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

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



Case Details (Reverse Sorted by Onset Date)

This is page 240 out of 8,010

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VAERS ID: 1705920 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

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

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


VAERS ID: 1705997 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 2 RA / IM

Administered by: Pharmacy       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: Error: Wrong Dose of Vaccine - Too Low-


VAERS ID: 1705998 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017E21A / 2 RA / IM

Administered by: Pharmacy       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: Error: Wrong Dose of Vaccine - Too Low-


VAERS ID: 1706444 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 3 OT / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Cough, Dizziness, Dyspnoea, Heart rate increased, Pyrexia, Tachycardia, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Abdominal Pain-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fever-Medium, Systemic: Shakiness-Medium, Systemic: Tachycardia-Medium, Additional Details: Within 5 min of admin, patient spiked a fever, w/ HR $g 90, coughing, trouble breathing, stomach pains (had prev hx of hernia surgery/condition). Had patient lie down, elevated feet, take 3 deep breaths. Brought epipen next to me in case, however, within 2-3 minutes, patients HR was lowering to baseline and fever was going down with a cold compress. Offered water and she was able to drink/swallow water. Told patient to stay as long as she needed - she later was sitting up and drinking water.


VAERS ID: 1706533 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2021-09-08
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Condition aggravated
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:
Current Illness: Toothache
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210924084

Write-up: PAIN SECONDARY TO TOOTHACHE WORSENED; This spontaneous report received from a patient concerned a 55 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: toothache. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 043A21A, and expiry: 19-SEP-2021) dose was not reported, administered on 08-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 08-SEP-2021, the patient experienced pain secondary to toothache worsened. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from pain secondary to toothache worsened. This report was non-serious. This case, from the same reporter is linked to 20161001746 and 20160930945.


VAERS ID: 1706560 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: South Carolina  
Vaccinated:0000-00-00
Onset:2021-09-08
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Body temperature, Hypoaesthesia, Pain, Pain assessment, Paraesthesia, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ASPIRINE
Current Illness: Penicillin allergy
Preexisting Conditions: Comments: The patient was not breastfeeding at time of vaccination.
Allergies:
Diagnostic Lab Data: Test Date: 20210908; Test Name: Pain scale; Result Unstructured Data: scale 9/10; Test Date: 20210909; Test Name: Body temperature; Result Unstructured Data: 102.4 degrees fahrenheit (F)
CDC Split Type: USJNJFOC20210925774

Write-up: FEVER (102.4 DEGREES FAHRENHEIT (F)); TINGLING DOWN THE ARMS, HANDS AND FEET; SEVERE UPPER BACK PAIN (SCALE 9/10); ACHING; NUMBNESS DOWN THE ARMS, HANDS AND FEET; This spontaneous report received from a patient concerned a 48 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: penicillin allergy, and other pre-existing medical conditions included: The patient was not breastfeeding at time of vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1821288 expiry: 30-OCT-2021) dose was not reported, administered on 08-SEP-2021 for prophylactic vaccination. Concomitant medications included acetylsalicylic acid for to prevent of blood clot. On 08-SEP-2021, the patient experienced severe upper back pain (scale 9/10). On 08-SEP-2021, the patient experienced aching. On 08-SEP-2021, the patient experienced numbness down the arms, hands and feet. On 08-SEP-2021, the patient experienced tingling down the arms, hands and feet. Laboratory data included: Pain scale (NR: not provided) scale 9/10. On 09-SEP-2021, the patient experienced fever (102.4 degrees fahrenheit (f) ). Laboratory data included: Body temperature (NR: not provided) 102.4 degrees fahrenheit (F). Treatment medications included: dextromethorphan hydrobromide/doxylamine succinate/ephedrine sulfate/ethanol/paracetamol, and paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from numbness down the arms, hands and feet, fever (102.4 degrees fahrenheit (f)), and tingling down the arms, hands and feet on 10-SEP-2021, and had not recovered from severe upper back pain (scale 9/10), and aching. This report was non-serious.


VAERS ID: 1706569 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Georgia  
Vaccinated:0000-00-00
Onset:2021-09-08
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Blood pressure measurement, Body temperature, Cardiac flutter, Chills, Dysgeusia, Dyspnoea, Fatigue, Flushing, Headache, Heart rate, Hot flush, Hyperhidrosis, Hypoaesthesia, Injection site pain, Injection site warmth, Lethargy, Pain, Pain assessment, Pain in extremity, Paraesthesia, Pyrexia, Respiratory rate, Speech disorder, Swollen tongue, Tinnitus, Tremor
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Hearing impairment (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Alcohol use (1 BEER IN EVERY 6 MONTH); Non-smoker
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19; Comments: The patient had no known drug allergies and no drug abuse or illicit drug use
Allergies:
Diagnostic Lab Data: Test Date: 20210908; Test Name: Body temperature; Result Unstructured Data: 102.6 F; Test Date: 20210908; Test Name: Heart rate; Result Unstructured Data: 60 {beats}/min; Test Date: 20210908; Test Name: Blood pressure; Result Unstructured Data: 128/62 mmHg; Test Date: 20210908; Test Name: Body temperature; Result Unstructured Data: 101.4 F; Comments: an hour after taking motrin body temperature decreased; Test Date: 20210908; Test Name: Heart rate; Result Unstructured Data: 84 {beats}/min; Comments: an hour after taking motrin heart rate decreased; Test Date: 20210908; Test Name: Body temperature; Result Unstructured Data: 98.9 F; Test Date: 20210908; Test Name: Heart rate; Result Unstructured Data: 82 {beats}/min; Comments: Temperature was decreasing, but heart rate was not normal at about 60 beats per minute; Test Date: 20210908; Test Name: Pain scale; Result Unstructured Data: 5 out of 10; Test Date: 20210908; Test Name: Body temperature; Result Unstructured Data: 97.4 F; Test Date: 20210908; Test Name: Heart rate; Result Unstructured Data: 69 {beats}/min; Test Date: 20210908; Test Name: Heart rate; Result Unstructured Data: 118 {beats}/min; Test Date: 20210908; Test Name: Respiratory rate; Result Unstructured Data: 12 {beats}/min; Test Date: 20210909; Test Name: Body temperature; Result Unstructured Data: 96.1 F; Test Date: 20210909; Test Name: Heart rate; Result Unstructured Data: 65 {beats}/min; Test Date: 20210909; Test Name: Pain scale; Result Unstructured Data: 4 out of 10; Test Date: 20210909; Test Name: Heart rate; Result Unstructured Data: 74 {beats}/min; Test Date: 20210909; Test Name: Body temperature; Result Unstructured Data: 96.3 F
CDC Split Type: USJNJFOC20210925879

Write-up: HEART FLUTTERING; HOT FLASH; PROFUSELY SWEATING; LETHARGIC; SPEAKING SLOWER THAN USUAL AND NOT IN COMPLETE SENTENCES; SHAKINESS; BODY ACHES; WEIRD, INDESCRIBABLE TASTE IN HIS MOUTH; HEAVY AND LABORED BREATHING; FLUSHED FACE; SLIGHTLY SWOLLEN TONGUE; INJECTION SITE ARM WAS WARM TO TOUCH; LEFT ARM PAIN; SEVERE CHILLS; SEVERE JOINT PAIN; EAR RINGING; HIGH FEVER; TINGLING SENSATION IN BOTH LEGS AND ARMS WHILE SITTING UPRIGHT; INJECTION SITE ARM WAS EXTREMELY TENDER; SEVERE HEADACHE; NUMBNESS IN BOTH LEG AND ARM ON SITTING; BECAME EXHAUSTED AGAIN; This spontaneous report received from a patient concerned a 32-year-old white male of unknown ethnicity. The patient''s height, and weight were not reported. The patient''s past medical history included: covid-19 infection, and concurrent conditions included: alcohol use, and non-smoker, conditions included: The patient had no known drug allergy and no drug abuse or illicit drug use. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 201A21A, expiry: 21-SEP-2021) dose was not reported, 1 total administered on 08-SEP-2021 on left arm for prophylactic vaccination. No concomitant medications were reported. On 08-SEP-2021, in afternoon patient began to experience a severe headache, shortly after headache he had severe chills (felt like freezing in winter with no clothes on). Within 20 minutes of chills, he had a hot flash and began to profusely sweat. By 14:00 patient had a high fever at 102.6 Fahrenheit (F). Patient felt that his heart was fluttering. He went to the clinic, and he had a high heart rate with no beats per minute number. The healthcare professional at the base sent him home to rest. Patient wished to be seen by a healthcare professional due to these unforeseen side effects, because the fever should not have been that high. At approximately 15:30 to 16:00 was soaking in pool bath in Epsom salt. He was lethargic, speaking slower than usual and not in complete sentences. The nurse recommended him not go to urgent care and continue home therapy with over the counter Motrin for fever. At 16:30 he was lethargic, had heavy and labored breathing (respiration rate 12), face was flushed even though he washed with cool water. Patient vital signs were taken body temperature was still 102.6 Fahrenheit (F) although he was soaking in the pool bath for an hour. Heart rate was 118 beats per minute, blood pressure was 128/62 mmHg. This was all while patient was sitting and resting on the chair, with no exertion. Given 400mg of Motrin at 17:15. At 18:00, patient complained of ear''s ringing for the past 2 hours, which may have started at 16:00. Only reported of ear ringing, because the ringing was unbearable. An hour after taking Motrin, body temperature was 101.4 Fahrenheit (F) and heart rate was 84 beats per minute. headache was still persistent, but felt like it was moving from one area to another. Patient stated that headache was painful by the frontal lobe area of his head. Complained of shakiness. He took a nap. At about 19:00, he woke up and ate a few snacks, then became exhausted again and fell asleep. Body temperature was 98.9 Fahrenheit (F) and heart rate 82 beats per minute. Temperature was decreasing, but heart rate was not normal at about 60 beats per minute. Patient complained that headache was still constant and now had left arm pain, body aches and severe joint pain in his entire body. He experienced a weird, indescribable taste in his mouth. His tongue was slightly swollen, but was not affecting his swallowing very much. Injection site on left arm was extremely tender and warm to touch. Nurse advised that him to seek treatment as soon as possible within 24 hours. Patient was not sure if he wanted to go to emergency room. At 22:00, patient woke up and ate a bit of homemade chicken and rice soup. He fell back to sleep after that. At 22:40, he was still complaining of headache and joint pain throughout body, and pain at injection site was a 5 out of 10. Sensation of tingling in both legs and arm started, while sitting upright. Tingling went away when he laid flat on his back and when he stood up, with mild improvement from the tingling sensation. Every time he sat, the sensation in both his legs and arms would go numb again. Body temperature was 97.4 Fahrenheit (F) and heart rate was 69 beats per minute. Patient went to bed for the night and at 2 AM. Vital signs were checked again. Body temperature dropped to 96.3 Fahrenheit (F) and heart rate was 74 beats per minute. Patient went back to sleep and woke up at 6:00 AM, body temperature was at 96.1 Fahrenheit (F) and heart rate was 65 beats per minute. Left arm pain decreased to a 4 out of 10. Patient went again to medical clinic at 9:30 AM on 10-SEP-2021. Patient looked fine that morning. The action taken with covid-19 vaccine was not applicable. The patient recovered from heart fluttering, hot flash, profusely sweating, lethargic, speaking slower than usual and not in complete sentences, shakiness, body aches, weird, indescribable taste in his mouth, heavy and labored breathing, flushed face, slightly swollen tongue, severe chills, severe joint pain, ear ringing, high fever, and tingling sensation in both legs and arms while sitting upright on 10-SEP-2021, recovered with sequelae from severe headache on 10-SEP-2021, was recovering from injection site arm was extremely tender, and left arm pain, and the outcome of injection site arm was warm to touch, numbness in both leg and arm on sitting and became exhausted again was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210925879-COVID-19 VACCINE-Heart fluttering. 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: 1706577 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Utah  
Vaccinated:0000-00-00
Onset:2021-09-08
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Application site bruise, Application site pain, Arthralgia, Contusion, Fatigue, Joint swelling, Muscle strain, Nausea, Pain, Pain assessment, Pain in extremity, Somnolence
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergy to metals; Allergy to molds
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19; Comments: The patient had not taking daily medications.
Allergies:
Diagnostic Lab Data: Test Name: Pain scale; Result Unstructured Data: 7/10
CDC Split Type: USJNJFOC20210925996

