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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 241 out of 8,010

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VAERS ID: 1717940 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
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 41-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) 1 dosage form. On 08-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (administered with expired vaccine). At the time of the report, 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. Crosslinked with MOD21-141427, MOD21-141586, MOD21-141640, MOD21-141641, MOD21-141642, MOD21-141643, MOD21-141644, MOD21-141645, MOD21-141646. There were 9 patients instead of 10 as initially reported. This case is for the 9th patient. Concomitant medications was not provided by the reporter Treatment information was not provided This case was linked to MOD-2021-314567, MOD-2021-314573, MOD-2021-314570, MOD-2021-314793 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 15-Sep-2021: Possible NNI.


VAERS ID: 1717946 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-01-22
Onset:2021-09-08
   Days after vaccination:229
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 642620A / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Dizziness, Feeling abnormal
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

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

Write-up: Feeling low; Dizzy; Weak; This spontaneous case was reported by a consumer and describes the occurrence of FEELING ABNORMAL (Feeling low), DIZZINESS (Dizzy) and ASTHENIA (Weak) in a 78-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 642620A) for COVID-19 vaccination. No Medical History information was reported. On 22-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 19-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 07-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 08-Sep-2021, the patient experienced FEELING ABNORMAL (Feeling low), DIZZINESS (Dizzy) and ASTHENIA (Weak). On 09-Sep-2021, FEELING ABNORMAL (Feeling low), DIZZINESS (Dizzy) and ASTHENIA (Weak) had resolved. Concomitant medication details were not reported by the reporter. Treatment details was not reported by the reporter.


VAERS ID: 1717951 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-09-08
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure measurement, Chest pain, Chills, Heart rate, Hypotension, Malaise, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FLONASE [MOMETASONE FUROATE]; MULTIVITAMIN [VITAMINS NOS]
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210909; Test Name: BLOOD PRESSURE; Result Unstructured Data: LOW; Test Date: 20210909; Test Name: HEART RATE; Result Unstructured Data: HIGH
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: My blood pressure was 101/52/ low blood pressure; CHEST PAIN; NAUSEA; CHILLS; MYALGIA; I received the dose at 4pm, I wasn''t feeling well when I went to bed.; This spontaneous case was reported by a consumer and describes the occurrence of MALAISE (I received the dose at 4pm, I wasn''t feeling well when I went to bed.), HYPOTENSION (My blood pressure was 101/52/ low blood pressure), CHEST PAIN (CHEST PAIN), NAUSEA (NAUSEA) and CHILLS (CHILLS) in a 25-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 020F21A and 939902) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Medical history was not provided by the reporter. Concomitant products included MOMETASONE FUROATE (FLONASE [MOMETASONE FUROATE]) and MULTIVITAMIN [VITAMINS NOS] for an unknown indication. On 10-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 08-Sep-2021 at 4:00 AM, 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 MALAISE (I received the dose at 4pm, I wasn''t feeling well when I went to bed.). On 09-Sep-2021, the patient experienced HYPOTENSION (My blood pressure was 101/52/ low blood pressure), CHEST PAIN (CHEST PAIN), NAUSEA (NAUSEA), CHILLS (CHILLS) and MYALGIA (MYALGIA). The patient was treated with IBUPROFEN (ADVIL [IBUPROFEN]) for Adverse event, at an unspecified dose and frequency. At the time of the report, MALAISE (I received the dose at 4pm, I wasn''t feeling well when I went to bed.), HYPOTENSION (My blood pressure was 101/52/ low blood pressure), CHEST PAIN (CHEST PAIN), NAUSEA (NAUSEA), CHILLS (CHILLS) and MYALGIA (MYALGIA) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 09-Sep-2021, Blood pressure measurement: 101/52 (Low) LOW. On 09-Sep-2021, Heart rate: 116 (High) HIGH.


VAERS ID: 1717952 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal discomfort, Chills, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: stomach is queasy; 100.4 fever; chills; This spontaneous case was reported by a consumer and describes the occurrence of ABDOMINAL DISCOMFORT (stomach is queasy), PYREXIA (100.4 fever) and CHILLS (chills) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 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 ABDOMINAL DISCOMFORT (stomach is queasy), PYREXIA (100.4 fever) and CHILLS (chills). At the time of the report, ABDOMINAL DISCOMFORT (stomach is queasy), PYREXIA (100.4 fever) and CHILLS (chills) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication was reported. No treatment medication was reported.


VAERS ID: 1717972 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
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 35-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 vaccine). At the time of the report, EXPIRED PRODUCT ADMINISTERED (administered with expired vaccine) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medication was not provided. Treatment information was not provided. This case was linked to MOD-2021-314567, MOD-2021-314570, MOD-2021-314573, MOD-2021-314793, MOD-2021-314545, MOD-2021-314555, MOD-2021-314805, MOD-2021-314810, MOD-2021-314805 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 15-Sep-2021: Follow-up information included no new information


VAERS ID: 1717973 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
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 62-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 concomitant medication were reported. No treatment information was provided by the reporter. This case was linked to MOD-2021-314570, MOD-2021-314573, MOD-2021-314805, MOD-2021-314545, MOD-2021-314555, MOD-2021-314567, MOD-2021-314810, 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: 1717977 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-29
Onset:2021-09-08
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination complication, Vaccination site erythema, Vaccination site warmth
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HYDROXYCHLOROQUINE; METHOTREXATE; FOLIC ACID; OMEPRAZOLE; LEUCOVORIN CALCIUM; DICYCLOVERINE; Vitamin C; Vitamin D
Current Illness: Immunocompromised; Lupus-like syndrome
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Arm is hot four fingers bellow the injection site.; Red is like four fingers bellow the injection site; Felt beaten up; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE WARMTH (Arm is hot four fingers bellow the injection site.), VACCINATION SITE ERYTHEMA (Red is like four fingers bellow the injection site) and VACCINATION COMPLICATION (Felt beaten up) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 058E21A, 042L20A and 01A21A) for COVID-19 vaccination. Concurrent medical conditions included Lupus-like syndrome and Immunocompromised. Concomitant products included HYDROXYCHLOROQUINE, METHOTREXATE, FOLIC ACID, OMEPRAZOLE, CALCIUM FOLINATE (LEUCOVORIN CALCIUM), DICYCLOVERINE, Vitamin C and Vitamin D for an unknown indication. On 29-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 25-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 07-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 08-Sep-2021, the patient experienced VACCINATION SITE WARMTH (Arm is hot four fingers bellow the injection site.), VACCINATION SITE ERYTHEMA (Red is like four fingers bellow the injection site) and VACCINATION COMPLICATION (Felt beaten up). At the time of the report, VACCINATION SITE WARMTH (Arm is hot four fingers bellow the injection site.), VACCINATION SITE ERYTHEMA (Red is like four fingers bellow the injection site) and VACCINATION COMPLICATION (Felt beaten up) outcome was unknown. No treatment medication reported. This case was linked to MOD-2021-314861 (Patient Link).


