inside hurt and she did not want to touch her thumbs; Temperature of 101/Had a temperature of 101; She just feels like the remnants of how you feel after you have a headache ; did not want to move; This is a spontaneous report from a contactable consumer or other non-Health Care Professional. A 56-years-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Lot number: EW0172 and Expiry date: Unknown), dose 2 via an unspecified route of administration, administered in Arm Right on 03Jun2021 as 2ND DOSE, SINGLE DOSE for covid-19 immunization. The patient medical history was not reported. The patient''s concomitant medications were not reported. On 04Jun2021 the patient experienced head spinning , body ache/intense body ache, aching or having such an intense ache that even her thumbs and ears on the inside hurt and she did not want to touch her thumbs, felt horrible, thumbs and ears on the inside were aching, aching or having such an intense ache that even her thumbs and ears on the inside hurt and she did not want to touch her thumbs, Temperature of 101/Had a temperature of 101. Also, At 5:00 am this morning, she took 325 mg Aspirin (treatment) and is feeling so much better now. She just feels like the remnants of how you feel after you have a headache ; did not want to move. The patient underwent lab tests and procedures which included body temperature: 101 on an unspecified date. The outcome of event was recovering. Follow up attempts are needed. Further information has been requested.


VAERS ID: 1391057 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Dysgeusia, Eating disorder, Headache, Nasopharyngitis, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: USPFIZER INC2021658761

Write-up: Headache; shakes; shivers/Chills; throwing up/vomiting; quit eating things; Bad taste in his mouth; Cold; This is a spontaneous report from a contactable consumer or other non health professional (Parent) reported for a patient(son). A male patient of an unspecified age received second dose of bnt162b2 (BNT162B2, Formulation: Solution for injection, Lot number: Unknown) via an unspecified route of administration on 03Jun2021 as 2ND DOSE, SINGLE DOSE for covid-19 immunisation. The patient medical history and concomitant medications were not reported. On 04Jun2021, the patient experienced headache, shakes and shivers/chills; throwing up/vomiting; quit eating things; bad taste in his mouth and cold. Reporter stated that he had headache at school the next day, he had the shot yesterday. Today real bad headache and stuff at school today. He came home and started having shakes and shivers. Then he started vomiting, throwing up, quit eating things. Had bad taste in his mouth. (distorted voice and unclear) but then he had problems like cold, chills, shakes in it. Reporter wants to know why patient was having chills, shakes and he was throwing up. The outcome of all events was unknown. Information on the lot/batch number has been requested.


VAERS ID: 1391062 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Off label use, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021658898

Write-up: 14 yr old received the 2nd dose of the Pfizer Covid vaccination; Sore arm; This is a spontaneous report from a non-contactable consumer. A 14-year-old patient of an unspecified gender received second dose of BNT162B2 (Pfizer Covid vaccine, Solution for injection) via an unspecified route of administration on 03Jun2021 (Lot number was not reported) as single dose for Covid-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient previously took first dose of BNT162B2 (at age of 14-year-old) as single dose for Covid-19 immunization. It was reported that, 14-year-old received the second dose of the Pfizer Covid vaccination on 03Jun2021 and had a slight sore arm the following morning. Event took place after use of product. Reporter did not wish to be contacted for follow-up. Outcome of the events was unknown. No follow-up attempts are possible; information about lot/batch number cannot be obtained.


VAERS ID: 1391065 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021658999

Write-up: slight sore arm; This is a spontaneous report from a non-contactable consumer reported for a 12-year-old male patient who received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection), via an unspecified route of administration on 03Jun2021 (Batch/Lot number was not reported) as second dose single for covid-19 immunization. The patient medical history and concomitant medications were not reported. The patient received the second dose of the Pfizer Covid vaccination on 03Jun2021 and experienced a slight sore arm the following morning (i.e., on 04Jun2021). The event took place after use of the product. The outcome of the event was unknown. No follow-up attempts are possible; information about lot/batch number cannot be obtained.