Write-up: LEFT ANKLE SWELLING (LEFT ANKLE APPEAR PUFFY SUCH THAT CAN NOT SEE THE BONES AND LOOKS THIRD BIGGER THAN THE RIGHT ANKLE); LEFT ANKLE PAIN ( FEELS LIKE A CONSTANT THROB, 7/10 PAIN LEVEL, PAIN FELT SHARP WHEN STANDS OR GOES DOWN THE STAIRS); TOP OF THE LEFT FOOT LOOKED DISCOLORED LIKE A LIGHT BRUISE/PURPLE; WANTED TO SLEEP; LEFT FOOT FELT STRAINED IN THE TOP ARCH; REALLY TIRED; SLIGHTLY NAUSEATED; TENDOR TO TOUCH; TENDER RIGHT ARM/LEFT FOOT PAIN/LEFT FOOT FELT TENDER AND MOVED TO THE ENTIRE LEFT ANKLE; RIGHT ARM THROBBED FOR 5 MINUTES AT THE INJECTION SITE; FEELS LIKE A BRUISE THAT''S 2 WEEKS OLD; This spontaneous report received from a patient concerned a 67 year old female. The patient''s weight was 180 pounds, and height was 66 inches. The patient''s past medical history included: covid-19 infection, and concurrent conditions included: mold allergy, and heavy metals allergy, and other pre-existing medical conditions included: The patient had not taking daily medications. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 202A21A, and expiry: UNKNOWN) dose was not reported, administered on 08-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 08-SEP-2021, the patient experienced right arm throbbed for 5 minutes at the injection site. On 08-SEP-2021, the patient experienced feels like a bruise that''s 2 weeks old. On 08-SEP-2021, the patient experienced tender right arm/left foot pain/left foot felt tender and moved to the entire left ankle. On 08-SEP-2021, the patient experienced tendor to touch. On 09-SEP-2021, the patient experienced wanted to sleep. On 09-SEP-2021, the patient experienced left foot felt strained in the top arch. On 09-SEP-2021, the patient experienced really tired. On 09-SEP-2021, the patient experienced slightly nauseated. On 10-SEP-2021, the patient experienced top of the left foot looked discolored like a light bruise/purple. On 14-SEP-2021, the patient experienced left ankle swelling (left ankle appear puffy such that can not see the bones and looks third bigger than the right ankle). On 14-SEP-2021, the patient experienced left ankle pain ( feels like a constant throb, 7/10 pain level, pain felt sharp when stands or goes down the stairs). Laboratory data (dates unspecified) included: Pain scale (NR: not provided) 7/10. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from right arm throbbed for 5 minutes at the injection site on 08-SEP-2021, left foot felt strained in the top arch, and really tired, and slightly nauseated on 10-SEP-2021, was recovering from top of the left foot looked discolored like a light bruise/purple, had not recovered from tender right arm/left foot pain/left foot felt tender and moved to the entire left ankle, left ankle swelling (left ankle appear puffy such that can not see the bones and looks third bigger than the right ankle), left ankle pain ( feels like a constant throb, 7/10 pain level, pain felt sharp when stands or goes down the stairs), feels like a bruise that''s 2 weeks old, and tendor to touch, and the outcome of wanted to sleep was not reported. This report was non-serious.


VAERS ID: 1706916 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-04
Onset:2021-09-08
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059E21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Extra dose administered, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Pain, Pruritus, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Site: Itching at Injection Site-Severe, Site: Pain at Injection Site-Severe, Site: Redness at Injection Site-Severe, Site: Swelling at Injection Site-Severe, Systemic: Allergic: Itch Generalized-Severe, Systemic: Allergic: Rash Generalized-Severe, Systemic: Body Aches Generalized-Medium, Systemic: Chills-Medium, Systemic: Fever-Medium


VAERS ID: 1707518 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Disturbance in attention, Dysarthria, Eructation, Eyelid function disorder, Feeling abnormal, Freezing phenomenon, Hallucination, Hyperhidrosis, Hypophagia, Limb discomfort, Malaise, Memory impairment, Mental impairment, Mobility decreased, Myalgia, Nausea, Neck pain, Tension headache, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (narrow), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: brain was not connecting to her eyelids or other parts of her body; hallucinating; trouble controlling her eyelids; motor skills issues with things like typing; slurred speech; memory issues; legs felt like Jello; hadn''t eaten; pain in the left side of her neck; light pressure on her chest; felt like she was really drunk minus the fun part; burping; sweating; freezing; blurred vision; tension headache; problems concentrating; was not doing well; body aches; felt nauseous; This spontaneous case was reported by a consumer and describes the occurrence of MENTAL IMPAIRMENT (brain was not connecting to her eyelids or other parts of her body) and HALLUCINATION (hallucinating) in a 52-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 037F21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Chronic fatigue and Fibromyalgia. Concomitant products included OXYCODONE for an unknown indication. On 07-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 08-Sep-2021, the patient experienced MENTAL IMPAIRMENT (brain was not connecting to her eyelids or other parts of her body) (seriousness criterion medically significant), HALLUCINATION (hallucinating) (seriousness criterion medically significant), EYELID FUNCTION DISORDER (trouble controlling her eyelids), MOBILITY DECREASED (motor skills issues with things like typing), DYSARTHRIA (slurred speech), MEMORY IMPAIRMENT (memory issues), LIMB DISCOMFORT (legs felt like Jello), HYPOPHAGIA (hadn''t eaten), NECK PAIN (pain in the left side of her neck), CHEST DISCOMFORT (light pressure on her chest), FEELING ABNORMAL (felt like she was really drunk minus the fun part), ERUCTATION (burping), HYPERHIDROSIS (sweating), FREEZING PHENOMENON (freezing), VISION BLURRED (blurred vision), TENSION HEADACHE (tension headache), DISTURBANCE IN ATTENTION (problems concentrating), MALAISE (was not doing well), MYALGIA (body aches) and NAUSEA (felt nauseous). At the time of the report, MENTAL IMPAIRMENT (brain was not connecting to her eyelids or other parts of her body), HALLUCINATION (hallucinating), EYELID FUNCTION DISORDER (trouble controlling her eyelids), MOBILITY DECREASED (motor skills issues with things like typing), DYSARTHRIA (slurred speech), MEMORY IMPAIRMENT (memory issues), LIMB DISCOMFORT (legs felt like Jello), HYPOPHAGIA (hadn''t eaten), NECK PAIN (pain in the left side of her neck), CHEST DISCOMFORT (light pressure on her chest), FEELING ABNORMAL (felt like she was really drunk minus the fun part), ERUCTATION (burping), HYPERHIDROSIS (sweating), FREEZING PHENOMENON (freezing), VISION BLURRED (blurred vision), TENSION HEADACHE (tension headache), DISTURBANCE IN ATTENTION (problems concentrating), MALAISE (was not doing well), MYALGIA (body aches) and NAUSEA (felt nauseous) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Treatment medication was not provided by the reporter Company Comment: Based on the current available information and temporal association between the use of the product and the start date of these events, a causal relationship cannot be excluded; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of these events, a causal relationship cannot be excluded


VAERS ID: 1707540 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Washington  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Muscle spasms, Vaccination site pain
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: my left leg has been cramping ever since i got it; injection site is sore; This spontaneous case was reported by a consumer and describes the occurrence of MUSCLE SPASMS (my left leg has been cramping ever since i got it) and VACCINATION SITE PAIN (injection site is sore) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 08-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 08-Sep-2021, the patient experienced MUSCLE SPASMS (my left leg has been cramping ever since i got it) and VACCINATION SITE PAIN (injection site is sore). At the time of the report, MUSCLE SPASMS (my left leg has been cramping ever since i got it) and VACCINATION SITE PAIN (injection site is sore) outcome was unknown. No concomitant medications were provided. No treatment medications were provided.


VAERS ID: 1707568 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Virginia  
Vaccinated:2021-01-01
Onset:2021-09-08
   Days after vaccination:250
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

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

Write-up: received her 1st dose of the Moderna Covid-19 vaccine in January 2021. She''s here to get her 2nd dose today.; This spontaneous case was reported by a pharmacist and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (received her 1st dose of the Moderna Covid-19 vaccine in January 2021. She''s here to get her 2nd dose today.) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In January 2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 08-Sep-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (received her 1st dose of the Moderna Covid-19 vaccine in January 2021. She''s here to get her 2nd dose today.). At the time of the report, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (received her 1st dose of the Moderna Covid-19 vaccine in January 2021. She''s here to get her 2nd dose today.) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported by reporter Treatment information was not provided


VAERS ID: 1707629 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Neck pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Systemic: Fever-Severe, Systemic: neck and back pain; fever over 102.4-Medium, Additional Details: patient has complained of fever over 102.4 even after alternating Motrin and Tylenol around the clock. Also moderate to severe neck and back pain


VAERS ID: 1707984 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia, Nausea
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omega, folic acid, calcium w/ vitamin d
Current Illness:
Preexisting Conditions: Asthma, migraines, chronic back pain, GERD, Obsetiy
Allergies: Compazine
Diagnostic Lab Data:
CDC Split Type:

Write-up: SEVERE DIZZINESS AND NAUSEA, ALMOST BLACKED OUT, NUMBNESS OF LEFT LEG, OXYGEN WAS DOWN TO 93


VAERS ID: 1707986 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye swelling, Mouth swelling, Pruritus, Pyrexia, Rash, Swelling face, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Systemic: Allergic: Itch (specify: facial area, extremities)-Mild, Systemic: Allergic: Rash (specify: facial area, extremities)-Mild, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Mild, Systemic: Fever-Mild


VAERS ID: 1708003 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-01
Onset:2021-09-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 - / IM

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? 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: Zosters on torso, prescribed valacyclovir 1g 3xday for 7 days, Prednisone taper


VAERS ID: 1708031 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Syncope, Unresponsive to stimuli
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), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Additional Details: AFTER 5-10 MINS GIVEN THE VACCINE @6;50PM, THE PT FELT DIZZY/FAINTED FOR 2-3 MINS. RPH MADE SURE HE DIDNT FELL OR HIT HIS HEAD. TECH CALLED 911. PARAMEDIC TOOK BP 134/86, BS 78, OSAT 99. PULSE 69. 9/9/21 CALLED PT TO FOLLOW UP/OK. PT STATED HE WAS BEING WATCHED FOR 20MINS IN THE AMBULANCE AND SENT HOME


VAERS ID: 1708227 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-27
Onset:2021-09-08
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal distension, Abdominal pain lower, Bacterial test positive, Chills, Full blood count, Headache, Micturition urgency, Pain, Pyrexia, Urinary tract infection, White blood cell count increased
SMQs:, 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), Infective pneumonia (broad), Opportunistic infections (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: vitamins D/ B and C. Magnesium and Zinc
Current Illness: none
Preexisting Conditions: none
Allergies: Mangoes
Diagnostic Lab Data: CBC was 82.
CDC Split Type:

Write-up: Serious UTI, chills, low fever, lower abdomen pain/bloating. Constant need to urinate. Started Wednesday evening, by Thursday afternoon needed to lay down. By Thursday evening seriously hurting and chills. All accompanied by a headache. Friday went to doctor, urine sample confirmed bacterial UTI, also my white blood count was extremely high. Received shot in hip of antibiotics, and Rx for Ciptro. Follow up one week later (started to feel better on Monday (3 days later). Doctor will retest my blood after I complete antibiotics.


VAERS ID: 1708261 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-01
Onset:2021-09-08
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Cough, Oxygen saturation decreased
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Respiratory failure (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? Yes
Hospitalized? No
Previous Vaccinations: diphtheria toxoid & tetanus toxoid
Other Medications: UNKNOWN
Current Illness:
Preexisting Conditions: coronary artery disease,
Allergies: Diphtheria toxoid, morphine, tetanus toxoid
Diagnostic Lab Data: Emergency Department recorded pt''s O2 at 91% on room air
CDC Split Type:

Write-up: diagnosed with COVID, LOW OXYGEN AT HOME 88%, minimal dry cough, MD Dx COVID pneumonia


VAERS ID: 1708345 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Movement disorder, Pain in extremity
SMQs:, Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (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: tylenol, ibuprofen, xanax
Current Illness: none
Preexisting Conditions: GERD
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt stated that left arm was extremely sore, unable to move for 1 day and extremely sore for 3 more days. Pain got better but 09/17/2021 she is unable to move arm again.


VAERS ID: 1708412 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-06
Onset:2021-09-08
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Computerised tomogram thorax abnormal, Condition aggravated, Gastrostomy, Infarction, Lung opacity, Magnetic resonance imaging, Mental status changes, Pneumonia, SARS-CoV-2 test positive, Seizure, Urinary tract infection
SMQs:, Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Dementia (broad), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: tamsulosin, finasteride
Current Illness: N/A
Preexisting Conditions: Seizure, toxic metabolic encephalopathy, acute kidney injury, hydronephrosis, enteritis, cirrhosis, DVT, Alzheimer''s, dysphagia causing pulmonary aspiration
Allergies: N/A
Diagnostic Lab Data: Nucleic Acid Amplification (NAA)/Polymerase Chain Reaction (RT-PCR) positive 8/24/2021. Acute infarction involving the right centrum semiovale. Moderate degree of scattered T2 FLAIR
CDC Split Type:

Write-up: Pt brought in for Altered Mental Status and witnessed seizure. Pt was seen within past month for UTI and pneumonia. CT performed paatchy right greater than left lower lobe opacities are concerning for pneumonia. PEG to be placed on 9/14/21 COVID test performed prior to procedure, resulted positive, and PEG consequently delayed.


VAERS ID: 1708748 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-04-12
Onset:2021-09-08
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 RA / IM

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

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

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


VAERS ID: 1708777 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: ADHD; ALLERGIC RHINITIS; CERVICAL HIGH RISK HPV TEST POSITIVE
Allergies: Adhesive Tape; Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 9/8/2021, left arm pit swelling. 3 hours after vaccination, felt pain and then swelling. The Plan was to Ice, elevate, and return precautions discussed.