VAERS ID: 1717983 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Burning sensation, Hyperhidrosis, Malaise, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: Not feeling well; Arm was sore ,body aches; Temperature; Sweats; Body was burning hot; This spontaneous case was reported by a consumer and describes the occurrence of MYALGIA (Arm was sore ,body aches), PYREXIA (Temperature), HYPERHIDROSIS (Sweats), BURNING SENSATION (Body was burning hot) and MALAISE (Not feeling well) in a 33-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 009C21A) 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) 1 dosage form. On 08-Sep-2021, the patient experienced MYALGIA (Arm was sore ,body aches), PYREXIA (Temperature), HYPERHIDROSIS (Sweats) and BURNING SENSATION (Body was burning hot). On an unknown date, the patient experienced MALAISE (Not feeling well). The patient was treated with PARACETAMOL (TYLENOL) for Adverse event, at an unspecified dose and frequency and DEXTROMETHORPHAN HYDROBROMIDE, GUAIFENESIN, PARACETAMOL, PSEUDOEPHEDRINE HYDROCHLORIDE (DAYQUIL) for Adverse event, at an unspecified dose and frequency. At the time of the report, MYALGIA (Arm was sore ,body aches), PYREXIA (Temperature), HYPERHIDROSIS (Sweats), BURNING SENSATION (Body was burning hot) and MALAISE (Not feeling well) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Temporal temperature on right aide was 102.2 and on left side was 102.3. No concomitant medications were reported.


VAERS ID: 1718136 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-20
Onset:2021-09-08
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Feeling abnormal, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MELOXICAM; VERAPAMIL; COENZYME Q10+; PRAVASTATIN
Current Illness:
Preexisting Conditions: Comments: No medical History was reported.
Allergies:
Diagnostic Lab Data: Test Date: 20210908; Test Name: Body temperature; Result Unstructured Data: Fever of 101 degrees Fahrenheit
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: felt really bad; nauseated; fever of 101 degrees Fahrenheit; This spontaneous case was reported by a consumer and describes the occurrence of FEELING ABNORMAL (felt really bad), NAUSEA (nauseated) and PYREXIA (fever of 101 degrees Fahrenheit) in a 67-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 012L20A and 010M20A) for COVID-19 vaccination. No medical History was reported. Concomitant products included MELOXICAM, VERAPAMIL, TOCOPHEROL, UBIDECARENONE, ZINC (COENZYME Q10+) and PRAVASTATIN for an unknown indication. On 20-Feb-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 07-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 08-Sep-2021, the patient experienced FEELING ABNORMAL (felt really bad), NAUSEA (nauseated) and PYREXIA (fever of 101 degrees Fahrenheit). The patient was treated with PARACETAMOL (TYLENOL) for Pyrexia, at an unspecified dose and frequency. At the time of the report, FEELING ABNORMAL (felt really bad), NAUSEA (nauseated) and PYREXIA (fever of 101 degrees Fahrenheit) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 08-Sep-2021, Body temperature: 101 (High) Fever of 101 degrees Fahrenheit. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. It was reported that patient had no known allergy. Most recent FOLLOW-UP information incorporated above includes: On 16-Sep-2021: Follow-up received significant information - Events Outcome updated.


VAERS ID: 1718313 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Body temperature increased, Diarrhoea, Dizziness, Fatigue, Hyperhidrosis, Loss of consciousness, Malaise, Nausea
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (narrow), 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: Test Date: 20210908; Test Name: Body temperature; Result Unstructured Data: Test Result:increased
CDC Split Type: USPFIZER INC202101190445

Write-up: hasn''t felt right; 2nd dose- had high temperatures to where he was sweating; felt like he was going to pass out/2nd dose- dizziness and a couple hours after that he almost fainted; dizzy/2nd dose- dizziness and a couple hours after that he almost fainted; had high temperatures; nauseous; tired; diarrhea; This is a spontaneous report from a contactable consumer. A 47-year-old male consumer (patient himself) reported received second dose of COMIRNATY (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Lot number-30130BA) via an unspecified route of administration, administered on 07Sep2021 as Dose 2, single (age at vaccination was 47-years-old) for covid-19 immunisation. The patient medical history little sore throat, tired ear ache, little cough. Patient concomitant medication not reported. Historical vaccine included first dose of COMIRNATY (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Lot number-FD8448) via an unspecified route of administration, administered on 17Aug2021 as Dose 1, single for covid-19 immunisation. Since his 2nd dose, Ever since he had the COVID vaccine, starting on 08Sep2021, he was dizzy, felt like he was going to pass out, he had high temperatures, felt nauseous, tired, and he was also had diarrhea as well. Patient stated , "After the second shot, I ran 5 miles. I felt great. And the next morning, I had 0 symptoms. It was weird, I thought I would have some symptoms earlier, like 20-24 hours. He had the 1st dose at 5:00 at night and when he got home he felt tired and just went to bed right away. Normally he stays up later than just 6:00 to 7:00. When he woke up he was tired. For these two weeks after the 1st dose he was tired, had a little sore throat, a little bit of an ear ache, a little cough and that was it with the 1st dose. Then when he woke up the next day he felt great and he started having the symptoms that afternoon of dizziness and a couple hours after that he almost fainted. He was dizzy that next night and then half of today he had still been dizzy. It had started to go away. He had the dizziness, he had high temperatures to where he was sweating, he was nauseous and he has had diarrhea. He confirms that his side effects after the 2nd dose began the next day, confirmed to 08Sep2021. He just didn''t feel right and he thought that he just had the common cold after the 1st dose because it wasn''t that bad but with the 2nd dose it ramped up on the following day about mid-day. He was 47-years-old and he had never felt dizzy and passed out in his entire life, which was a little odd. He confirms that he was still experiencing all of this side effects but they had improved some. When he got up this morning he figured he was going to be fine but he still felt dizzy. He was able to walk but he was a little dizzy and his high temperatures had went away. He was still having nausea and he still feels tired. It seems like from this morning he does feel better than how he did when he woke up around 6:00 to 7:00 this morning. He was hoping that it all goes away and he would feel normal tomorrow. Everywhere he reads it says that you may have 2 to 3 days of side effects, Inquired if he recovered completely from the side effects experienced after the 1st dose and he says yes. He had those for a week to a week and a half and he didn''t feel good but he definitely could function. He felt a touch of something and it had went away and then he felt normal. Then he had the 2nd dose and the 2nd dose really felt worse than having COVID. He might of gotten dizzy when he had COVID but it was not every time that he stood up to where he couldn''t walk. He would sit down and then get up and be dizzy to where he couldn''t walk and that went on for about 5 to 6 hours. He has never experienced anything like that in his life. This has been the third day since the 2nd dose and he feels better today. The patient underwent lab test included body temperature was increased on 08-sep-2021. The outcome of dizziness, diarrhea, nausea, high temperatures, sweating was not recovered. The outcome of event malaise, fatigue, loss of consciousness were unknown.


VAERS ID: 1718373 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-08-24
Onset:2021-09-08
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
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 INC202101218821

Write-up: Rash all over body and come backagain next day; Rash all over body and come backagain next day; This is a spontaneous report from a contactable consumer, the patient. A 45-year-old male patient received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 24Aug2021 at 15:30 (at the age of 45-years-old) as a single dose for COVID-19 immunisation. The patient had no medical history. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the COVID-19 vaccine. The patient did not receive any concomitant medications. On 08Sep2021, the patient experienced rash all over body and come back again next day, on 09Sep2021. The events resulted in doctor or other healthcare professional office/clinic visit. Since the vaccination, the patient had not been tested for COVID-19. Therapeutic measures were taken as a result of the events which included treatment with diphenhydramine (BENADRYL). The clinical outcome of the events rash all over body and come back again next day was resolving at the time of this report. The patient received second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 14Aug2021 at 15:30 (at the age of 45-year-old), as a single dose for COVID-19 immunisation. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1718827 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-07
Onset:2021-09-08
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Decreased appetite, Fatigue, Malaise, Pyrexia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CHRONIC CONDITIONS INCLUDE CKD, IGA NEPHROPHATHY, HTN
Allergies:
Diagnostic Lab Data: POSITIVE SARS-COV-2
CDC Split Type:

Write-up: This case meets vaccine breakthrough criteria review. SXS INCLUDE FEVER, MALAISE, POOR APPETITE, FATIGUE, COUGH


VAERS ID: 1718897 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-08
Onset:2021-09-08
   Days after vaccination:153
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood culture, Blood gases, COVID-19, Chest X-ray, Computerised tomogram thorax, Cough, Dyspnoea, Electrocardiogram, Fibrin D dimer, Full blood count, Glycosylated haemoglobin, Metabolic function test, Pyrexia, Scan with contrast
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81mg daily Flonase 50mcg/inh daily ibuprofen 600mg q4hr PRN omeprazole 20mg daily simvastatin 40mg HS tamsulosin 0.8mg daily
Current Illness: None documented
Preexisting Conditions: Erectile dysfunction, history of prostate cancer, smoker, hypertension, hypogonadism, allergies seasonal, diverticular disease of colon,
Allergies: amlodipine - anxiety lisinopril - jittery losartan - malaise
Diagnostic Lab Data: CMP, CBC, Blood Cultures, HgbA1c, D-dimer, Blood gases EKG, chest xray, CT angiography chest with contrast
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated Presented on 9/14/2021 to ER with complaints of SOB, cough, fever for two weeks.


VAERS ID: 1719002 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-01-12
Onset:2021-09-08
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram, Pulmonary thrombosis, X-ray
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? Yes
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: Losartan Potassium - 50mg, amLodipebesylate 5mg, Omerprazoledr-40mg, Rosuvastatin Calcium-20, Low Dose Asprin, Centrium Sliver, Vitamin B12 c
Current Illness: No illnesses.
Preexisting Conditions: By pass 1 artery, pace maker and high blood pressure.
Allergies: No allergies that I''m aware of.
Diagnostic Lab Data: Xray, CTscan 9/9/2021
CDC Split Type:

Write-up: Blood Clots in lung.


VAERS ID: 1719047 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-01
Onset:2021-09-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia, Tinnitus, Vertigo
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hearing impairment (narrow), Vestibular 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: Zyrtec, zoloft
Current Illness: None
Preexisting Conditions: Endometriosis, Anxiety
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mild intermittent vertigo, tinnitus, paresthesias


VAERS ID: 1719240 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-16
Onset:2021-09-08
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Cough, Fever, sore throat


VAERS ID: 1719259 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-05
Onset:2021-09-08
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone normal, C-reactive protein normal, Chest pain, Dyspnoea exertional, Electrocardiogram normal, Fatigue, Full blood count normal, Loss of personal independence in daily activities, Pain in extremity, Palpitations, SARS-CoV-2 test negative, Serum ferritin normal, Troponin normal, Vitamin D
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma and Pectus Excavatum
Allergies:
Diagnostic Lab Data: 9/8, 9/9, 9/12 - tropinins and ekg were all normal 9/12 - cbc, ferritin, TSH, CRP, Vitamin D all normal. 9/13 COVID negative
CDC Split Type:

Write-up: Had arm pain after the vaccine. Starting about 3 days after the vaccine, he developed chest pain, shortness of breath and fatigued after playing water polo. These symptoms were significant enough that his mother brought him to the ED for evaluation wherein tropinins, EKGs and chest xray were normal. These symptoms were severe enough to interfere with school and his sports. He now has symptoms of intermittent palpitations, chest pain and persistent fatigue.


VAERS ID: 1719278 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA WAAS11865 / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Chest pains and shortness of breath, the first shot was given and the same symptoms but over the course of a couple weeks these went away and returned to normal. Now this has been 3 weeks and still having shortness of breath and pain in my chest


VAERS ID: 1719381 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 2 - / IM

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

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

Write-up: RED,SWOLLEN, SORE "SPLOTCHES", PRIMARILY ON OPPOSITE SIDE OF BODY THAN VACCINE ADMINISTRATION


VAERS ID: 1719420 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Injection site pain, Lymphadenopathy, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Dophlinac 75 mg, Omeprazole 20 mg, Fluticasone 50 mcg, one a day men''s vitamin
Current Illness: N/A
Preexisting Conditions: Lower back pain, heart burn, allergies
Allergies: sulfa base meds.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Common, Pain at injection site. Body, Muscle pain, slight headache. Not common (adverse) Swollen left lymph node. Not quite as bad as the swollen lymph node from my first covid shot (report #617152).


VAERS ID: 1719662 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Headache, Injection site reaction, Injection site swelling, Injection site warmth, Nausea, Pain, Pyrexia, Skin exfoliation
SMQs:, Severe cutaneous adverse reactions (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swelling at injection site size of golf ball, warm to the touch, nausea, headaches, body ache, fever and skin peeling at injection site


VAERS ID: 1720054 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-01
Onset:2021-09-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Full blood count, Headache, Metabolic function test, Muscular weakness, Pain in extremity, Vision blurred, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flu vaccine 2 weeks of severe cold-like symptoms
Other Medications: Xanax and melatonin
Current Illness: None
Preexisting Conditions: Insomnia
Allergies: Phenobarbital
Diagnostic Lab Data: PVL, CBC, metabolic blood work
CDC Split Type:

Write-up: Headache and blurred vision with vomiting the first 10 days following shot then 14 days following shot, severe right leg pain treated at ED. Treated pain at ED with dilaudid and prescription sent home for Flexeril, prednisone, lidocaine patches and Naprosyn. PVL complete and negative for blood clot. Weakness following ED visit in bilateral legs and feet. Awaiting referral for neurologist and ortho. Pcp appointment within week of discharge of ED


VAERS ID: 1720101 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / IM

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

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

Write-up: Pt said she experienced severe swelling after getting the shot on her arm. Swelling has gone down but still feeling itching. Told her to apply coco butter and rub ice pack.


VAERS ID: 1720317 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (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: Prenatal vitamins
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: heavy bleeding, possible miscarriage


VAERS ID: 1721476 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-09-08
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Contusion, Hypoaesthesia, Lethargy, Lymphadenopathy, Nausea, Paraesthesia, Sinusitis, Toothache, Vision blurred
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal 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: Blood pressure high; Sulfonamide allergy; Vaccination adverse reaction
Preexisting Conditions: Medical History/Concurrent Conditions: Dermal filler injection; Comments: The patient was at a higher risk for blood clots
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210933687