VAERS ID: 1391071 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New York  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Migraine
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: USPFIZER INC2021659160

Write-up: She experienced migraine; This is a spontaneous report from a contactable consumer (patient) via a Pfizer sponsored program. A female patient of an unspecified age received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: solution for injection), via an unspecified route of administration on 04Jun2021 as single dose for COVID-19 immunization. The patient medical history and concomitant medications were not reported. It was reported that she received the 1st dose of Pfizer COVID- 19 vaccine yesterday and she experienced migraine that was yesterday on 04Jun2021 and this morning and she drank acetaminophen (NDC number, UPC number and Expiry Date of acetaminophen were unknown) as treatment and now she was asking if she can drink Butalbital 335 mg? It was reported that she was still experiencing Migraine. The outcome of the event was not recovered. Information on Lot/Batch number has been requested.


VAERS ID: 1391076 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021659384

Write-up: Fatigue; Dizziness; This is a spontaneous report from a Non-contactable pharmacist. This pharmacist reported that a 12-year-old male patient received second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Batch/Lot Number: unknown), via an unspecified route of administration on 03Jun2021, as single dose for Covid-19 immunization. The patient''s medical history and concomitant medications were not reported. The patient received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Batch/Lot Number: unknown), via an unspecified route of administration on an unspecified date, as single dose for Covid-19 immunization. On 04Jun2021, the patient complained of fatigue and dizziness. The outcome of the events was unknown. No follow-up attempts are possible; information about lot/batch number cannot be obtained.


VAERS ID: 1391102 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dyspnoea, Fatigue, Headache, Malaise, Nausea, Pain in extremity, Vaccination site erythema, Vaccination site pain, Vaccination site pruritus, Vaccination site swelling
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LEVOTHYROXIN; PROBIOTICS NOS
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021662911

Write-up: I have side effects:Injections pain, swelling, redness, itching.; I have side effects:Injections pain, swelling, redness, itching.; I have side effects:Injections pain, swelling, redness, itching.; I have side effects:Injections pain, swelling, redness, itching.; Tiredness; Headache; Nausea; Feeling unwell; Arm pain; Weakness; Short of breath; This is a spontaneous report from a contactable consumer (patient). A 55-year-old non-pregnant female patient received second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Lot number: EW0178), via an unspecified route of administration, administered in Left arm on 03Jun2021 at 17:00 (at the age of 55-years-old) as 2ND DOSE, SINGLE DOSE for covid-19 immunisation. The patient medical history was not reported. and the patient had no known allergies. Concomitant medications included levothyroxine sodium (LEVOTHYROXIN) taken for an unspecified indication, probiotic supplement (PROBIOTICS NOS) taken for an unspecified indication, on an unspecified date received in two weeks of vaccination. The patient previously took first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Lot Number: EW0185, Expiration date: unknown), via an unspecified route of administration, administered in Left arm on 13May2021 17:00 at the age of 55-years-old for covid-19 immunisation. The patient did not receive other vaccine in four weeks of vaccination. The patient was not diagnosed with COVID-19 prior vaccination. The patient has not been tested for COVID-19 post vaccination. On 04Jun2021 at 11:00, the patient experienced side effect Injections pain, swelling, redness, itching, Tiredness, Headache, Nausea, feeling unwell, Arm pain, Weakness and Short of breath. patient did not received any treatment for adverse events. The outcome of the events was unknown. .


VAERS ID: 1391119 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-09
Onset:2021-06-04
   Days after vaccination:56
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / 2 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021664738