VAERS ID: 1708894 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-29
Onset:2021-09-08
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 03/08/2021 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Arthralgia, Asthenia, Atelectasis, Blood culture negative, Blood lactic acid, Blood magnesium decreased, Blood uric acid increased, C-reactive protein increased, COVID-19, COVID-19 pneumonia, Chemotherapy, Chest X-ray abnormal, Condition aggravated, Contusion, Dyspnoea exertional, Fall, Hyperkalaemia, Hyperuricaemia, Lung opacity, Mental status changes, Neurological examination, Pain, Plasma cell myeloma, Pneumonia, Pyrexia, Renal failure, Renal impairment, SARS-CoV-2 test positive, Tumour lysis syndrome, Urine analysis normal, Wound
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Malignancy related conditions (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Arthritis (broad), Tumour lysis syndrome (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Outpatient Medications acetaminophen (TYLENOL) 500 MG tablet acyclovir (ZOVIRAX) 400 MG tablet ADVAIR DISKUS 250-50 MCG/DOSE diskus inhaler albuterol (PROVENTIL) (2.5 MG/3ML) 0.083% nebulization albuterol (VENTOLIN) 108 (90 BASE) MCG/ACT in
Current Illness: Getting chemotherapy treatment every Tuesday 8.17.21: reported being sore all over body 8.18.21: office visit for hip pain 8.31.21: ED - fall, weakness, hyperkalemia, renal insufficiency (multiple falls over past week, increasing weakness and shortness of breath upon exertion. on chemo, last dose today, for multiple myeloma. denies pain, no LOC) 9.1.21: ED weakness 9.8.21: ED - altered mental status; COVID-19 positive (9.8.21) - admitted
Preexisting Conditions: Hospital Tumor lysis syndrome AKI (acute kidney injury) Multiple myeloma not having achieved remission COVID-19 virus infection Non-Hospital Hx of adenomatous polyp of colon Diverticulosis Type 2 diabetes mellitus with diabetic neuropathy Morbid obesity with BMI of 60.0-69.9, adult Depression with anxiety Vertigo Falls Sepsis Hypertension CKD (chronic kidney disease) stage 4, GFR 15-29 ml/min Chronic bronchitis Asymptomatic COVID-19 virus infection History of anemia due to chronic kidney disease Anemia due to stage 3 chronic kidney disease, unspecified whether stage 3a or 3b CKD Atrial flutter Hyperkalemia Atrial flutter, unspecified type Chronic pain Goals of care, counseling/discussion Medication management contract agreement Anemia Physical debility Overactive bladder CAD (coronary artery disease) Acute cystitis without hematuria Morbid obesity with BMI of 45.0-49.9, adult
Allergies: AlfalfaShortness of Breath White PineShortness of Breath CodeineGI Upset Insulin GlargineRash MetforminDiarrhea
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized 9.8.21; COVID-19 positive (9.8.21); fully vaccinated Admitted for Tumor Lysis Syndrome Brief history and medical decision making: 62F with myeloma admitted for worsening renal function and altered mental status in the context of COVID-19. Would be unusual to note tumor lysis syndrome with myeloma - and most likely her hyperuricemia is related to acute renal injury. Appreciate Infectious Disease guided monoclonal antibody treatment. Nephrology assisting. No additional chemotherapy while inpatient. SUBJECTIVE: This is a 62 y.o. patient with a past medical history significant for recurrent Falls, Right/left hip replacement, DM type II, Morbid obesity, CKD IV and Multiple Myeloma who presented to ED with symptoms of altered mental status and fever. In the ED, patient was found to be also Covid 19 positive, her CXR revealed Left basilar airspace opacity, atelectasis versus pneumonia with a low magnesium. Patient was treated with IVF and antibiotics and her magnesium was replaced. Upon arrival to, patient was found to have an elevated uric acid 10.1. Patient denies SOB, chest pain, palpitation, nausea/vomiting, abdominal pain, dysuria, hematuria and melena. This patient also reports recurrent falls at home despite the use of a walker and last fall was on 9/7/21 which resulted in bruising to the left hip and an open wound to the right foot, she denies hitting her head, headaches and trouble with vision. Note from 9.17.21 (still admitted) ASSESSMENT / PLAN: Covid 19 Pneumonia - Febrile at home- no fever here, no SOB - CXR with Left basilar airspace opacity, atelectasis versus pneumonia - Covid 19 positive on 9/8-S/P Regeneron 9/9 - Lactic acid neg, CRP 79.1 - Blood cx NGTD - ID following - s/p cefepime/azithro in ED- stopped per ID - s/p dex but stopped as no hypoxia - Tessalon pearls, Mucinex - stable on room air TLS-resolved - Nephrology following - monitor labs - IVF held - continue allopurinol AMS- resolved - possibly secondary to renal function, TLS, or infection - UA neg - Neuro checks - Fall precautions


VAERS ID: 1708947 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 1 RA / IM

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

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

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


VAERS ID: 1708998 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-18
Onset:2021-09-08
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Muscle spasms, Paraesthesia, Visual impairment
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Extreme cramps, tingling in feet + hands, cold sweats, clammy, spots in vision, nearly fainted


VAERS ID: 1709124 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Dizziness, Dyspnoea, Injection site erythema, Injection site pain, Injection site swelling, Joint stiffness, Nausea, Pruritus, Rash, Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (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: flu vaccine redness and swelling at site with seeping and swelling
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Pork and latex
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: rash on right leg, itching on body all over, scratchy throat, dizziness, SOB, hives, nausea, stiffiness in right wrist, also pain and redness and swelling at the injection site for 8 days


VAERS ID: 1709137 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-22
Onset:2021-09-08
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram normal, Blood creatine phosphokinase increased, Chest pain, Myocarditis, Troponin
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: No drug allergy
Diagnostic Lab Data: Elevated CK, Troponin
CDC Split Type:

Write-up: Acute chest pain diagnosed with acute myocarditis, symptoms onset acutely on 9/8/21, cardiac CTA done ruled out CAD, pending outpatient cardiac MRI.


VAERS ID: 1709649 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

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

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

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


VAERS ID: 1709655 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

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

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

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


VAERS ID: 1709660 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

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

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

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


VAERS ID: 1709668 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-01
Onset:2021-09-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Rash with itching, pain, burning on palms of both hands ,fingers,and between toes. Treatment was a steroid shot .followed 5 days later by a steroid pack of pills and a steroid cream. Total time of rash was 11 days.


VAERS ID: 1709669 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Dysgeusia, Hypersensitivity, Peripheral swelling, Pharyngeal swelling, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported by patient and none filled at pharmacy
Current Illness:
Preexisting Conditions:
Allergies: aspirin, codeine, penicillins, PEG, and possibly more per patient. Patient reported allergies to Benadryl thereafter, having used it after the allergic reaction to Moderna
Diagnostic Lab Data: none reported by patient
CDC Split Type:

Write-up: Arm swelled up 2 hours after shot. Sense of taste lost, metallic taste in the evening of the day of vaccination. Fingertips and throat swollen a day after. Patient also reports felt itchy all over. Patient reports having used Benadryl which helped but was allergic to that also as she experienced a feeling of welling in the throat. Patient reports has EpiPen but expired but didn''t need to use it. Patient also reports has consulted with multiple doctors to see what the issue is and felt that it might have been PEG polyethylene glycol


VAERS ID: 1710780 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Washington  
Vaccinated:0000-00-00
Onset:2021-09-08
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202C21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose, Blood pressure increased, Blood pressure measurement, Chest X-ray, Computerised tomogram, Dysphagia, Electrocardiogram, Hypersensitivity, Obstructive airways disorder, Oxygen saturation, Oxygen saturation decreased, Painful respiration, Pulmonary pain, Swelling, Tremor, White blood cell count
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anaphylaxis
Allergies:
Diagnostic Lab Data: Test Date: 20210909; Test Name: Blood pressure; Result Unstructured Data: 176/97 mmHg; Test Date: 20210909; Test Name: Blood pressure; Result Unstructured Data: 170/90 mmHg; Test Date: 20210909; Test Name: Oxygen saturation; Result Unstructured Data: 85 %; Test Date: 20210910; Test Name: Oxygen saturation; Result Unstructured Data: 97-98 %; Test Date: 20210910; Test Name: Blood pressure; Result Unstructured Data: 165/87 mmHg; Test Date: 20210910; Test Name: Oxygen saturation; Result Unstructured Data: 78-79 %; Test Date: 20210910; Test Name: Blood pressure; Result Unstructured Data: 154/92 mmHg; Test Date: 20210911; Test Name: Chest X-ray; Result Unstructured Data: not reported; Test Date: 20210911; Test Name: CT scan; Result Unstructured Data: not reported; Test Date: 20210911; Test Name: Electrocardiogram; Result Unstructured Data: not reported; Test Date: 20210912; Test Name: Blood pressure; Result Unstructured Data: 130/81 mmHg; Test Date: 20210912; Test Name: Glucose; Result Unstructured Data: elevated; Test Date: 20210912; Test Name: White blood cells; Result Unstructured Data: elevated
CDC Split Type: USJNJFOC20210923840

Write-up: CHEST PAIN ON LEFT LUNG; BURNING SENSATION ON LEFT SIDE WHEN INHALATION; SHAKY LEGS; ALLERGIC REACTION; AIRWAY ISSUES; DYSPHAGIA; DECREASED 02 SATURATION WHEN SLEEPING; INCREASED BLOOD PRESSURE; SWELLING BETWEEN CHEEK BONE, COLLAR BONE; This spontaneous report received from a patient concerned a 51 year old female. The patient''s weight was 250 pounds, and height was not reported. The patient''s past medical history included: anaphylaxis. The patient experienced drug allergy when treated with prednisone. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported and batch number: 202C21A expiry: UNKNOWN) dose was not reported, 1 total, administered on 08-SEP-2021 10:00 to left arm for prophylactic vaccination. No concomitant medications were reported. On 08-SEP-2021, the patient experienced decreased 02 saturation when sleeping, increased blood pressure, swelling between cheek bone and collar bone. The patient was able to grab 4 inches around the neck due to swelling and so many had discounted that swelling. Due to swelling caller was forced to lay on their side while sleeping to avoid pressure on neck from swelling. The patient Seen Primary Physician to try to get a medical waiver for receiving the shot on 07-SEP-2021. On 09-SEP-2021, the patient experienced dysphagia, allergic reaction and airway issues. On same day patient started taking Claritin 20mg once a day, Pepcid 20mg twice a day Benadryl 25mg at noon with more de-sating during the night. Doctor instructed patient to go to urgent Care or ER (emergency room) to receive another dose of Decadron. The patient took 75mg of Benadryl (25mg in the morning, 25mg in the afternoon and 25mg in the evening). The patient visited to local urgent care and 20mg Decadron was administered and 6mg a day for 3 days prescribed. The patient was continuing to take the Claritin, Pepcid and Benadryl. On 10-SEP-2021, the patient experienced, shaky legs. On 11-SEP-2021, the patient started to feel chest pain on left lung, burning sensation when inhaling. Ambulance was called and patient brought to emergency room by 20:00. Chalked up to Steroids and stress. The patient got sent back home on 12-SEP-2021. The patient was sent home and told to follow-up with primary Physician and 12-SEP-2021, 13-SEP-2021 was staying as low impact as possible. The Swelling was started to subside as of 13-SEP-2021. Ruled out myocarditis, pericarditis, pulmonary embolism and laboratory data included: Blood pressure (NR: not provided) 170/90 mmHg, 176/97 mmHg, and Oxygen saturation (NR: not provided) 85 %, Blood pressure (NR: not provided) 165/87 mmHg, 154/92 mmHg, and Oxygen saturation (NR: not provided) 97-98 %, 78-79, CT scan (NR: not provided) not reported, Chest X-ray (NR: not provided) not reported, and Electrocardiogram (NR: not provided) not reported. On 12-SEP-2021, Laboratory data included: Blood pressure (NR: not provided) 130/81 mmHg, Glucose (NR: not provided) elevated, and White blood cells (NR: not provided) elevated. Treatment medications (dates unspecified) included: famotidine, loratadine, dexamethasone, and diphenhydramine hydrochloride. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from swelling between cheek bone and collar bone, increased blood pressure, decreased 02 saturation when sleeping, allergic reaction, dysphagia, shaky legs, chest pain on left lung, and burning sensation on left side when inhalation, and had not recovered from airway issues. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210923840-covid-19 vaccine ad26.cov2.s-Decreased 02 saturation when sleeping. 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: 1711078 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-01-28
Onset:2021-09-08
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Product dose omission issue
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: USMODERNATX, INC.MOD20213

Write-up: Missed 2nd dose $g 6 months after first shot; This spontaneous case was reported by a pharmacist and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (Missed 2nd dose $g 6 months after first shot) in a 66-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 004M20A) for COVID-19 vaccination. No Medical History information was reported. On 28-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 08-Sep-2021, the patient experienced PRODUCT DOSE OMISSION ISSUE (Missed 2nd dose $g 6 months after first shot). On 08-Sep-2021, PRODUCT DOSE OMISSION ISSUE (Missed 2nd dose $g 6 months after first shot) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant product use was provided by the reporter. No treatment medication was provided. The patient ever received the second dose because he felt that he had 70% efficacy.