Write-up: SINUS INFECTION/ PAINFUL NOSE/SINUS/ SEVERE HEADACHE/ COULD NOT TOUCH HER FACE/ SICK ALL WEEKEND; BLURRY VISION; PAINFUL TEETH; VERY LETHARGIC; NAUSEOUS; SWOLLEN LYMPH NODES/ SWOLLEN GLANDS BEHIND THE KNEES/ SWOLLEN THROAT GLANDS; NUMBNESS IN THE LEFT ARM/ FELT LIKE THE AREA WHERE SHE HAD THE INJECTION WAS MISSING; TINGLY LIPS AND FACE LIKE BUGS CRAWLING AROUND; BRUISE 6 IN BENEATH THE INJECTION SITE/ GRAVITY BRUISE; This spontaneous report received from a patient concerned a 55 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included: dermal fillers, and concurrent conditions included: high blood pressure, allergy to sulfas, and reaction to vaccine in general, and other pre-existing medical conditions included: The patient was at a higher risk for blood clots. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 201A21A expiry: UNKNOWN) dose was not reported, administered on 08-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 08-SEP-2021, the patient experienced bruise 6 in beneath the injection site/ gravity bruise. On 08-SEP-2021, the patient experienced numbness in the left arm/ felt like the area where she had the injection was missing. On 08-SEP-2021, the patient experienced tingly lips and face like bugs crawling around. On 09-SEP-2021, the patient experienced swollen lymph nodes/ swollen glands behind the knees/ swollen throat glands. On 10-SEP-2021, the patient experienced sinus infection/ painful nose/sinus/ severe headache/ could not touch her face/ sick all weekend. On 10-SEP-2021, the patient experienced blurry vision. On 10-SEP-2021, the patient experienced painful teeth. On 10-SEP-2021, the patient experienced very lethargic. On 10-SEP-2021, the patient experienced nauseous. On 16-SEP-2021, treatment medications included: ethambutol dihydrochloride. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from tingly lips and face like bugs crawling around on 10-SEP-2021, had not recovered from sinus infection/ painful nose/sinus/ severe headache/ could not touch her face/ sick all weekend, and the outcome of numbness in the left arm/ felt like the area where she had the injection was missing, bruise 6 in beneath the injection site/ gravity bruise, swollen lymph nodes/ swollen glands behind the knees/ swollen throat glands, very lethargic, nauseous, painful teeth and blurry vision was not reported. This report was non-serious. This case, from the same reporter is linked to 20210933069.; Sender''s Comments: V0: Medical Assessment Comment not required as per standard procedure as case assessed as non serious.


VAERS ID: 1721592 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-09-08
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Influenza like illness, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever returned; Headache/having headaches mostly when i lay down; flu like symptoms; This spontaneous case was reported by a consumer and describes the occurrence of INFLUENZA LIKE ILLNESS (flu like symptoms), PYREXIA (Fever returned) and HEADACHE (Headache/having headaches mostly when i lay down) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 08-Sep-2021, the patient experienced INFLUENZA LIKE ILLNESS (flu like symptoms). On 09-Sep-2021, the patient experienced PYREXIA (Fever returned) and HEADACHE (Headache/having headaches mostly when i lay down). On 08-Sep-2021, INFLUENZA LIKE ILLNESS (flu like symptoms) had resolved. On 10-Sep-2021, PYREXIA (Fever returned) had resolved. At the time of the report, HEADACHE (Headache/having headaches mostly when i lay down) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant products were reported. No treatment drugs were reported This case was linked to MOD-2021-293439 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 12-Sep-2021: Follow-up information received on 12-09-2021 contains non-significant information.


VAERS ID: 1721632 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-08-11
Onset:2021-09-08
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D2NA / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Illness, Myalgia, Pyrexia, Rhinorrhoea, Tachycardia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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

Write-up: runny nose; strange illness; has never been this sick on her life; body pain/ body aches/really bad body pain/body pain that was severe; fever/ had a fever/fever of 102; chest pain; tachycardia/120''s tachycardia; This spontaneous case was reported by a patient and describes the occurrence of RHINORRHEA (runny nose), ILLNESS (strange illness), CHEST PAIN (chest pain), TACHYCARDIA (tachycardia/120''s tachycardia) and ILLNESS (has never been this sick on her life) in a 43-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 049CZ1A and 011D2NA) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. Concomitant products included FAMOTIDINE for an unknown indication. On 11-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 08-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 CHEST PAIN (chest pain) and TACHYCARDIA (tachycardia/120''s tachycardia). On an unknown date, the patient experienced RHINORRHEA (runny nose), ILLNESS (strange illness), ILLNESS (has never been this sick on her life), MYALGIA (body pain/ body aches/really bad body pain/body pain that was severe) and PYREXIA (fever/ had a fever/fever of 102). The patient was treated with KETOROLAC TROMETHAMINE (TORADOL) for Pain, at a dose of 15 mg and PARACETAMOL (TYLENOL) for Adverse event, at an unspecified dose and frequency. On 09-Sep-2021, CHEST PAIN (chest pain) and TACHYCARDIA (tachycardia/120''s tachycardia) had resolved. At the time of the report, RHINORRHEA (runny nose), ILLNESS (strange illness), ILLNESS (has never been this sick on her life), MYALGIA (body pain/ body aches/really bad body pain/body pain that was severe) and PYREXIA (fever/ had a fever/fever of 102) outcome was unknown. Diagnostic results: On 08 Sep2021-D dimer was slightly elevated (it was at 5 58). She went to the hospital, to the emergency department, she was all day there with tachycardia, fever of 102 and chest pain and body pain that was severe. she had a CAT scan for that. She was given IV fluids but nothing brought her heart rate down. She was discharged that nigh but was still with chest pain and 120''s tachycardia, they just diagnosed that it was vaccine reaction symptoms This case was linked to MOD-2021-286386 (Patient Link). Reporter did not allow further contact


VAERS ID: 1721950 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101223860

Write-up: Period arrived 11 days late; This is a spontaneous report from a non-contactable consumer, the patient. A 27-year-old non-pregnant female patient received BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration on 07Sep2021 at 00:30 (at the age of 27-years-old) as a single dose for COVID-19 immunisation. The patient had no relevant medical history. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the COVID-19 vaccine. The patient did not receive any concomitant medications. On 08Sep2021, the patient''s period arrived 11 days late. 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 period arrived 11 days late was resolved on an unknown date in Sep2021. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1722047 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-03
Onset:2021-09-08
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Palpitations
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

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

Write-up: Heart palpitations with dizziness


VAERS ID: 1722048 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Depression, Diarrhoea, Emotional distress, Extra dose administered, Fatigue, Irritability, Menstrual disorder, Nausea, Suicidal ideation
SMQs:, Acute pancreatitis (broad), Suicide/self-injury (narrow), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Depression (excl suicide and self injury) (narrow), Noninfectious diarrhoea (narrow), Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: -Hizentra infusion weekly (CVID) -Wellbutrin xl 150 mg -Lexapro 20mg -adderall 10mg (ADHD)
Current Illness: None
Preexisting Conditions: Primary immunodeficiency (CVID), endometriosis
Allergies: Hydrocodone
Diagnostic Lab Data: None
CDC Split Type:

Write-up: -my first dose of pfizer I got my period even though I am on continuous birth control, so I shouldn?t lot #: EN6205 -each dose takes me about 2 weeks to recover from, but the 3rd dose is taking longer to recover -with the 3rd dose only I got terrible nausea and diarrhea, I am 15 days out and still getting bad diarrhea off an on, my stomach is so messed up I can?t take my adhd meds and I?m have trouble eating, I will be fine and then randomly get very sick to my stomach, it is not consistent -I noticed this the most with the 3rd dose, but I am having awful depression, much worse than usual almost to the point of suicidal thoughts, I have no motivation to do anything, terrible fatigue and depression, also very angry and irritated