Write-up: He said he had just started having muscle pain in his leg; This is a spontaneous report from a contactable consumer (patient). A 36-years-old male patient received second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE Solution for injection, Batch/Lot Number: ER8729; Expiration Date: 31Jul2021), via an unspecified route of administration, administered in Arm Left on 09Apr2021 (at the age of 36-years-old) 09:30 as 2ND DOSE, SINGLE for covid-19 immunisation. The patient had no medical history and concomitant medications were not reported. The patient previously received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE Solution for injection, Batch/Lot Number: EN6206; Expiration Date: 30Jun2021), via an unspecified route of administration, administered in Arm Left on 19Mar2021 as 1ST DOSE, SINGLE DOSE for covid-19 immunisation. History of all previous immunization with the Pfizer vaccine considered as suspect was none. Patient had no prior vaccinations (within 4 weeks). No additional administered Vaccines. On 04Jun2021, the patient experienced muscle pain in leg. Patient stated that he wanted to know if this was still associated with the vaccine and heard of people who had side effects 1 week or just 24 hours after receiving the Pfizer-BioNTech Covid-19 Vaccine. He wanted to know if there had been reports of people having side effects almost 2 months after receiving the vaccine and had tried to find out if the side effect he was having from the Pfizer vaccine. He has a primary care doctor but declined to provide HCP information and he just put ice on it. Patient had not visited emergency room and physician office. The patient had no relevant tests. The outcome of event was not resolved.


VAERS ID: 1391138 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-06-04
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dysarthria, Epistaxis, Pain, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021665196

Write-up: difficult to speak; nose bleed; fever; body aches; This is a spontaneous report from a contactable consumer (patient). A 30-years-old female patient received bnt162b2 (PFIZER- BIONTECH COVID- 19 VACCINE, Solution for injection), dose 2 via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as 2nd dose, single dose for covid-19 immunisation. The patient''s medical history and concomitant medications were not reported. The patient received bnt162b2 (PFIZER- BIONTECH COVID- 19 VACCINE, Solution for injection), dose 1 via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as 1st dose, single dose for covid-19 immunisation. On 04Jun2021, the patient experienced fever and body aches. On 07Jun2021, she experienced nosebleed and on an unspecified date she experienced difficult to speak. The patient stated she received her second Pfizer covid vaccine on Friday. Over the weekend she had fever and body aches. On 07Jun2021, morning she developed a nose bleed. She wanted to know how to what to do about her nose bleed specifically. She was calling for treatment advice and agent referred her to her doctor. Agent asked if patient would like to complete a safety report based on the adverse events she has been experiencing. Patient stated if it is quickly, she could not speak more, and she would like to rest. Patient stated the fever has gone and she still has body aches. Patient stated did not had history and investigations, she was all good. Therapeutic measures were taken as a result of fever. The outcome of the event fever was recovered on 06Jun2021. The outcome of the event body aches was not recovered and unknown for nosebleed and difficult to speak.


VAERS ID: 1391382 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-20
Onset:2021-06-04
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 OT / -

Administered by: Other       Purchased by: ?
Symptoms: Bell's palsy, Computerised tomogram, Magnetic resonance imaging, Ultrasound Doppler
SMQs:, Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Simvastatin, Atenolol, Esomeprazole MA DR, L-Thyroxine, Androgel, Finesteride, Monoxidil, Aspirin (81 mg), Folic Acid, Vitamin D3, Naproxin Sodium, Align, daily multiple vitamin.
Current Illness: None
Preexisting Conditions: High blood pressure High Chloresterol Aorotic Stenosis
Allergies: None
Diagnostic Lab Data: CAT scan, MRI, and Coratid Ultrasound
CDC Split Type:

Write-up: Belle''s Palsy, Left side of face. Treatment Anti-Viral and Prednisone. Has not normalized to date.


VAERS ID: 1391467 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Confusional state, Dizziness, Flushing, Grunting, Headache, Loss of consciousness, Nausea, Syncope, Tremor, Unresponsive to stimuli, Visual impairment
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Confusion-Mild, Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Headache-Mild, Systemic: Nausea-Mild, Systemic: Shakiness-Mild, Systemic: Visual Changes/Disturbances-Mild, Systemic: Weakness-Mild, Additional Details: made grunting sounds before passing out


VAERS ID: 1391468 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fear of injection, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: During monitoring period post Pfizer COVID-19 vaccine, pt experienced lightheadedness, feeling faint, sweating. 2 minutes post vaccine, BP was 108/70, P-64, O2 100% RA. Patient was easily aroused, stated he hadn''t eaten or had hydration for $g 12 hours and "needles make him nervous." Crackers and orange juice provided. After extended observation patient stated he felt better and symptoms were relieved.