VAERS ID: 1711080 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-09
Onset:2021-09-08
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Dizziness, Headache, Myalgia, Pyrexia, Vaccination complication, Vaccination site pain, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: worried and concerned; dizzy; she feels yucky and miserable; she''s experimenting blurry vision, blurred vision; headaches; achy/ got hit like a ton of bricks; one minute she has fever, next minute the fever is broken; her arm aches from the shot; This spontaneous case was reported by a consumer and describes the occurrence of ANXIETY, dizzy, VACCINATION COMPLICATION, VISION BLURRED, and HEADACHES in a 59-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 09-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 07-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 08-Sep-2021, the patient experienced ANXIETY, DIZZINESS, VACCINATION COMPLICATION, VISION BLURRED, HEADACHE, MYALGIA, PYREXIA, and VACCINATION SITE PAIN. At the time of the report, ANXIETY, DIZZINESS, VACCINATION COMPLICATION, VISION BLURRED, HEADACHE, MYALGIA, PYREXIA, and VACCINATION SITE PAIN outcome was unknown. No concomitant medications were reported. No treatment details were reported. She provided one lot number 033C21A, but could not specify of which dose it was.


VAERS ID: 1711129 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain
SMQs:, Retroperitoneal fibrosis (broad)

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

Write-up: Sore lower back; This spontaneous case was reported by a consumer and describes the occurrence of BACK PAIN (Sore lower back) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) for COVID-19 vaccination. No Medical History information was reported. On 08-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 08-Sep-2021, the patient experienced BACK PAIN (Sore lower back). At the time of the report, BACK PAIN (Sore lower back) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant medications were not provided. Treatment information was not provided.


VAERS ID: 1711148 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032N20A / 1 LA / OT

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

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

Write-up: administered with expired Moderna Covid-19 vaccine; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (administered with expired Moderna Covid-19 vaccine) in a 34-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 032N20A) for COVID-19 vaccination. No Medical History information was reported. On 08-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 milliliter. On 08-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (administered with expired Moderna Covid-19 vaccine). On 08-Sep-2021, EXPIRED PRODUCT ADMINISTERED (administered with expired Moderna Covid-19 vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No relevant concomitant medications were reported. Treatment information was unknown. This case was linked to MOD-2021-314567, MOD-2021-314573, MOD-2021-314570, MOD-2021-314793, MOD-2021-314805, MOD-2021-314810 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 15-Sep-2021: Additional source document received contains NNI.


VAERS ID: 1711151 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032N20A / 1 LA / OT

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

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

Write-up: administered with expired vaccine; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 09-Sep-2021 and was forwarded to Moderna on 09-Sep-2021. This spontaneous case was reported by a health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (administered with expired vaccine) in a 36-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 032N20A) for COVID-19 vaccination. No Medical History information was reported. On 08-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 ml. On 08-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (administered with expired vaccine). On 08-Sep-2021, EXPIRED PRODUCT ADMINISTERED (administered with expired vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No relevant concomitant medications were reported. Treatment medication was not provided by the reporter. This case was linked to MOD-2021-314570, MOD-2021-314573, MOD-2021-314793, MOD-2021-314805, MOD-2021-314810 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 15-Sep-2021: follow up received contain No New Information


VAERS ID: 1711156 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032N20A / 1 LA / OT

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

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

Write-up: Administered with expired vaccine; This spontaneous case was reported by a health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Administered with expired vaccine) in a 47-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 032N20A) for COVID-19 vaccination. No Medical History information was reported. On 08-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 ml. On 08-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Administered with expired vaccine). On 08-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Administered with expired vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. There were 9 patients instead of 10 as initially reported of which this case is for the 7th patient. No concomitant medications were mentioned. No treatment details were reported. This case was linked to MOD-2021-314567, MOD-2021-314573, MOD-2021-314468, MOD-2021-314517, MOD-2021-314545, MOD-2021-314555, MOD-2021-314793, MOD-2021-314805, MOD-2021-314810 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 15-Sep-2021: Follow-up information included no new information


VAERS ID: 1711160 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-01
Onset:2021-09-08
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, Vaccination site swelling
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: USMODERNATX, INC.MOD20213

Write-up: Swelling about 1 inch high at injection site / diameter of a baseball at injection site; 1st dose maybe 1Aug20212nd dose yesterday 8Sep2021; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE SWELLING (Swelling about 1 inch high at injection site / diameter of a baseball at injection site) and INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (1st dose maybe 1Aug20212nd dose yesterday 8Sep2021) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 01-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 08-Sep-2021 at 5:00 PM, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 08-Sep-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (1st dose maybe 1Aug20212nd dose yesterday 8Sep2021). On an unknown date, the patient experienced VACCINATION SITE SWELLING (Swelling about 1 inch high at injection site / diameter of a baseball at injection site). On 08-Sep-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (1st dose maybe 1Aug20212nd dose yesterday 8Sep2021) outcome was unknown. At the time of the report, VACCINATION SITE SWELLING (Swelling about 1 inch high at injection site / diameter of a baseball at injection site) outcome was unknown. Concomitant product use was not provided. Treatment information was not provided. This case was linked to MOD-2021-314674 (Patient Link).


VAERS ID: 1711165 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Diarrhoea, Nausea, Oropharyngeal pain
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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: Chest pain - cardiac (Cardiac history: Has chest pains sometimes (1-2x/month, or every 3 months).); Rheumatoid arthritis (Has body aches from that)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: I felt like I had something is sitting on my chest, Feels like I have something sitting on my chest; I felt like I had something is sitting on my throat, Feels like I have something sitting on my throat; Diarrhea; Nausea; This spontaneous case was reported by an other health care professional and describes the occurrence of CHEST DISCOMFORT (I felt like I had something is sitting on my chest, Feels like I have something sitting on my chest) and OROPHARYNGEAL PAIN (I felt like I had something is sitting on my throat, Feels like I have something sitting on my throat) in a 29-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 053E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Rheumatoid arthritis (Has body aches from that) and Chest pain - cardiac (Cardiac history: Has chest pains sometimes (1-2x/month, or every 3 months).). On 07-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 08-Sep-2021, the patient experienced CHEST DISCOMFORT (I felt like I had something is sitting on my chest, Feels like I have something sitting on my chest) (seriousness criterion medically significant), OROPHARYNGEAL PAIN (I felt like I had something is sitting on my throat, Feels like I have something sitting on my throat) (seriousness criterion medically significant), DIARRHOEA (Diarrhea) and NAUSEA (Nausea). At the time of the report, CHEST DISCOMFORT (I felt like I had something is sitting on my chest, Feels like I have something sitting on my chest) and OROPHARYNGEAL PAIN (I felt like I had something is sitting on my throat, Feels like I have something sitting on my throat) had not resolved and DIARRHOEA (Diarrhea) and NAUSEA (Nausea) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were mentioned. No treatment details were reported. Company comment: This case refers to a 29-year-old female patient with a medical history of rheumatoid arthritis and cardiac chest pain who experienced the unexpected events of Chest Discomfort and Oropharyngeal Pain approximately 1 day after the first dose of Spikevax. No causality assessment was provided by the reporter. The past medical history of chest pain remains a confounder.The benefit-risk relationship of Spikevax is not affected by this report.; Sender''s Comments: This case refers to a 29-year-old female patient with a medical history of rheumatoid arthritis and cardiac chest pain who experienced the unexpected events of Chest Discomfort and Oropharyngeal Pain approximately 1 day after the first dose of Spikevax. No causality assessment was provided by the reporter. The past medical history of chest pain remains a confounder.The benefit-risk relationship of Spikevax is not affected by this report.


VAERS ID: 1711937 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH SP8448 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Malaise, Pain, 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 INC202101182759

Write-up: body aches; feels a little sore in left arm; not feeling well; This is a spontaneous report from a contactable consumer (patient). A 21-years-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Formulation: Solution for injection, Batch/Lot Number: SP8448), dose 2 via an unspecified route of administration, administered in Arm Left on 08Sep2021 (at the age of 21-years-old) as dose 2, single for covid-19 immunisation. The patient medical history was not reported. No Patient History was reported. The patient''s concomitant medications were not reported. Historical vaccine included bnt162b2 (Batch/lot number: FC3180 Expiration: unknown) via an unspecified route of administration, administered in Arm Left on 16Aug2021 around 0900 (at the age of 21-years-old) as dose 1, single for covid-19 immunisation. On 08Sep2021, the patient experienced body aches, feels a little sore in left arm and not feeling well. The patient wanted to know if she could take tea and Theraflu for her body ache she was having. When the patient took the shot she was fine then started feeling pain from 10pm-midnight and early morning around 1am and 6am. The she felt a little sore in left arm. The body aches come and goes, right now she was fine. She received treatment with tylenol around 6am. She was at work. Clarified she was not having a fever. When she took first dose she was fine but for some reason the second dose affected her. Outcome of the events were unknown. Follow-Up (09Sep2021): This is a spontaneous report from a contactable consumer. This consumer (patient) reported new information included date of birth, height, weight, event onset date, first dose information and clinical information.


VAERS ID: 1711955 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Lip swelling, Nasal oedema, Rash, Swelling of eyelid, Vaccination site rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101183005

Write-up: developed swelling of the eyelids, nose, and lips; developed swelling of the eyelids, nose, and lips; developed swelling of the eyelids, nose, and lips; a rash at the injection site; a rash on certain finger and toes on both the left and right side; lip swelling; This is a spontaneous report from a contactable consumer (patient). A 39-year-old female patient received second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Lot number and expiry date: not reported), via an unspecified route of administration on 07Sep2021 as single dose for COVID-19 immunisation. The patient medical history was not reported. The patient''s concomitant medications were not reported. The patient previously took first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Lot number and expiration date: not reported), via an unspecified route of administration on an unspecified date as single dose for COVID-19 immunisation. On 08Sep2021, the patient experienced lip swelling. On 09Sep2021, the patient developed swelling of the eyelids, nose, and lips, a rash at the injection site, a rash on certain finger and toes on both the left and right side. Caller received her second dose of the bnt162b2 vaccine on 07Sep2021. Last night (day before reporting date) she noticed some lip swelling and then day of reporting date she developed swelling of the eyelids, nose, and lips as well as a rash at the injection site, and a rash on certain finger and toes on both the left and right side. The outcome of all the events was unknown. No follow up attempts are possible. No further information is expected.; Sender''s Comments: Linked Report(s) : US-PFIZER INC-202101183653 mom/baby case


VAERS ID: 1711973 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Asthenia, Dizziness, Headache, Joint range of motion decreased, Lethargy, Nausea, Pain, Pyrexia, Restlessness
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Akathisia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), 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: NORCO; DIAZEPAM; WELLBUTRIN; GABAPENTIN; PROGESTERON
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101183817

Write-up: High fever; lethargic; nausea; upset stomach; severe headache; body aches; restless; very weak; dizziness; could not move arm that shot was received in; This is a spontaneous report received from a contactable consumer(patient). A 61-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection; lot number and expiry were reported) via an unspecified route of administration, at the age of 61-year-old, on 08Sep2021 18:45, at the left arm, at dose number unknown, single for covid-19 immunisation in a Pharmacy/drug store. The patient had no known allergies. The patient''s medical history was not reported. Concomitant medications in two weeks included hydrocodone bitartrate, paracetamol (NORCO), diazepam, bupropion hydrochloride (WELLBUTRIN), gabapentin and progesteron. The patient is not pregnant at the time of vaccination. The patient did not any other vaccines within 4 weeks prior to the COVID vaccine. The patient did not have prior COVID vaccination and was not tested post vaccination. On 08Sep2021 at 23:00, the patient experienced High fever, lethargic, nausea, upset stomach, severe headache, body aches, restless, very weak, dizziness, could not move arm that shot was received in. The patient did not receive treatment in response to the events. The outcome of the events was not recovered at the time of report. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1712008 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-29
Onset:2021-09-08
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MULTIVITAMIN [ASCORBIC ACID;BIOTIN;CALCIUM PANTOTHENATE;CYANOCOBALAMIN;FOLIC ACID;NICOTINIC ACID;PYR; VITAMIN D [VITAMIN D NOS]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy to metals (known allergies: Gallium); Asthma; Cervical cancer; Latex allergy (known allergies: Latex)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101191276

Write-up: I developed shingles for the first time in my life after receiving the first dose of the Pfizer coronavirus vaccine.; This is a spontaneous report from a contactable consumer (patient) reported for herself. A 44-year-old non pregnant female patient received bnt162b2 (PFIZER BIONTECH COVID-19 MRNA VACCINE Solution for injection Lot Number: FC3184) via an unspecified route of administration in arm left on 29Aug2021 17:00 as dose 1, single (age at vaccination: 44 years) for covid-19 immunisation. Medical history included known allergies: gallium, known allergies: latex, asthma and 15 yr survivor of cervical cancer, all from an unknown date and unknown if ongoing. Concomitant medications included ascorbic acid, biotin, calcium pantothenate, cyanocobalamin, folic acid, nicotinic acid, pyridoxine hydrochloride, riboflavin, thiamine hydrochloride, tocopheryl acetate (MULTIVITAMIN [ASCORBIC ACID;BIOTIN;CALCIUM PANTOTHENATE;CYANOCOBALAMIN;FOLIC ACID;NICOTINIC ACID;PYRIDOXINE HYDROCHLORIDE;RIBOFLAVIN;THIAMINE HYDROCHLORIDE;TOCOPHERYL ACETATE]); vitamin d [vitamin d nos] (VITAMIN D [VITAMIN D NOS]), both taken for an unspecified indication, start and stop date were not reported. The patient previously took erythromycin and experienced allergies. The most recent COVID-19 vaccine was administered at pharmacy or drug Store. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. On 08Sep2021, it was reported that I developed shingles for the first time in my life after receiving the first dose of the Pfizer coronavirus vaccine. The adverse event resulted in doctor or other healthcare professional office/clinic visit. Treatment received was valacyclovir HCL 1 Gram tablet and Hydroxyzine HCL. The clinical outcome of the event was resolving. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1712018 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / UNK RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Nasal congestion, Oropharyngeal pain, Productive cough, SARS-CoV-2 test
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210910; Test Name: NAAT/Molecular; Test Result: Negative ; Comments: Nasal Swab; Test Date: 20210910; Test Name: Antigen; Test Result: Negative ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC202101192406