VAERS ID: 1722156 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-09-08
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal pain upper, Ageusia, Body temperature, Cardiac flutter, Chills, Choking, Diarrhoea, Dizziness, Dysgeusia, Dyspepsia, Dysphagia, Feeling abnormal, Flushing, Headache, Hypersensitivity, Lethargy, Limb discomfort, Musculoskeletal stiffness, Myalgia, Nasal congestion, Nausea, Oropharyngeal pain, Pain in extremity, Paraesthesia oral, Pruritus, Skin discomfort, Swollen tongue, Thirst, Throat tightness, Tongue discolouration
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tachyarrhythmia terms, nonspecific (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PROBIOTICS NOS; CBD COMPLEX; VITAMIN D2; VITAMIN B COMPLEX; MAGNESIUM
Current Illness: Food allergy
Preexisting Conditions: Medical History/Concurrent Conditions: Arrhythmia; Brain injury; Postural orthostatic tachycardia syndrome
Allergies:
Diagnostic Lab Data: Test Date: 20210908; Test Name: fever; Result Unstructured Data: At the time of vaccination patient was having slight fever (99.5).
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: felt foggy and dizzy/felt identical to food allergy reactions she has had in past.; very thirsty; trouble swallowing, was choking on rice; throat closed up felt identical to food allergy reactions she has had; stuffy nosy congestion, nose normally runs in AM and did not today; Flushed face; sore throat; Whole left hand hurts and is stiff; random pinches in random spots like something biting under skin; lips were tingling; felt foggy and dizzy; beyond lethargic; which was itchy; limbs feel exaggerated and heavy; whole left hand hurts and is stiff; rapid heart flutter; can feel fine but her digestion is not; I believe it was allergic reaction; nausea; headache; Chills; Muscles ache; tongue swelled and felt too big for mouth; Diarrhea; upset stomach; Stomach Hurts; Tongue''s light, not the usual color; metallic sensation taste in mouth; Lost her taste; choked on rice; Metallic taste on mouth; This spontaneous case was reported by a consumer and describes the occurrence of SWOLLEN TONGUE (tongue swelled and felt too big for mouth), CARDIAC FLUTTER (rapid heart flutter), CHOKING (choked on rice), FEELING ABNORMAL (felt foggy and dizzy/felt identical to food allergy reactions she has had in past.) and THIRST (very thirsty) in a 46-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 002F21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Brain injury, Arrhythmia and Postural orthostatic tachycardia syndrome. Concurrent medical conditions included Food allergy. Concomitant products included PROBIOTICS NOS, CANNABIS SATIVA (CBD COMPLEX), ERGOCALCIFEROL (VITAMIN D2), VITAMIN B COMPLEX and MAGNESIUM for an unknown indication. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 08-Sep-2021, the patient experienced CHOKING (choked on rice), DYSGEUSIA (Metallic taste on mouth), DYSGEUSIA (metallic sensation taste in mouth) and AGEUSIA (Lost her taste). On 10-Sep-2021, the patient experienced SWOLLEN TONGUE (tongue swelled and felt too big for mouth), ABDOMINAL DISCOMFORT (upset stomach), ABDOMINAL PAIN UPPER (Stomach Hurts), TONGUE DISCOLOURATION (Tongue''s light, not the usual color), DIARRHOEA (Diarrhea), CHILLS (Chills) and MYALGIA (Muscles ache). On an unknown date, the patient experienced CARDIAC FLUTTER (rapid heart flutter), FEELING ABNORMAL (felt foggy and dizzy/felt identical to food allergy reactions she has had in past.), THIRST (very thirsty), DYSPHAGIA (trouble swallowing, was choking on rice), THROAT TIGHTNESS (throat closed up felt identical to food allergy reactions she has had), NASAL CONGESTION (stuffy nosy congestion, nose normally runs in AM and did not today), FLUSHING (Flushed face), OROPHARYNGEAL PAIN (sore throat), PAIN IN EXTREMITY (Whole left hand hurts and is stiff), SKIN DISCOMFORT (random pinches in random spots like something biting under skin), PARAESTHESIA ORAL (lips were tingling), DIZZINESS (felt foggy and dizzy), LETHARGY (beyond lethargic), PRURITUS (which was itchy), LIMB DISCOMFORT (limbs feel exaggerated and heavy), MUSCULOSKELETAL STIFFNESS (whole left hand hurts and is stiff), DYSPEPSIA (can feel fine but her digestion is not), HYPERSENSITIVITY (I believe it was allergic reaction), NAUSEA (nausea) and HEADACHE (headache). On 09-Sep-2021, DYSGEUSIA (metallic sensation taste in mouth) and AGEUSIA (Lost her taste) had resolved. At the time of the report, SWOLLEN TONGUE (tongue swelled and felt too big for mouth) had not resolved and CARDIAC FLUTTER (rapid heart flutter), CHOKING (choked on rice), FEELING ABNORMAL (felt foggy and dizzy/felt identical to food allergy reactions she has had in past.), THIRST (very thirsty), DYSPHAGIA (trouble swallowing, was choking on rice), THROAT TIGHTNESS (throat closed up felt identical to food allergy reactions she has had), NASAL CONGESTION (stuffy nosy congestion, nose normally runs in AM and did not today), FLUSHING (Flushed face), OROPHARYNGEAL PAIN (sore throat), PAIN IN EXTREMITY (Whole left hand hurts and is stiff), SKIN DISCOMFORT (random pinches in random spots like something biting under skin), PARAESTHESIA ORAL (lips were tingling), DIZZINESS (felt foggy and dizzy), LETHARGY (beyond lethargic), PRURITUS (which was itchy), LIMB DISCOMFORT (limbs feel exaggerated and heavy), DYSGEUSIA (Metallic taste on mouth), MUSCULOSKELETAL STIFFNESS (whole left hand hurts and is stiff), ABDOMINAL DISCOMFORT (upset stomach), ABDOMINAL PAIN UPPER (Stomach Hurts), TONGUE DISCOLOURATION (Tongue''s light, not the usual color), DYSPEPSIA (can feel fine but her digestion is not), DIARRHOEA (Diarrhea), HYPERSENSITIVITY (I believe it was allergic reaction), CHILLS (Chills), MYALGIA (Muscles ache), NAUSEA (nausea) and HEADACHE (headache) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 08-Sep-2021, Body temperature: high (High) At the time of vaccination patient was having slight fever (99.5).. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter considered THROAT TIGHTNESS (throat closed up felt identical to food allergy reactions she has had) to be possibly related. No further causality assessments were provided for SWOLLEN TONGUE (tongue swelled and felt too big for mouth), CARDIAC FLUTTER (rapid heart flutter), CHOKING (choked on rice), FEELING ABNORMAL (felt foggy and dizzy/felt identical to food allergy reactions she has had in past.), THIRST (very thirsty), DYSPHAGIA (trouble swallowing, was choking on rice), NASAL CONGESTION (stuffy nosy congestion, nose normally runs in AM and did not today), FLUSHING (Flushed face), OROPHARYNGEAL PAIN (sore throat), PAIN IN EXTREMITY (Whole left hand hurts and is stiff), SKIN DISCOMFORT (random pinches in random spots like something biting under skin), PARAESTHESIA ORAL (lips were tingling), DIZZINESS (felt foggy and dizzy), LETHARGY (beyond lethargic), PRURITUS (which was itchy), LIMB DISCOMFORT (limbs feel exaggerated and heavy), DYSGEUSIA (Metallic taste on mouth), MUSCULOSKELETAL STIFFNESS (whole left hand hurts and is stiff), ABDOMINAL DISCOMFORT (upset stomach), ABDOMINAL PAIN UPPER (Stomach Hurts), TONGUE DISCOLOURATION (Tongue''s light, not the usual color), DYSGEUSIA (metallic sensation taste in mouth), DYSPEPSIA (can feel fine but her digestion is not), DIARRHOEA (Diarrhea), AGEUSIA (Lost her taste), HYPERSENSITIVITY (I believe it was allergic reaction), CHILLS (Chills), MYALGIA (Muscles ache), NAUSEA (nausea) and HEADACHE (headache). Concomitant medications reported included Omega supplements. Treatment received was children''s liquid Benadryl, resting, drinking fluids . It was reported that patient had existing things such as poor digestion including POTS. and patient stated that she will not have second dose. Most recent FOLLOW-UP information incorporated above includes: On 10-Sep-2021: Folllow up document received on 14/09/20201 contains narrative updated, events were added. On 14-Sep-2021: Significant follow up received on 14 Sep 2021,event added; Sender''s Comments: This case concerns a 46 year-old, female patient with a history of food allergy and brain injury, who experienced non-serious expected event of hypersensitivity and multiple expected and unexpected non-serious events after receiving the first dose of mRNA-1273 vaccine. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.