VAERS ID: 1391475 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Discomfort, Dizziness, Dyspnoea, Eye swelling, Fatigue, Hyperhidrosis, Lip swelling, Oropharyngeal pain, Pruritus, Rash, Tachycardia, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: During monitoring period post initial Pfizer COVID-19 vaccine, pt experienced lip swelling, "ball in throat," itching, lightheaded, sweaty, then chills, dizziness, fatigue, tachycardia, heaviness all over. Medications Given: Epi-Pen injection 0.3ml SC in left thigh, Benadryl 25mg IM for itching given before and after Epi-Pen due to severe itching/rash. Patient has had severe anaphylactic reactions to other vaccines previously that was not disclosed during intake. Patient remained in extended Observation for over 2 hours. VS: 140/82, P-79, Resp 17, O2 97% on RA. Refused to transfer to ER after observation. Later presented to ER with swollen eyes and SOB, rashes, sore throat and took fexofenadine at home. Given additional diphenhydramine 25mg IV and methylprednisolone 125mg IV. Discharged from ED with medrol dosepak.


VAERS ID: 1391485 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / IM

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

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

Write-up: Patient became lightheaded and fainted in her chair in the observation room post injection. BP 103/71, HR 66, R 16, O2 sat 100%. Patient was given water and graham crackers. Continued to monitor patient; at 1003, BP 106/70, HR 73, R 16, O2 sat 100%. Patient stated that she was feeling better and was ready to leave. Patient was discharged to mother to go home.


VAERS ID: 1391767 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-22
Onset:2021-06-04
   Days after vaccination:74
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6199 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 UN / IM

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea, Laboratory test abnormal
SMQs:, 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? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Congestive heart failure, asthma HX of stroke
Allergies: Unknown
Diagnostic Lab Data: Antigen testing on 06/06/2021, came back positive PCR testing on 06/06/2021, came back positive
CDC Split Type:

Write-up: Patient became symptomatic with shortness of breath on 06/04/2021. She was admitted into the hospital on 06/06/2021. She was discharged on 06/08/2021.


VAERS ID: 1391791 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

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

Write-up: Patient administered 2nd dose in series on day 15 instead of 21.


VAERS ID: 1391928 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-06-01
Onset:2021-06-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 2 - / IM

Administered by: Work       Purchased by: ?
Symptoms: Blood test abnormal, Chest pain, Computerised tomogram, Echocardiogram, Electrocardiogram, Infection, Myocardial infarction, Troponin
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Have taken creatine for workout supplement.
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: Echocardiogram 6/5/21 CT Scan 6/4/21 Blood work (2) 6/4/21 and 6/10/21 EKG (2) 6/4/21 and 6/10/21
CDC Split Type:

Write-up: On Friday patient woke up with severe chest pain. He had to be taken to the emergency room. His troponin levels were above 1300 which indicated a heart attack so they admitted him to the hospital overnight. However, the blood work indicated an infection and Ibuprofen was the only medicine that helped with the pain. While at the hospital a series of tests were done to find out what was going on. Once the patient was stable enough he left the hospital and he is now undergoing more tests and getting his medical records transferred to the doctors here. We are still in the process of finding out the exact issue and will hopefully get some answers soon.


VAERS ID: 1391971 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

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

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

Write-up: PATIENT HAS EXPERIENCED MUSCLE PAIN FROM THE SHOULDER TO THE TOE OF THE LEFT SIDE OF HIS BODY FROM 06/04/2021 UNTIL NOW . THE PAIN HAS PERSISTED AND NOT GOTTEN ANY BETTER. HE WENT TO MASSAGE PARLOR ON JUNE 7,2021 FOR MASSAGE , THE PAIN WAS GETTING WORSE AFTER MASSAGE.


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