Write-up: Sore throat; Congestion; Cough with some phlegm; This is a spontaneous report from a non-contactable consumer, the patient. A 24-year-old non-pregnant female patient received BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FC3181) via an unspecified route of administration in the right arm on 07Sep2021 at 19:00 (at the age of 24-years-old) as a single dose for COVID-19 immunisation. Medical history and concomitant medications were not reported. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. On 08Sep2021, the patient experienced sore throat, congestion and cough with some phlegm. The patient was tested negative for COVID in two different methods of testing over three times. The events resulted in doctor or other healthcare professional office/clinic visit. Since the vaccination, the patient had been tested for COVID-19. On 10Sep2021, the patient underwent antigen test and nucleic acid amplification test (NAAT)/molecular test via nasal swab and the results were negative. Therapeutic measures were not taken as a result of the events. The clinical outcome of the events sore throat, congestion and cough with some phlegm were resolving at the time of the report. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1712032 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-09-08
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (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 INC202101192770

Write-up: Severe diarrhea; This is a spontaneous report from a non-contactable consumer, the patient. A 37-year-old female patient received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration on an unknown date as a single dose and also received second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration on an unknown date as a single dose for COVID-19 immunisation. The medical history was not reported. Prior to the vaccination, the patient was not diagnosed with COVID-19. The concomitant medications were not reported. The patient did not receive any other vaccines within four weeks prior to the vaccination. On 08Sep2021, the patient experienced severe diarrhea. The event did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Since the vaccination, the patient was not tested for COVID-19. Therapeutic measures were not taken as a result of the reported event. The clinical outcome of the event severe diarrhea was not resolved at the time of this report. No follow-up attempts are possible, information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1712036 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-05
Onset:2021-09-08
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Hypokinesia, Inappropriate schedule of product administration, Ocular discomfort, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ATORVASTATIN CALCIUM; DOCUSATE; FERROUS SULFATE; MIDODRINE; MILK OF MAGNESIA; PANTOPRAZOLE; QUETIAPINE; DUTASTERIDE ACCORD; FLUDROCORTISON; LEVETIRACETAM; VENLAFAXINE; SPIRIVA HANDIHALER; CHOLECALCIFER EG; ACETAMINOPHEN; MONTELUKAST [MONTEL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Urinary tract infection
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101192938

Write-up: Patient administered first dose of Pfizer-BioNTech Covid-19 Vaccine on 05Sep2021 and second dose on 07Sep2021; sleeping a lot; has not been opening his eyes; has not been much responsive; This is a spontaneous report from a contactable consumer or other non-health care professional. A 68-year-old male patient received bnt162b2 (PFIZER BIONTECH COVID-19 VACCINE, solution for injection, Lot Number: FD0809, NDC and UPC number: unknown) dose 1 via an unspecified route of administration on 05Sep2021 (at the age of 68 years old) as dose 1, single and dose 2 via an unspecified route of administration on 07Sep2021 (Lot Number: FF2589) as dose 2, single for COVID-19 immunization at hospital. Vaccine was not administered at military facility. Medical history included urinary tract infection but prior to these events the patient was admitted to the hospital on 01Sep2021 for a urinary tract infection and was discharged home on 08Sep2021. Concomitant medication(s) included atorvastatin calcium; docusate; ferrous sulphate; midodrine; milk of magnesia; pantoprazole; quetiapine; dutasteride accord; fludrocortisone acetate; levetiracetam; venlafaxine; spiriva handihaler (tiotropium bromide monohydrate); cholecalciferol; acetaminophen; montelukast sodium; senna glycosides; amoxicillin taken from 08Sep2021 and. Investigation assessment was reported as unknown. He has other unspecified medications that are prescribed only as needed and have not been taken in the 2 weeks prior to onset of events. On an unspecified date the patient experienced patient administered first dose of pfizer-BioNTech covid-19 vaccine on 05sep2021 and second dose on 07sep2021. On 08Sep2021 sleeping a lot, has not been opening his eyes, has not been much responsive. Reporter stated that these doses were administered while the patient was hospitalized for unrelated reason. The clinical outcome of the events was unknown. No follow-up attempts are possible. No further information is expected


VAERS ID: 1712045 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vaccination site pain
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: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101195354

Write-up: Soreness at injection site; This is a spontaneous report from a non-contactable consumer, the patient. A 36-year-old non-pregnant female patient received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FD8448) via an unspecified route of administration in the left arm on 08Sep2021 at 10:00 (at the age of 36-years-old) as a single dose for COVID-19 immunisation. The patient had no medical history reported. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. Concomitant medications were not reported. On 08Sep2021, approximately 6 hours later, the patient experienced soreness at injection site which lasted for 2 to 3 days. The event did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Therapeutic measures were not taken as a result of the event. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the event soreness at injection site was resolved on an unknown date in Sep2021. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1712046 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysmenorrhoea, Menstruation irregular
SMQs:, Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LO LOESTRIN FE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101195742

Write-up: Started bleeding later that evening after the shot.; Also started having severe menstual cramps; This is a spontaneous report from a contactable nurse, the patient. A 36-year-old non-pregnant female patient received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FE3592) via an unspecified route of administration on 08Sep2021 at 16:30 (at the age of 36-years-old) as a single dose for COVID-19 immunisation. Medical history was reported as not applicable (N/A). The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. Concomitant medications included ethinylestradiol, ferrous fumarate, norethisterone acetate (LO LOESTRIN FE) for birth control from an unknown date and was ongoing. On 08Sep2021 at 22:30, in the evening the patient started bleeding after the shot. The patient was on birth control in a very strict schedule. On the day of the COVID-19 shot, the patient was on day ten of the cycle (taking active pills). The patient also started having severe menstrual cramps. Both the bleeding and the cramping had not subsided even though the patient had continued to taking birth control at the exact same time every day. Prior to getting the COVID shot the patient had a full gynaecological work up and everything was normal, so the only variable was the COVID vaccine. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events started bleeding later that evening after the shot and also started having severe menstrual cramps were not resolved at the time of this report.


VAERS ID: 1712053 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-01
Onset:2021-09-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Headache, Insomnia, Musculoskeletal stiffness, Myalgia, Nausea, Ocular discomfort
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Lyme disease (Lyme)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101197146

Write-up: This is a spontaneous report from a contactable consumer, the patient. A 33-year-old non-pregnant female patient received the first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FC3184) via an unspecified route of administration in the left arm on an unknown date in Sep2021 at 18:00 (at the age of 33-years-old) as a single dose for COVID-19 immunisation. Medical history included lyme. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. Concomitant medications were not reported. On 08Sep2021, the patient experienced stiff neck, headache, fatigue, nausea, muscle pain, insomnia and vision issues- bright light discomfort. The events resulted in doctor or other healthcare professional office/clinic visit. It was unknown whether any therapeutic measures were taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events stiff neck, headache, fatigue, nausea, muscle pain, insomnia and vision issues- bright light discomfort was not resolved at the time of this report.


VAERS ID: 1712106 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Cough, Nasal congestion, Oropharyngeal pain, Productive cough, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210911; Test Name: PCR; Test Result: Negative ; Comments: Nasal swab; Test Date: 20210910; Test Name: 3 Antigen Tests; Test Result: Negative ; Comments: Nasal swab; Test Date: 20210910; Test Name: NAATS; Test Result: Negative ; Comments: Nasal swab
CDC Split Type: USPFIZER INC202101206307

Write-up: Cough; Cough and phlegm; Congestion; Sore throat (similar to Laryngitis); Pain on the right underarm/axillary; This is a spontaneous report from a contactable consumer, the patient. A 24-year-old non-pregnant female patient received second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FC3181) via an unspecified route of administration in the right arm on 07Sep2021 (at the age of 24-years-old) as a single dose for COVID-19 immunisation. Medical history and concomitant medications were not reported. The patient had no known allergies. Prior to vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient previously received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FC3181) via an unspecified route of administration on an unknown date as a single dose for COVID-19 immunisation. On 08Sep2021, the patient experienced cough and phlegm, congestion, sore throat (similar to laryngitis) and pain on the right underarm/axillary. The patient took multiple COVID tests and all came out negative. The events resulted in a visit to the doctor or other healthcare professional office/clinic visit. Therapeutic measures were taken as a result of the events and included treatment prescribed by the doctor with an unspecified inhaler (MANUFACTURER UNKNOWN), guaifenesin (MUCINEX) and an unspecified nasal spray (MANUFACTURER UNKNOWN). Since the vaccination, the patient had been tested for COVID-19. On 10Sep2021, the patient underwent Nucleic Acid Amplification Test (NAATS) via nasal swab and the result was negative. On 10Sep2021, the patient underwent 3 Antigen Tests via nasal swab and the result was negative. On 11Sep2021, the patient underwent Polymerase Chain Reaction (PCR) test via nasal swab and the result was negative. The clinical outcome of the events cough and phlegm, congestion, sore throat (similar to laryngitis) and pain on the right underarm/axillary was resolving at the time of the report.


VAERS ID: 1712714 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-11
Onset:2021-09-08
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Fatigue, Oxygen saturation decreased, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: azithromycin (ZITHROMAX) 250 MG Oral Tablet Take 2 tablets (500 mg) on Day 1, followed by 1 tablet (250 mg) once daily on Days 2 through 5. 1/9/20 benzonatate (TESSALON) 100 MG Oral Capsule Take 1 capsule by mouth 3 times daily as ne
Current Illness:
Preexisting Conditions: ? Arthritis ? Hyperlipidemia ? Hypertrophy of breast
Allergies: Codeine
Diagnostic Lab Data: SARS-COV-2, NAA, Detected: 09/08/21
CDC Split Type:

Write-up: Patient required hospitalization due to breakthrough infection. Patient received J&J vaccine on 03/11/21. Patient was hospitalized from 09/08/21 - 09/13/21. Below is copied from discharge summary: Patient a is with 60-year-old female with no past medical history was admitted for chief complaint of shortness of breath. Patient reported the symptoms started four days prior to admission and reported ongoing progressive shortness of air associated with cough and fatigue. She denied any chest pain, nausea, vomiting, diarrhea. She reported that she was vaccinated with the single dose J&J vaccine. In the emergency department her oxygen saturation was in the low 80s on room air. She was placed on supplemental oxygen and admitted for further management. She was started on remdesivir and Decadron. She completed a five day course of remdesivir while inpatient. She had improvement in her symptoms and was only on 1 liter of oxygen on day of discharge. Home oxygen evaluation was done revealing the patient needed 2 liters of oxygen on exertion to maintain saturation above 88 percent. This was set up for her prior to discharge. She was prescribed an additional four days of p.o. Decadron to complete a 10 day course. Patient is discharged in stable condition with stable vital signs. All questions rearding hospital course and plan of care after discharge have been answered to satisfaction. Prescriptions for medications needed to be taken after discharge have been given to patient. Patient has been instructed to follow up with PCP within the next 7 days after discharge. Patient verbalizes understanding all given instructions and has no further doubts regarding discharge.


VAERS ID: 1712721 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Breast pain, Burning sensation, Dizziness, Head discomfort, Headache, Hypoaesthesia, Insomnia, Nipple pain, Pain, Polyuria, Pyrexia, Toothache
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Lipodystrophy (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad), Sexual dysfunction (broad)

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

Write-up: Extreme pain in bilateral breasts and nipples, extreme diuresis (urinating without taking in fluids every 15 minutes for approximately 12 hours with 500ml of urine each time), dizziness, at hour 12 post-vaccine fever of 102.5 that lasted for 1 day until dropping to 100.5. Extreme pain to all teeth starting at hour 12 through 48. Body pain, insomnia, burning sensation in lungs, and numbness in left facial area. Extreme headache with pressure from left neck area just below ear extending into middle top of skull that felt like having your head in a vice grip. The symptoms with the exception of the headaches and breast pain resolved within 50 hours. The headaches are now episodic. Breast pain is still present as of 9-18-21.


VAERS ID: 1713330 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-03
Onset:2021-09-08
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Headache, Nausea, Pruritus, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: No
Current Illness:
Preexisting Conditions: Bronchial asthma
Allergies: Mild PCN Cantaloupe
Diagnostic Lab Data:
CDC Split Type:

Write-up: 24 hrs headache nausea, fever, chills. (Took Motrin 400mg) 5 days later severe itchiness from head to toe. (Took antihistamine xyzal)


VAERS ID: 1713548 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-01-17
Onset:2021-09-08
   Days after vaccination:234
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Pain, Skin discolouration, Swelling, Thrombosis
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (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: Simvastatin, baby aspirin, multivitamin, 1/2 tablet metoprolol
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had what looked to be a superficial blood cot right under the skin on my right hand, in the soft flesh right above my thumb joint. It was purple, enlarged and painful. It lasted 2 days, then went down in size and turned purplish brown like an older bruise. I did not injure myself there. My husband had a similar thing happen before mine, about a week before. He had a purplish raised vein also at the base of his small finger and his finger was numb. It also went away within a few days.