VAERS ID: 1722481 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-08-31
Onset:2021-09-08
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FCO3184 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Pain, Pain in extremity
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Intermittent shooting pain in legs, arms, and chest (both sides). The pain mainly persists in my arms. Some days are better than others.


VAERS ID: 1722571 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site hypoaesthesia, Injection site induration, Injection site nodule, Injection site pruritus, Injection site urticaria, Injection site warmth, Lymphadenopathy, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zinc, Vit D, probiotics
Current Illness: N/A
Preexisting Conditions: hsv2
Allergies: Hydroquinone Tide
Diagnostic Lab Data: Did not seek medical care as this is a known side effect
CDC Split Type:

Write-up: Initial numbness surrounding injection site extending from shoulder to elbow. The following day nausea & redness, itching, warmth, and a hard knot at injection site. Persisted for 3 days then subsided. On day 8 itching, hives at the injection site that progressed to large knot, warmth, redness, and continuous itching for 3 inch diameter surrounding injection site. Also swollen lymph node under arm on side of injection. Symptoms improved to just mild, occasional itching to date. Treatment with oral and topical antihistamine and ice pack


VAERS ID: 1722679 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Ear pruritus, Erythema, Feeling hot, Hyperhidrosis, Pruritus
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (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: Glatiramer Injection
Current Illness: no
Preexisting Conditions: CIS
Allergies: Pineapples, Hair dye
Diagnostic Lab Data:
CDC Split Type:

Write-up: Full head itch, ears red and itchy. Hot, sweating and coughing


VAERS ID: 1722723 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-03
Onset:2021-09-08
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 - / IM

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

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

Write-up: Breakthrough case of COVID not resulting in hospitalization


VAERS ID: 1722742 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-25
Onset:2021-09-08
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 - / IM

Administered by: Other       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? 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: Breakthrough COVID 19 infection


VAERS ID: 1722783 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-05
Onset:2021-09-08
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / IM

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

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

Write-up: Accelerated heart rate , pounding hearth rate for several days


VAERS ID: 1722926 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 3 LA / IM

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

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

Write-up: Error, Booster Given Too Early.


VAERS ID: 1723011 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-12
Onset:2021-09-08
   Days after vaccination:208
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9269 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Blood gases abnormal, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Cough, Dyspnoea, Headache, Hypoxia, Lung consolidation, Nausea, Pneumonia, SARS-CoV-2 test positive, Sputum discoloured
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Lactic acidosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin, calcium with vitaminD, levothyroxine, lisinopril-hydrochlorothiazide, meclizine, propranolol
Current Illness:
Preexisting Conditions: obesity, hypertension, hypothyroidism, history of being at increased risk of breast cancer being followed by oncologist as an outpatient on Aromasin
Allergies: bactrim, doxy, statins
Diagnostic Lab Data: 9/8/21 COVID19: Positive 9/16/21 Chest xray: Patchy bilateral airspace disease most consistent with COVID-19 pneumonia. 9/16/21 CTA chest: Multifocal bilateral consolidation most consistent with COVID-19 pneumonia.
CDC Split Type:

Write-up: Since 9/8/2021, she has been having some problems with cough, shortness of breath, and headache. She thought she had a sinus infection. She went to see her primary care physician and was tested positive for COVID-19. She was sent over to ER for Regeneron transfusion on 9/16/21. However, the patient was found to be quite hypoxemic with ABG showing a pO2 of only 54.8 on room air. The patient was then started on Decadron and since the CTA of the chest showed bilateral consolidation, she was started on Rocephin and Zithromax and then the Hospitalist Service was called for admission. When I saw the patient, she was saturating 93% to 94% on 2 L nasal cannula. Her main complaint is her cough right now. She does not feel short of breath at this point of time. No chest pain. Mild nausea, but no vomiting. No diarrhea. No loss of taste or smell. Says she lives alone. Admitted on 9/16/21 as an inpatient. Continued Decadron on her. Started her on remdesivir as well. Put her on oxygen. Started her on vitamin C and vitamin D as well. For the Bilateral pneumonia, gave her Rocephin and Zithromax. Patient says occasionally she is able to bring up a sputum, mostly it is clear, but sometimes slightly yellow ting as well, but no epistaxis, no hemoptysis. On 9/21/21 patient''s symptoms resolved. REquires 1L NC with exertion. Discharged on 9/22/21 with 5 more days of azithromycin and cephalexin.


VAERS ID: 1723054 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-01-20
Onset:2021-09-08
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 - / IM

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

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

Write-up: Breakthrough infection after COVID 19 vaccination that didn''t require hospitalization


VAERS ID: 1723061 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-01-15
Onset:2021-09-08
   Days after vaccination:236
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 - / -

Administered by: Other       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough COVID 19 infection not requiring hospitalization


VAERS ID: 1723071 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-19
Onset:2021-09-08
   Days after vaccination:232
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 - / -

Administered by: Other       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough COVID 19 infection not requiring hospitalization


VAERS ID: 1723083 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-06
Onset:2021-09-08
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 - / -

Administered by: Other       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough COVID 19 infection not requiring hospitaliation


VAERS ID: 1723111 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-26
Onset:2021-09-08
   Days after vaccination:225
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 - / -

Administered by: Other       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough COVID 19 vaccine not requiring hospitalization


VAERS ID: 1723117 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-15
Onset:2021-09-08
   Days after vaccination:236
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 - / -

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

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

Write-up: Breakthrough COVID 19 infection not requiring hospitalization


VAERS ID: 1723180 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-02
Onset:2021-09-08
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Lip swelling, Peripheral swelling, Rash, Swelling, Swelling face, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Discussed with the patient and she states none
Current Illness: Discussed with the patient and she states none
Preexisting Conditions: Discussed with the patient and she states none
Allergies: Discussed with the patient and she states none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash and swelling on and off since she received her first dose of the vaccination against SARS-CoV2 virus on Sept 2. The patient states that starting on Sept 9th, the patient had swelling of her lips which resolved the following day, then over the next 2 weeks she experienced swelling throughout different parts of her body such as her right foot, right hand, one of her fingers, her face, and she also developed hives and large welts on her hips. At no time did she have difficulty breathing or swallowing and has not felt that her tongue has been swollen. Has never had a reaction to vaccinations or anything in the past. She is not taking any medications or over the counter vitamins or supplements. Currently treating with antihistamines and prednisone


VAERS ID: 1723186 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure decreased, Extra dose administered, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Medication errors (narrow), Dehydration (broad)

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

Write-up: nose runs all the time blood pressure actually lower than before Note, this was a booster shot


VAERS ID: 1723192 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Condition aggravated, Hypersensitivity, Stridor, Vocal cord disorder, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ALBUTEROL MULTI DOSE INHALER EPI-PEN (PRN) ANXITY MEDICIATONS (UNSURE OF NAMES)
Current Illness: VOCAL CORD DISORDER ANXIETY DISORDER ASTHMA
Preexisting Conditions: ANXIETY ASTHMA VOCAL CORD DISORDER
Allergies: MAYBE ALLERGIC TO EGGS (PATIENT STATED AFTER RECEIVING COVID-VACCINATION)
Diagnostic Lab Data: PATIENT SPENT 1 DAY IN HOSPITAL; PATIENT WAS DISCHARGED 9/9/2021@12:14 FROM THE HOSPITAL SYSTEM. PATIENT VISITIED PHARMACY AND TOLD US SHE WAS OK AND FEELING WELL. PATIENT SHOWED BOTH PHARMACISTS ON DUTY AND STORE MANAGER HER DISCHARGE PAPERS. HER DIAGNOSES: ALLERGIC REACTION, STRIDOR, VOCAL CORD DYSFUNCTION, ANXIETY. TEMPRATURE ORAL 37.1DEGREES C, HEART RATE: 123 MONITORED; HEART RATE, PERIPHERAL:121, BLOOD PRESSURE: 105/64
CDC Split Type:

Write-up: APPROXIMATELY 5 MINUTES POST VACCINE ADMINISTRATION, PATIENT REPORTED TO FRONT COUNTER WITH WHEEZING. BOTH PHARMACISTS ON DUTY ADVISED PATIENT TO WALK TO IMMUNIZATION ROOM. PATIENT ADVISED SHE IS ASTHMATIC AND SUFFERS FROM CHRONIC ANXIETY. PHARMACIST ASKED PATIENT IF SHE THOUGHT SHE WAS HAVING AN ANXIETY ATTACK, PATIENT WAS UNSURE. PHARMACIST ASKED IF SHE FELT LIKE SHE WAS HAVING AN ASTHMA ATTACK, PATIENT SELF ADMINISTERED 2 ORAL PUFFS OF ALBUTEROL MULTI DOSE INHALER. AFTER A FEW MINUTES, PATIENT SAID SHE MAYBE HAVING AN ANAPHYLACTIC REACTION AND SELF ADMINISTERED 2 DOSES OF EPI-PEN 5 MINUTES APART. AFTER EMERGENCY PERSONNEL ARRIVED, THEY CHECKED PATIENT''S OXYGEN ( PER EMT, OXYGEN WAS NEAR 100%), EMT ADVISED PATIENT TO SLOW HER BREATHING AND OPEN HER EYES, PATIENT RESPONDED POSITIVELY. EMT ASKED PATIENT ABOUT ALLERGIES, PATIENT ADVISED SHE MAY BE ALLERGIC TO EGGS. PATIENT WAS TAKEN BY EMT AND TRANSPORTED TO LOCAL HOSPITAL.


VAERS ID: 1723194 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-15
Onset:2021-09-08
   Days after vaccination:236
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 - / -

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

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

Write-up: COVID 19 Breakthrough infection not requiring hospitalization


VAERS ID: 1723198 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-06
Onset:2021-09-08
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Breakthrough COVID 19 infection not requiring hospitalization


VAERS ID: 1723221 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-20
Onset:2021-09-08
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Breakthrough COVID 19 infection not requiring hospitalization


VAERS ID: 1723232 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-25
Onset:2021-09-08
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Breakthrough COVID 19 infection not requiring hospitalization


VAERS ID: 1723245 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-25
Onset:2021-09-08
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Tinnitus, Vertigo
SMQs:, Hearing impairment (narrow), Vestibular disorders (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: I had the mumps vaccine as a child and then got the mumps.
Other Medications: Multi Vitamin Omega 3 Vitamin C Vitamin D Lexapro
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: I visited doctor at ENT on Monday, September 22nd for the Epley treatment, which resolved the vertigo by 72 hours after treatment. I have had a couple of "ringing in the ear" episodes that only last for a minute or two.
CDC Split Type:

Write-up: On September 8, 2021, I woke up with vertigo. I''ve never had vertigo before.


VAERS ID: 1723253 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-19
Onset:2021-09-08
   Days after vaccination:232
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Breakthrough COVID 19 infection not requiring hospitalization


VAERS ID: 1723278 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-17
Onset:2021-09-08
   Days after vaccination:83
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 2 - / -

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

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

Write-up: Breakthrough COVID 19 infection not requiring hospitalization


VAERS ID: 1723279 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Dose given from vial opened/punctured on 09/01/2021. Vial not discarded after the recommended 12 hours after puncture. Dose given on 09/08 from previously punctured vial. Vial kept in refrigerator at appropriate temperature with no temperature excursions. Reported to Moderna.


VAERS ID: 1723284 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-20
Onset:2021-09-08
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 - / -

Administered by: Other       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough COVID 19 infection not requiring hospitalization


VAERS ID: 1723350 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-06-09
Onset:2021-09-08
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 2 - / -

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

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

Write-up: Breakthrough COVID-19 infection not requiring hospitalization.


VAERS ID: 1723406 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-20
Onset:2021-09-08
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Chest discomfort, Chills, Condition aggravated, Cough, Dizziness, Ear pain, Fatigue, Feeling abnormal, Head discomfort, Illness, Influenza, Inhalation therapy, Nasal congestion, Oropharyngeal pain, Pyrexia, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive, Sinusitis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Blood Pressure Medicine; Estrogen; Vit D3 and B12 and a regular multivitamin; Tylenol and Ibuprofen as needed (but I only took Tylenol that day). Allergy shots - monthly (for cats and mold)
Current Illness: no
Preexisting Conditions: Arthritis in my back and hands; 20 lbs overweight
Allergies: Sulfa drugs
Diagnostic Lab Data: COVID test - on the 7th - before I actually had the symptoms.
CDC Split Type: vsafe

Write-up: My 11 year old brought it home from school. Four days later my husband and I were sick. I was fine when I tested for COVID on the 7th and had a positive result. I am still feeling a little bit - on the 8th, I felt extremely tired and dizzy. That Saturday - low grade temperature 99.8 and a little bit of chills and coughing and sore throat and lots of snot and congestion. The highest the fever got was 100.8 or .9 for three days. The chills were awful. Sore throat and ear aches and extreme congestion in my head that went down to my chest. My oxygen stayed above 96 - never dropped real low. My blood pressure was always fine. I didn''t need my rescue inhaler until later on. I didn''t feel a whole lot of chest tightness until when I started feeling a bit better. It felt like a bad case of flu. As I got better for 16th and 17th. I taught online the entire week that I was sick - I was seriously sick and fever broke Tuesday morning early finally. I started feeling better The following Saturday, the 18th, I started feeling bad again - my head started feeling bad again. Doctor didn''t put me on anything until I felt sick again and then he put me on Prednisone (one course - that I finished yesterday)- it had gone into a sinus infection. I get those - because my sinuses rest on my upper jaw bone. They are real lift. I had one side lifted because I had to get a tube replacement (in the past.) I am just now getting over the congestion today but I''m still coughing. I had to do my rescue inhaler finally the past couple of days. I went back to work in person on Monday. My 10th day out of the building was 17th - my last isolation day. I have to talk loud and through a mask at work - so I''m using a lot of oxygen doing that and that might contribute me to using my inhaler now - have only needed it use it only once a day. I am recovering slowly. Note: I had a sinus infection - prior to this but about three months after the vaccination. But I didn''t get bronchitis with it.


VAERS ID: 1723555 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Pruritus, Rash, Skin laceration, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prednisone
Current Illness: Poison ivy rash
Preexisting Conditions: None
Allergies: Allegra-severe, debilitating joint pain
Diagnostic Lab Data: None, because I don''t have time to actually go to a doctor and can only telehealth.
CDC Split Type:

Write-up: Broke out in full body rash. Severely itchy to where I couldn''t sleep at night and was tearing my skin open itching. Totally unbearable. Had to telehealth a doctor on saturday, 3 days later because I hadn''t slept and could not stoSaturday, and my skin was opening due to this. Was told by the MD that it was a reaction to the covid vaccine and that I would need a prednisone burst of 40mg for 5 days. I completed that and I still have "growths" under my skin that have not gone away and continue to itch. The itch has never gone away and I''m still tearing my skin open because of this on a daily basis.