VAERS ID: 1713587 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Burning sensation, Pain
SMQs:, Peripheral neuropathy (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: Hives from a Hepatitis vaccine 15 years ago
Other Medications: Lamictal 200MG daily, Metformin 500MG daily, Aspirin 81MG daily, Vitamin D3 50,000 units weekly, Vitamin D3 5000 units with Vitamin K 3 times per week; Phentermine 15MG 1 Cap Sun and Thu; Phentermine 15MG 2 cap Tue and Sat; Vitamin C 1000MG
Current Illness: Minor cold 2 weeks before - tested negative for Covid19
Preexisting Conditions: High CRP levels; unexplained fractures; polycythemia;
Allergies: Prozac, Iodine, IVP Dye, Clindamycin, Hepatitis vaccine (unknown whether it is Hep A or B vaccine)
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 36 hours after shot: left armpit started with small intermittent burning pain. 48 hours after: burning pain intermittent but moderate. 60 hours: Burning pain small at level of 3-4, sharp burning pains intermittently, started using ice and tylenol. 72 hours: Burning pain constant at 4-6; sharp pains intermittent - felt like being burned with cigarette at level 7-8; using ice and tylenol. Had telehealth visit and was advised to start motrin and topical voltaren. 84 hours: Constant moderate burning pain, intermittent sharp burning pains 8-10; Took a total of 1800MG of Motrin and 2000MG of Tylenol, topical voltaren twice and ice with no relief, went to Emergency room. Was prescribed Prednisone 60MG daily for 5 days, Gabapentin for pain and antibiotics for possible infection


VAERS ID: 1713623 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Vaccinated with expired vaccine by 8 days. No adverse reaction


VAERS ID: 1713636 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-01
Onset:2021-09-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure increased, Hypertensive crisis
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (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: Pt reports that about a week after his vaccination he was reporting to his infectious disease doctor and his blood pressure was so elevated to the point of hypertensive crisis and they debated sending him to the ER. He also had he blood pressure tested by a relative who is a dental hygienist and he trusts is medically competent to test blood pressure, and was found to still be elevated days later. He was advised to test his blood pressure to verify it was not White Coat Hypertension, and it is still remaining elevated, as is his girlfriends, weeks later. He reports that this is consistent with information he has, "read online." and wants this reported as an adverse effect of the vaccine, as does his girlfriend. He reports no lifestyle changes or medication changes since the vaccination and will follow up with pcp.


VAERS ID: 1713674 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-21
Onset:2021-09-08
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Muscle spasms
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After over 5 years without periods (nexplanon user), I had a heavy period with cramping 2 weeks after the injection. My nexplanon is fresh (April 2021) so based on my personal history with the nexplanon it should be completely suppressing my periods at this time.


VAERS ID: 1713877 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-18
Onset:2021-09-08
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SYR

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

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

Write-up: Paresthesias in upper and lower extremities.


VAERS ID: 1713880 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Vaccinated with expired vaccine by 8 days. No adverse reactions


VAERS ID: 1713894 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blepharospasm, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Periorbital and eyelid disorders (narrow), Ocular motility 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Still nauseous 11 days later and getting headaches and have had a twitch in my right eye since the vaccine


VAERS ID: 1713903 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Arthralgia, Dyspepsia, Dyspnoea, Fatigue, Headache, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (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:
Other Medications: Birth control
Current Illness:
Preexisting Conditions: Asthma
Allergies: Cephalexin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever 103, headache, nausea, difficulty breathing, heart burn, muscle pain, joint pain, fatigue, still have headaches and fatigue with heart pain after 2 weeks


VAERS ID: 1713919 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-03
Onset:2021-09-08
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / SYR

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

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

Write-up: Menstrual cycle was 12 days late according to regular tracking for 3 years. Onset of menstrual cycle was accompanied by more severe cramping and heavier bleeding than is normally experienced.


VAERS ID: 1713973 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Headache, Pruritus
SMQs:, Anaphylactic reaction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Per patient she had pre-medicated with an anti-histamine and as soon as the anithistamine wore off she experience itching all over her body. Upon taking another anti-histamine itching subsided. Then, while asleep the night of the vaccination, patient experienced profound chest pain while having a dream someone was stepping on her chest - after getting up and eating patient felt fine and has not had any other chest pain. Patient also complains of mild headache every evening after receiving vaccine.


VAERS ID: 1714025 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-31
Onset:2021-09-08
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

Administered by: Work       Purchased by: ?
Symptoms: Asthenia, Fatigue, Hypersomnia, Impaired work ability, Lymph node pain, Lymphadenitis, Lymphadenopathy, Panic attack, Ultrasound lymph nodes
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Benadryl and Midol
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: ER visit on 9/13 which inflammation of lymph nodes. PCP visit on 9/16 which also confirmed visible lymph nodes. PCP sent me for ultra sound and results are not back. I check online and neither physician documented my concerns or statement about these symptoms coming from the Covid-19 vaccine which I clearly stated several times.
CDC Split Type:

Write-up: About 9 days after receiving my first vaccine, I became very weak and fatigued. I slept most of the days from 9/10-9/12. During that time, I experienced panic attacks, my lymph nodes in my neck and throat begin to swell and became painful. On 9/13 I attempted to start my shift at work but by 10:30am I was in the ER. Antibiotics were given due to my lymph nodes being enlarged.


VAERS ID: 1714075 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Expired vaccine administered by 8 days. No adverse reaction noted.


VAERS ID: 1714088 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Vaccinated with expired vaccine by 8 days. No adverse reaction noted.


VAERS ID: 1714103 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Vaccinated with expired vaccine by 8 days. No adverse reaction noted.


VAERS ID: 1714127 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-01-13
Onset:2021-09-08
   Days after vaccination:238
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ6186 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood culture negative, COVID-19, Cardiomegaly, Chest X-ray abnormal, Cognitive disorder, Computerised tomogram head abnormal, Condition aggravated, Dementia, Haemoglobin decreased, Hypokalaemia, Lip haemorrhage, Metabolic encephalopathy, Mouth injury, Pyrexia, SARS-CoV-2 test positive, Sialoadenitis, Speech disorder
SMQs:, Cardiac failure (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (narrow), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Accidents and injuries (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: A&D ointment, acetaminophen, ascorbic acid, bisacodyl suppository PRN, calcium with vitamin D, dorzolamide eye drops, latanoprost eye drops, loratadine, milk of magnesia PRN, multivitamin, senna, vitamin D3, apixaban
Current Illness:
Preexisting Conditions: Alzheimer''s dementia, arthritis, history of DVT and IVC filter, history of peptic ulcer disease, osteoporosis, osteoarthritis, mitral valve regurgitation, a fib
Allergies: morphine tramadol
Diagnostic Lab Data: 9/8/21 COVID19: positive 9/8/21 chest: negative 9/8/21 CT head: Opacification of the right anterior ethmoid air cells extending into the right frontal sinus and to a lesser extent the right maxillary sinus. 9/11/21 chest xray: mild cardiomegaly
CDC Split Type:

Write-up: brought from nursing home secondary to fever and dried blood around her lips. History was obtained from ER physician, also from her daughter. The patient had blood around her mouth and her lips. There was a question of seizure activity raised by ER physician, but patient has on examination a lower tooth, which is quite anterior and every time we move her lip up and down it completely covers underneath the lip, which could be a source of occasional mouth trauma. She is already on anticoagulation Eliquis which would increase the risk of bleeding even from a small area. She underwent a CT face, which shows evidence of what seems to be a sialoadenitis. The patient had a fever. Her COVID test came positive. She was vaccinated about 7 months ago. The patient suffers from dementia, slightly poor historian, but her eyes are open. She tries to verbalize. Does not follow commands appropriately. Does not look in any distress. After evaluation and discussion with the ER physician and review of CT, patient is being admitted for the IV antibiotic for sialoadenitis. She has no hypoxia. COVID-19 test Abbott is positive. Will obtain a PCR test with a different technology since she has been already vaccinated. Treatment may not change. Eliquis was placed on hold at this time, hemoglobin 10.2 , plan for recheck outpatient 09/17/21. Currently no active bleeding noted. Patient is also scheduled to have her teeth pulled 09/22/21. I recommended for her to stay off anticoagulants , if no bleeding , Eliquis can be resumed after her procedure . She was noted to have Acute metabolic encephalopathy on chronic severe dementia There was also Concern for oropharyngeal mass as well as acute right sialoadenitis on CT 09/08/21 , ENT evaluating s/p EGD with PEG 09/13/21 and microlaryngoscopy with biopsy right tonsil 09/13/21 . Pathology negative for malignancy. Patient was managed on Unasyn for suspected Sialadenitis right. Blood cultures 09/08/21 negative. She was discharged on Augmentin. Hypokalemia resolved Apparently vaccinated with Pfizer about 7 months prior , COVID-19 positive 09/08/21 . CXR no acute infiltrates , she is on room air.


VAERS ID: 1714135 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-01-25
Onset:2021-09-08
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9263 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Atelectasis, Atrial fibrillation, Blood gases abnormal, Brain natriuretic peptide increased, C-reactive protein increased, COVID-19, COVID-19 pneumonia, Cardiac failure congestive, Cardiomegaly, Chest X-ray abnormal, Condition aggravated, Diarrhoea, Dyspnoea, Electrocardiogram abnormal, Fibrin D dimer, Gravitational oedema, Hypertension, Hyponatraemia, Legionella test, Leukocytosis, Lung consolidation, Metabolic acidosis, Oxygen saturation decreased, Pleural effusion, Pulmonary oedema, QRS axis abnormal, Respiratory alkalosis, SARS-CoV-2 test positive, Serum ferritin increased, Streptococcus test negative
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen, calcium carbonate, calcium with vitamin D, docusate, ferrous sulfate, hydrocortisone ointment, loperamide, metoprolol tartrate, omeprazole, trazodone
Current Illness:
Preexisting Conditions: paroxysmal fibrillation with RVR, aortic stenosis, Dyslipidemia, and insomnia, depression, GERD, neuropathy
Allergies: ibuprofen
Diagnostic Lab Data: 9/8/21: Covid + -Leukocytosis and was hyponatremia. -ABG suggestive of primary respiratory alkalosis with secondary metabolic acidosis. -BNP was 390, CRP 9.7, ferritin 356, D-dimer 2.95. -CXR showed evidence of HF with cardiomegaly with moderate R and small L pleural effusions and likely pulmonary edema. -CTA demonstrated no presence of PE, only changes of CHF and moderate b/l pleural effusions and consolidation likely representing atelectasis. - EKG - afib, left axis deviation -Strep and Legionella neg 9/8/21 chest xray:Evidence of congestive failure with cardiomegaly, moderate right and small left pleural effusions, and likely pulmonary edema. Recommend correlation with clinical findings of superimposed infection. 9/8/21 CTA chest: Cardiomegaly with changes of CHF and moderate bilateral pleural effusions. Consolidation adjacent to the pleural fluid likely represents atelectasis and dependent edema.
CDC Split Type:

Write-up: presented to the ED on 9/8/21 and admitted with SOB and diarrhea. The pt was sent 9/8/2021. The patients daughter stated that the patient received both doses of the covid vaccine. In the ED, the pt test positive for COVID-19. She was hypertensive and sat at 81% on 4LNC. She had a leukocytosis and was hyponatremic. ABG suggestive of primary respiratory alkalosis with secondary metabolic acidosis. The patients BNP was 390, CRP 9.7, ferritin 356, D-dimer 2.95. CXR showed evidence of HF with cardiomegaly with moderate R and small L pleural effusions and likely pulmonary edema. CTA demonstrated no presence of PE, only changes of CHF and moderate b/l pleural effusions and consolidation likely representing atelectasis. Pt was admitted for management of COVID 19 pnuemonia and CHF exacerbation, and hyponatremia. She was started on Remdesivir 200mg x1 followed by 100mg daily, Decadron 6mg daily, Rocephin 1g IV daily, Azithromycin 500mg x1 followed by 250mg daily, Lopressor 25mg BID. She received 1 dose of Lasix 40mg. She was started on 4L oxygen. She tested negative for legionella and strep. Over the 6 day course of her hospitalization the pt?s oxygen levels improved and was gradually weaned off oxygen. Her COVID labs were monitored daily. Her hyponatremia resolved with improved oral intake. She was evaluated by PT/OT. She was discharged back to Residence. Pt is to continue home medications and starting decadron for 4 more days, Mucinex 600mg, Albuterol inhaler, Miconazole Nitrate Powder as described above.


VAERS ID: 1714244 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF258 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Pallor, Tunnel vision, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PREDNISONE PRN FOR UNDIAGNOSED AUTOIMMUNE DISORDER. HAS NO TAKEN RECENTLY.
Current Illness: NONE
Preexisting Conditions: AUTOIMMUNE POSSIBLR MS SHE IS BEING SEEN BY A SPECIALIST FOR DX
Allergies: NKDA
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PATIENT PRESENTED 15 MINUTES AFTER VACCINATION WITH DIZZINESS, PALLOR, TUNNEL VISION AND BLURRY "LIKE I''M GOING TO PASS OUT", LIGHTHEADEDNESS. PATIENT IMMEDIATLEY PLACED IN SUPINE POSTION. SHE STATED SHE FELT BETTER AFTER 10 MINUTES AND SHE WAS GIVEN WATER AND A LOLLIPOP. SHE STATED THAT SHE HAD NOT EATEN MUCH DURING THE DAY. AFTER HYDRATION AND SOME SUGAR ON BOARD SHE WAS ABLE TO SIT UP WITHOUT ANY SYMTPOMS. VSS THROUGHOUT. VS TAKEN Q5'' SAO2 94-97%, BP 126/80, HR 87, RR 18 AND UNLABORED. LUNGS CLEAR. AFTER 15 MINUTES SHE WAS ABLE TO STAND WITHOUT ISSUES AND AMBULATE INSIDE TO A TABLE WHERE HER EMPLOYER WAS BRINGING HER LUNCH. NO FURTHER ISSUES.


VAERS ID: 1714341 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-15
Onset:2021-09-08
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Blood potassium decreased, Bronchial wall thickening, COVID-19, COVID-19 pneumonia, Chest X-ray normal, Computerised tomogram thorax, Fatigue, Hiatus hernia, Left ventricular hypertrophy, Lung opacity, Lymphadenopathy, SARS-CoV-2 test positive, Troponin
SMQs:, Interstitial lung disease (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Carvedilol, hydralazine, metformin, ecpirin, furosemide, latanoprost eye drops, pravstatin, tramadol, vitamin
Current Illness:
Preexisting Conditions: hypertension, hyperlipidemia, obstructive sleep apnea, uncontrolled type 2 diabetes non-insulin-dependent, and morbid obesity. Acute peptic ulcer, unspecified site, with hemorrhage and perforation, without mention of obstruction, Chest pain, unspecified, Complete rupture of rotator cuff, Idiopathic cysts of iris, ciliary body, and anterior chamber, Kidney disease, Nonspecific abnormal electrocardiogram (ECG) (EKG), Symptomatic menopausal or female climacteric states, TIA (transient ischemic attack) (1994), Unspecified disorder of skin and subcutaneous tissue, Unspecified disorder of skin and subcutaneous tissue, and Unspecified essential hypertension. She also has no past medical history of Breast cancer (HCC) or Breast lump.
Allergies: ace inhibitors, acetaminophen, propoxyphene, rosuvastatin, diltiazem
Diagnostic Lab Data: 9/8/21 COVID 19: positive 9/8/21 chest xray: negative 9/8/21 CTA chest: 1. No evidence of acute pulmonary embolism. 2. Suspected left ventricular hypertrophy. 3. Multifocal bilateral airspace disease and ground-glass opacities most consistent with changes of COVID-19 pneumonia. Mild bronchial wall thickening also present. 4. Sequela prior granulomatous disease. Additional borderline sized lymph nodes are likely reactive. 5. Hiatal hernia.
CDC Split Type:

Write-up: Presented to the emergency department on 9/8/21 with complaints of fatigue and abnormal labs. Patient was tested positive for COVID in ER. She has no COVID symptoms. Saturating well on room air. Labs unremarkable except for troponin which was minimally elevated 0.074, downtrending. CT chest showed no acute PE. Evidence of ground-glass opacities consistent with changes of COVID pneumonia. Admitted on 9/8/21. Will discharge on cefdinir and azithromycin. Her potassium was 2.8 which was replaced and repeat BMP within normal limits. Will continue 10 mEq potassium at home at discharge since she is also on Lasix. Hemodynamically stable for discharge. Follow-up with primary care. Discharged 9/9/21


VAERS ID: 1714373 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Diarrhoea, Fatigue, Influenza, Nausea, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test negative, Vaccination complication, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (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: metoprolol losartan
Current Illness:
Preexisting Conditions: high blood pressure
Allergies: sulfa
Diagnostic Lab Data: PCR test 9/16 negative, rapid test 9/18 negative. We did tell the person doing the tests. We did let his doctors office know, no physical visit as no insurance. They said it was an immune response to the vaccine and it should go away.
CDC Split Type:

Write-up: Vomiting 4 hour and 6 minutes after shot, 5 times in an hour. Next day flu symptoms started. Slight fever, chills, nausea, fatigue, coughing, congestion, some diarrhea. Symptoms continuing, starting to get better, today 9/19/21. 11 days. Have needed to take Mucinex DM, pseudoephedine, zyrtec, pepto bismol.


VAERS ID: 1714429 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-04
Onset:2021-09-08
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Alcohol test, Blood magnesium, Computerised tomogram, Full blood count, Lipase, Metabolic function test, Pancreatitis acute, Ultrasound scan
SMQs:, Acute pancreatitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Wellbutrin, Lisinopril, Prozac, Lamictal, Fenofibric Acid, Vitamin D3, Dexilant
Current Illness:
Preexisting Conditions: Sarcoidosis
Allergies: Penicillin, Sulfa
Diagnostic Lab Data: Blood - CBC, CMP, Magnesium, Lipase, Alcohol Imaging - Ultrasound, CT
CDC Split Type:

Write-up: Acute Pancreatitis


VAERS ID: 1714623 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032N20A / 1 LA / OT

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

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

Write-up: Administered with expired vaccine; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Administered with expired vaccine) in a 36-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 032N20A) for COVID-19 vaccination. No Medical History information was reported. On 08-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 ml. On 08-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Administered with expired vaccine). On 08-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Administered with expired vaccine) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product use was not provided. Treatment information was not provided. This case was linked to MOD-2021-314573, MOD-2021-314517, MOD-2021-314793, MOD-2021-314545, MOD-2021-314805, MOD-2021-314570, MOD-2021-314810 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 15-Sep-2021: Follow Up received : Possible No new information.


VAERS ID: 1714674 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-04
Onset:2021-09-08
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Dizziness, Erythema, Fatigue, Feeling abnormal, Peripheral swelling, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Next day, he felt awful; dizziness; anxiousness; fatigue; hot red spot the size of a silver dollar; arm was swollen and large/Next day, his arm felt the same; hot red spot the size of a silver dollar; This spontaneous case was reported by a consumer and describes the occurrence of FEELING ABNORMAL (Next day, he felt awful), DIZZINESS (dizziness), ANXIETY (anxiousness), SKIN WARM (hot red spot the size of a silver dollar) and PERIPHERAL SWELLING (arm was swollen and large/Next day, his arm felt the same) in a 52-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 005C21A and 006C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 04-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 07-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 08-Sep-2021, the patient experienced SKIN WARM (hot red spot the size of a silver dollar), PERIPHERAL SWELLING (arm was swollen and large/Next day, his arm felt the same) and ERYTHEMA (hot red spot the size of a silver dollar). On 09-Sep-2021, the patient experienced FEELING ABNORMAL (Next day, he felt awful), DIZZINESS (dizziness), ANXIETY (anxiousness) and FATIGUE (fatigue). At the time of the report, FEELING ABNORMAL (Next day, he felt awful), DIZZINESS (dizziness), ANXIETY (anxiousness), SKIN WARM (hot red spot the size of a silver dollar), PERIPHERAL SWELLING (arm was swollen and large/Next day, his arm felt the same), ERYTHEMA (hot red spot the size of a silver dollar) and FATIGUE (fatigue) was resolving. No concomitant medications were reported. No treatment medications were reported.


VAERS ID: 1714676 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-11
Onset:2021-09-08
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Expired product administered, Fatigue, Product administration error, Product storage error, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (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: Test Name: Body temperature; Result Unstructured Data: High
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: 101.6 degrees fever; Post vaccine fatigue; product storage error; product administration error; Expired dose administered to patient/Expired vaccine dose; This spontaneous case was reported by a nurse and describes the occurrence of PYREXIA (101.6 degrees fever), FATIGUE (Post vaccine fatigue), EXPIRED PRODUCT ADMINISTERED (Expired dose administered to patient/Expired vaccine dose), PRODUCT STORAGE ERROR (product storage error) and PRODUCT ADMINISTRATION ERROR (product administration error) in a 98-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 002S21A) for COVID-19 vaccination. No Medical History information was reported. On 11-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 milliliter. On 08-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to .5 milliliter. On 08-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired dose administered to patient/Expired vaccine dose) and PRODUCT ADMINISTRATION ERROR (product administration error). On an unknown date, the patient experienced PYREXIA (101.6 degrees fever), FATIGUE (Post vaccine fatigue) and PRODUCT STORAGE ERROR (product storage error). The patient was treated with PARACETAMOL (TYLENOL) at an unspecified dose and frequency and IBUPROFEN at an unspecified dose and frequency. On 08-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Expired dose administered to patient/Expired vaccine dose) and PRODUCT ADMINISTRATION ERROR (product administration error) had resolved. At the time of the report, PYREXIA (101.6 degrees fever) and FATIGUE (Post vaccine fatigue) outcome was unknown and PRODUCT STORAGE ERROR (product storage error) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: 101.6 (High) High. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medications were not reported. The reporter states that the patient received expired vaccine. vial that was opened on 01 September 2021 from the refrigerator was used that put back in refrigerator and took back out of refrigerator on 08 Sep 2021 and reporter states patient had an immune response due to fever 101.6 degrees fever and post vaccine fatigue


VAERS ID: 1715050 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-26
Onset:2021-09-08
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Covid positive contact unknown


VAERS ID: 1715071 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-13
Onset:2021-09-08
   Days after vaccination:148
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blister, Herpes zoster
SMQs:, Severe cutaneous adverse reactions (broad), Hypersensitivity (broad), Opportunistic infections (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: Several eye exams 9/11/21 hospital then 9/13/21
CDC Split Type:

Write-up: Broke out in Shingles to th face, scalp and eye on right side. I have NEVER had chicken pox or been exposed to my knowledge. Emergency Room was baffled and yet had someone else in with similar case. Blisters in eye and had to be dyed and checked for cornea damage. Went to specialist 2 days later, cornea checked again.


VAERS ID: 1715139 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood glucose, Full blood count, Gait inability, Laboratory test, Metabolic function test
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre 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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol inhaler, ASA, calcium/ vit D3, Vit D3, furosemide, insulin aspart, insulin glargine, lenalidomide, magnesium, omega 3, miralax, potassium. senna plus, simvastatin
Current Illness: none
Preexisting Conditions: CKD, OSA, type 2 diabetes, hyperlipidemia, hypothyroidism, BPH, Vit D deficiency, lymphedema of lower extremities
Allergies: NKA
Diagnostic Lab Data: CMP, CBC, SARS, POCT glucose 9/8/2021
CDC Split Type:

Write-up: 9/8/2021 patient became very weak and unable to walk. Patient presented to the ER was admitted acutely for observation.


VAERS ID: 1715185 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-21
Onset:2021-09-08
   Days after vaccination:110
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / UNK - / -

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

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

Write-up: Covid positive household member


VAERS ID: 1715423 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-19
Onset:2021-09-08
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH F08448 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Culture urine positive, Kidney infection
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: Aromasin, D3, Calcium, Melatonin, Pepcid AC
Current Illness:
Preexisting Conditions: Breast cancer
Allergies: PCN, Bactrim, Gluten sensitivity
Diagnostic Lab Data: urine culture, positive for infection
CDC Split Type:

Write-up: Kidney infection diagnosed on 9/10/21, supported diagnosis with a culture, given Cipro


VAERS ID: 1715578 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 RA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Blood pressure increased, Chills, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (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: 25 mg Hydrochlorothiazide
Current Illness:
Preexisting Conditions:
Allergies: Ceclor
Diagnostic Lab Data:
CDC Split Type:

Write-up: 101 fever, chills, severe headache, elevated blood pressure that has not went back down


VAERS ID: 1715583 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-08
Onset:2021-09-08
   Days after vaccination:212
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / UNK - / -

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

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

Write-up: Covid positive household member


VAERS ID: 1715595 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-11
Onset:2021-09-08
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025021A / UNK - / -

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

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

Write-up: Covid positive work related


VAERS ID: 1715683 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Computerised tomogram, Laboratory test
SMQs:

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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lamital lipitor Eliquest Prilosec Zoloft Vitamin B12 Vitamin D3 Magnesium
Current Illness: No
Preexisting Conditions: Previous TIA in ~2018 Grand Mal Seizures - 2018
Allergies: None
Diagnostic Lab Data: CT scan and Labs and Fluids
CDC Split Type:

Write-up: Fluids and monitoring


VAERS ID: 1715693 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-06
Onset:2021-09-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 OT / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain upper, Fatigue, Headache, Hypersomnia, Influenza like illness, Lethargy, Pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Testosterone CYP 200 MG/ML .5ml every two weeks Tadafafil 5mg Carvedilol 12 .5 MG 2 X per day Mil Thistle 275 mg Vitamin C 1000 Mg per day Vitamin D 500 Mg per day
Current Illness: none
Preexisting Conditions: Hypertension Low T BPH
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:

Write-up: I got the injection in upper left sholder. The next day I had a bit of pain. The second day the pain was down my arm. At the same time the second day I had a feeling of Fatigue and a bad headache. I felt like I had the flu. The forth and fifth day I was feeling very Lethargic and slept a bunch. I also had pain in my somach. I started to feel better about day 6.


VAERS ID: 1715711 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-06
Onset:2021-09-08
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aripiprazole 2mg daily atorvastatin 20mg daily cyclobenzaprine 10mg PRN for spasm duloxetine 90mg daily estradiol topical 4mcg vaginal insert fluticasone nasal 50mcg inhale PRN for allergy symptoms meloxicam 15mg daily multivitamin daily Fi
Current Illness: None
Preexisting Conditions: vaginal atrophy, allergies, depression, menopausal, hyperlipidemia, osteoarthritis, inflamed seborrheic keratosis.
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Contracted COVID after being fully vaccinated


VAERS ID: 1715722 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (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: Rosuvastatin (1 x 25mg tablet), Losartan 2 x 25mg tablets), Kirkland Calcium (1 x 600mg tablet), Nature''s Bounty Fish Oil (1 x 1400mg tablet), Kirkland Daily Multi Vitamins (1 tablet). I stopped my chemotherapy (Capecitabine 6 x 500mg tabl
Current Illness: N/A
Preexisting Conditions: I have Cancer stage 4, HYPERTENSION (HIGH BLOOD PRESSURE) and DIABETES TYPE 2 LOW HDL AND HIGH TRIGLYCERIDE
Allergies: Enalaprilat
Diagnostic Lab Data: Just video call to doctor which suggested I report the side effects.
CDC Split Type:

Write-up: Sweating of my hands and feet profusely. All day and nigh long.


VAERS ID: 1715757 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 RA / IM

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

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

Write-up: Swollen injection site the size of golf ball according to pt


VAERS ID: 1715874 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-06
Onset:2021-09-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Facial pain, Migraine
SMQs:, Glaucoma (broad)

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

Write-up: Ongoing facial pain on right side of face starting Sept. 8. followed by migraine headache since 9/17.


VAERS ID: 1715913 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site pain, Pain in extremity, Paraesthesia, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, b-complex, vitamin d
Current Illness: End of a cold
Preexisting Conditions:
Allergies: no
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: When I received the shot in my left arm my left arm became immediately sore down to my elbow. Shortly after this, my hand from my wrist down began shaking. My fingers were shaking and it was very noticeable, especially when drinking water with that hand. Additionally, the soreness stopped at my elbow and my arm from my elbow to my fingertips felt tingly, sometimes slightly numb, and it felt like it was vibrating even when it wasn''t actively shaking. Additionally, my fingertips on my left hand, especially my ring fingertip hurt when touching things for the first few days. When I washed my hair it was especially noticeable. The pressure on my fingertips on that hand when washing my hair was painful to the touch. Now the shaking in my hand comes back on and off. There is still sometimes sensitivity in my left ring finger and my arm from my elbow down feels slightly asleep and quite frankly just "off."


VAERS ID: 1715928 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-02-26
Onset:2021-09-08
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Discharge, Lower respiratory tract congestion, Productive cough, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin; Metformin; lots of supplements (does not want to list)
Current Illness: None
Preexisting Conditions: Elevated Calcium Score which is the reason for the metformin, family HX of diabetes which is also reason for the metformin.
Allergies: None
Diagnostic Lab Data: Covid.
CDC Split Type: vsafe

Write-up: Tested positive for Covid on 09/08/2021. I had Coughing and congestion. The congestion started going down into chest and I did have a severe case of bronchitis that turned into walking pneumonia in 2010 due to overwork. I was concerned about the possibility of Covid influenced pneumonia. No fever, no pulse oxygenation, copious amounts of drainage were all clear, lots of congestion, gunk going down and the beginning of congestion and coughing up from the upper respiratory tract. No muscle aches. I did receive monoclonal antibodies on September 10 and symptoms started getting better.


VAERS ID: 1716094 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0890 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product administered to patient of inappropriate age, Product administration 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: Not disclosed
Current Illness: Not disclosed
Preexisting Conditions: Not Disclosed
Allergies: NKA
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Vaccine administration error. The patient is 11 years old. The Pfizer COVID 19 vaccine is not indicated for pediatric patients under the age of 12. Mother called and informed to please do not bring the child in for their 2nd dose until the Pfizer COVID 19 vaccine is authorized for pediatric patients under the age of 12. The patients mother did not report any adverse side effects.


VAERS ID: 1716339 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-30
Onset:2021-09-08
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D2W / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Magnetic resonance imaging, Vertigo, Vestibular neuronitis
SMQs:, Vestibular 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Calcium Vitamin D
Current Illness: Cold 2 weeks prior
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data: Blood draw 9/9/21 MRI 9/9/21
CDC Split Type:

Write-up: Vertigo caused by Vestibular Neutitis


VAERS ID: 1716367 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-12
Onset:2021-09-08
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 2 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Alanine aminotransferase normal, Anion gap, Aspartate aminotransferase normal, Asthenia, Blood albumin decreased, Blood bicarbonate, Blood bilirubin decreased, Blood calcium normal, Blood chloride normal, Blood creatinine decreased, Blood glucose increased, Blood magnesium normal, Blood pH increased, Blood phosphorus normal, Blood potassium normal, Blood sodium normal, Blood urea decreased, Condition aggravated, Culture urine positive, Diarrhoea, Haematocrit normal, Haemoglobin normal, Laboratory test, Multiple sclerosis, Muscular weakness, Platelet count normal, Pyuria, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Optic nerve disorders (broad), Demyelination (narrow), Noninfectious diarrhoea (narrow), Immune-mediated/autoimmune 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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG capsule acetaminophen (TYLENOL) 650 MG suppository amLODIPine (NORVASC) 10 MG tablet baclofen (LIORESAL) 10 MG tablet bisacodyl (DULCOLAX) 10 MG suppository Carboxymeth-Glycerin-Polysorb (REFRESH OPTIVE ADVANC
Current Illness: weakness, acute cytitis without hematuria
Preexisting Conditions: Respiratory Acute respiratory failure with hypoxia (HCC) Circulatory Essential hypertension Previous (DVT) of femoral vein of right lower extremity (HCC) Digestive Irritable bowel Lower GI bleed Proctitis Gastroenteritis Bowel dysfunction Infectious/Inflammatory Urinary tract infection associated with indwelling urethral catheter (HCC) Recurrent UTI Septic shock (HCC) Cellulitis of right lower extremity Hematologic Acute blood loss anemia Nervous Multiple sclerosis (HCC) Multiple sclerosis (HCC) Genitourinary Bladder dysfunction AKI (acute kidney injury) (HCC) Chronic indwelling Foley catheter Endocrine/Metabolic Steroid-induced hyperglycemia Hypokalemia Other H/O Clostridium difficile infection Weakness generalized Wheelchair bound Foot drop, right Spasticity Generalized weakness
Allergies: LatexItching
Diagnostic Lab Data: Recent Labs 09/10/21 0929 WBC 5.74 HGB 13.5 HCT 40.9 PLATELET 356 Recent Labs 09/10/21 0929 SODIUM 137 POTASSIUM 3.6 CHLORIDE 99 HCO3 24 ANIONGAP 14 CREATININE 0.49* BUN 5* GLUCOSE 227* CALCIUM 9.1 MAGNESIUM 1.6 PHOSPHORUS 3.1 TOTALPROTE 7.0 ALBUMIN 2.6* BILIRUBINT 0.2 AST 17 ALT 12 ALKALINEPH 86
CDC Split Type:

Write-up: PT is a 82 yrs female with MH of multiple sclerosis, neurogenic bladder s/p chronic Foley, hyperlipidemia, hypertension, DVT, and CVA with chronic left-sided weakness who presented to the ED 9/8 for generalized weakness. The patient is wheelchair/bed bound as a result of MS and previous CVA. Over the past 3 weeks she noted increasing generalized weakness particularly of her bilateral upper extremities. This had been much worse within the last week. She was concerned that this was related to MS because she stopped taking her q48hr Interferon beta in July because it was too expensive. Her acute on chronic weakness was felt to be due to progression of MS off of Interferon beta and COVID. PT rec discharge home with assist which CM ensured was in place prior to discharge. SLP evaluated and recommended dysphagia diet. No hypoxemia, imaging findings, or significant respiratory symptoms to suggest COVID pneumonia during admission. She had diarrhea on presentation that self resolved. She had asymptomatic pyuria and was given Ceftriaxone in the ED, urine cultures showed mixed flora antibiotics were not continued during admission.


VAERS ID: 1717839 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-09-08
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Blood pressure decreased, Blood pressure measurement, Body temperature, Capillary nail refill test, Cardiovascular examination, Coma scale, Concussion, Dizziness, Heart rate, Heart rate decreased, Hyperhidrosis, Hypersensitivity, NIH stroke scale, Nausea, Neurological examination, Oxygen saturation, Pain assessment, Physical examination, Radial pulse, Respiratory rate, Tunnel vision, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Optic nerve disorders (broad), Retinal disorders (narrow), 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: FIBER
Current Illness:
Preexisting Conditions: Comments: No past medical history. Patient never had a similar reaction to other vaccinations. Patient did not have any allergies.
Allergies:
Diagnostic Lab Data: Test Date: 20210908; Test Name: Blood pressure; Result Unstructured Data: 128/50 mmHg, dropped; Comments: Method: Manual Cuff; Test Date: 20210908; Test Name: Heart rate; Result Unstructured Data: 50 (dropped); Comments: Method: Palpated; Test Date: 20210908; Test Name: Glasgow coma scale; Result Unstructured Data: (4/5/6) EVM score of 15; Test Date: 20210908; Test Name: Neurological examination; Result Unstructured Data: AAO x 3, Appropriate Behavior, Clear Speech, Event Memory Intact; Test Date: 20210908; Test Name: stroke scale; Result Unstructured Data: Negative; Test Date: 20210908; Test Name: Capillary nail refill test; Result Unstructured Data: Less than 2 Seconds; Test Date: 20210908; Test Name: Cardiovascular examination; Result Unstructured Data: Normal; Test Date: 20210908; Test Name: Physical examination; Result Unstructured Data: Normal; Test Date: 20210908; Test Name: Body temperature; Result Unstructured Data: 98.3 F; Test Date: 20210908; Test Name: Oxygen saturation; Result Unstructured Data: 95; Test Date: 20210908; Test Name: Respiratory rate; Result Unstructured Data: 16 (normal); Test Date: 20210908; Test Name: Pain scale; Result Unstructured Data: 0; Test Date: 20210908; Test Name: Radial pulse; Result Unstructured Data: Normal
CDC Split Type: USJNJFOC20210929255

Write-up: TUNNEL VISION; DIAPHORESIS (PROFUSE SWEATING); ARM CONCUSSIONS; FEELING OF "PASSING OUT"; BLOOD PRESSURE DROPPED; HEART RATE DROPPED; FEELING WEAK; VOMITING; ALLERGIC REACTION; NAUSEA; This spontaneous report received from a patient concerned a 30 year old male. The patient''s weight was 130 pounds, and height was not reported. The patient''s pre-existing medical conditions included: No past medical history. Patient never had a similar reaction to other vaccinations. Patient did not have any allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A) dose was not reported, 1 total, administered on 08-SEP-2021 for prophylactic vaccination. Concomitant medications included polycarbophil calcium (fiber) for drug used for unknown indication. On 08-SEP-2021, within less than 5 minutes after getting vaccination, patient experienced profuse sweating, arm concussions, vomiting and tunnel vision. The pharmacist called emergency medical technician on behalf of patient. Patient experienced nausea and a feeling of "passing out" approximately 30 minutes after receiving the vaccination. Patient did not present loss of consciousness. Patient vomited once after receiving the shot and begun to feel weak, Patient stated that his symptoms had improved by the time of emergency medical services (EMS) arrival. Patient denied pain or shortness of breath (SOB), and there was no evidence of hives or other skin irritation. Laboratory data included: Body temperature was 98.3 degrees F. and Respiratory rate was 16 (normal). Oxygen saturation was 95, Pain scale was 0, pupils equal and reacting to light (PERL) were normal. Patient''s cardiovascular examination was normal i.e no evidence of Jugular vein distention (JVD), No evidence of peripheral edema, peripheral pulses were intact and equal bilaterally, Heart rate was 50 (dropped), Stroke Scale (resource stroke scale) stated Negative, Capillary refill test was less than 2 Seconds. Blood pressure was 128/50 mmHG (dropped). Radial pulse was normal. basic life support team (BLS) obtained patient vital signs and noted low heart rate but patient stated this was his baseline. Patient''s neurological examination included, awake, alert, and oriented (AAO x 3), Appropriate Behavior, Clear Speech, Event Memory was Intact, Glasgow coma scale was (4/5/6) with eye, verbal, and motor response (EVM score) of 15. Patient''s consciousness level was alert. Patient''s Physical examination included (NR: not provided) Normal i.e Gastrointestinal (Abdomen soft and nondistended), gag reflex was intact, Skeletal (Long bones, Spinal bones, Skull and facial bones were intact with no deformity, spinal bones intact, was inline with no deformities, thorax bones were intact and symmetrical expansion with no deformities) noted, Skin (intact without evidence of breakdown, mucous membranes were moist and pink, non- pallor, no cyanosis, good turgor, warm and dry to touch). Patient had movement and sensation in all four extremities, which was considered normal. Patient''s general skin presentation was warm and diaphoretic. Patient''s mental status and neurological was in normal baseline Respiration and airway data included: Natural/Patent Airway, Trachea Midline, Breath sounds (both left and right) were clear and equal to auscultation, no evidence of retractions and no nasal flaring. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from diaphoresis (profuse sweating), vomiting, and nausea, and was recovering from arm concussions, tunnel vision, feeling of "passing out", feeling weak, blood pressure dropped, heart rate dropped, and allergic reaction. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210929255- COVID-19 VACCINE AD26.COV2.S-TUNNEL VISION. This event is considered unassessable. The event 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.


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