VAERS ID: 1723838 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Chest pain, Dizziness, Myositis, Pain in extremity, Paraesthesia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Lightheadedness, fever, chest pain, tingling hands, leg pain, weakness, inflammation in muscles all over body. Started immediately after the shot


VAERS ID: 1724473 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysmenorrhoea, Heavy menstrual bleeding, Thrombosis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

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

Write-up: 15 plus days of heavy vaginal bleeding 1 day after 2nd dose of Pfizer vaccine. Experiencing large blood clots and cramping throughout period. Never had a period this long with this amount of blood and clotting.


VAERS ID: 1725300 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
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 30-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). At the time of the report, 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. All of the patients were administered with the 1st dose, 0.5ml, intramuscular on the left deltoid. Lot number 032N20A, expiration date 27Aug2021. This case is for the 3rd patient. No concomitant medications reported. No treatment reported. This case was linked to MOD21-141642, MOD21-141643, MOD21-141644, MOD21-141645, MOD21-141646, MOD21-141586, MOD21-141427, MOD21-141647, MOD-2021-314573, MOD-2021-314570, MOD-2021-314517, MOD-2021-314545, MOD-2021-314555, MOD-2021-314793, MOD-2021-314805, MOD-2021-314793 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 15-Sep-2021: Follow-up received on 15-SEP-2021 contains no new information. On 15-Sep-2021: Follow-up received on 15-SEP-2021 contains no new information.


VAERS ID: 1725472 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Hypoaesthesia, Muscular weakness, Myalgia, Neuropathy peripheral, Pain, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (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: ASPIRIN 81; COQ10 [ASCORBIC ACID;BETACAROTENE;CUPRIC OXIDE;MANGANESE SULFATE;SELENIUM;TOCOPHERYL ACETATE;UBIDECA; DHEA
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hernia repair; Neuropathy; Sciatica; Vertebral hernia
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101175708

Write-up: numbness; tingling; pain; neuropathy in both hands and both feet; Joint pain; muscle soreness; mild weakness in hands and feet; This is a spontaneous report from a contactable other healthcare professional (patient). A 43-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; Batch/Lot number was not reported) via an unspecified route of administration, administered into left arm on 07Sep2021 11:15 (at the age of 43-year-old) as dose 2, single for COVID-19 immunisation. Medical history included L4-5 spinal hernia, removal of L4-5 spinal hernia on Dec2019, sciatica and neuropathy on L leg due to spinal hernia. Patient was not pregnant. Concomitant medications included acetylsalicylic acid (ASPIRIN 81); ascorbic acid, betacarotene, cupric oxide, manganese sulfate, selenium, tocopheryl acetate, ubidecarenone, zinc oxide (COQ10), dhea (DHEA) and unspecified prenatal vitamins. Historical vaccine includes first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; Batch/Lot number was not reported) administered into left arm on 17Aug2021 11:45 AM (at the age of 43-year-old) for COVID-19 immunisation. On 08Sep2021 03:00 patient experienced neuropathy in both hands and both feet, joint pain, muscle soreness and mild weakness in hands and feet. On 08Sep2021 15:00 patient experienced numbness, tingling and pain. Patient did not receive treatment for the events reported. Outcome of events was recovered with sequelae. The lot number for the vaccine, BNT162B2, was not provided and will be requested during follow up.; Sender''s Comments: Based on the reported information, the causal association between the event neuropathy peripheral and the suspect drug BNT162B2 cannot be excluded. The case will be reassessed once new information is available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.


VAERS ID: 1725479 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Bradykinesia, Dizziness, Fall, Feeling abnormal, Injury, Loss of consciousness, Malaise
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), Dementia (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? 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 INC202101176656

Write-up: passed out/hit the ground; felt weird/loopy; injured himself in the fall; injured himself in the fall; feeling lightheaded; walking really slow; didn''t look like he felt well.; This is a spontaneous report received from a contactable pharmacist via a Pfizer-sponsored program. A 21-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE Solution for injection), via an unspecified route of administration, on 08Sep2021 11:45 (Batch/lot number: FF2588; Expiration date: Dec2021; NDC number: 59267-1000-1), at age 21 years old, as dose 2, 0.3 ml single, for COVID-19 immunisation. Relevant medical history was reported as none. Concomitant medications were not reported. On 08Sep2021 at 11:50, 5 minutes after the second vaccination, the patient felt weird, stood up to get attention and then passed out and hit the ground. The patient was alert and fine but injured himself in the fall, the pharmacist stated that it had nothing to do with the vaccine itself. The patient was feeling lightheaded, looked a little loopy and was walking really slow. The patient did not look like he felt well. The patient had to be rushed to the hospital. The events resulted to hospitalization. It was reported that the patient fainted or passed out before and nothing like this, this was new to him. The outcome of the events was unknown. The reporting pharmacist stated that the events were serious.; Sender''s Comments: Based on plausible dose- event relationship post-vaccination and no alternate explanation the causal role of BNT162B2 vaccine cannot be excluded for the reported events The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate


VAERS ID: 1725517 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Work       Purchased by: ?
Symptoms: Anaphylactic reaction, Erythema, Feeling hot, Headache, Peripheral swelling, Swelling, Swelling face, Vomiting
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101182904

Write-up: Turned completely red.; Hot.; Started swelling in the face, neck and arms.; Started swelling in the face, neck and arms.; Started swelling in the face, neck and arms; Started vomiting; Severe headache.; Rushed to ER for suspected anaphylactic reaction.; This is a spontaneous report from a contactable Nurse (patient). A 27-years-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), dose 2 via an unspecified route of administration, administered in Arm Left on 08Sep2021 15:15 (Batch/Lot number was not reported) age at vaccination of 27-years-old, as single dose, for covid-19 immunisation. Medical history included hypothyroidism from an unknown date and unknown if ongoing. The patient was not pregnant and was not pregnant at the time of vaccination. The patient had no allergy. The patient received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), dose 1 via an unspecified route of administration, administered in Right arm on 18Aug2021 15:00 (Batch/Lot number was not reported), age at vaccination of 27-years-old, as single dose, for covid-19 immunisation. There were no concomitant medications. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. On 08Sep2021 (15:30), the patient turned completely red, hot, started swelling in the face, neck and arms, started vomiting and had severe headache; she rushed to ER for suspected anaphylactic reaction. The events resulted in emergency room/department or urgent care; medication and fluids were given as treatments of the events. Facility type vaccine: Workplace clinic. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient has not been tested for COVID-19. The patient was recovering from the events. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Based on the reported information ,a causal relationship between the events and suspected drug cannot be excluded.


VAERS ID: 1725536 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Eating disorder, Electrocardiogram, Inflammation, Oesophagitis, Pain
SMQs:, Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19; Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data: Test Name: chest xRay; Result Unstructured Data: Test Result:UNKNOWN; Test Name: ECG,; Result Unstructured Data: Test Result:UNKNOWN
CDC Split Type: USPFIZER INC202101198154

Write-up: Chest pain, inability to eat food.; Chest pain, inability to eat food.; Very painful to drink any fluid; Inflammation of the esophagus, esophagitis,; Inflammation of the esophagus, esophagitis,; This is a spontaneous report from a contactable consumer. This 13-Year-old male contactable consumer reported for himself. A 13-years-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; solution for injection, Lot Number: FC3184), dose 1 via an unspecified route of administration, administered in Arm Right on 07Sep2021 16:00 (at the age of 13-years-old) as a single dose for covid-19 immunization. Medical history included covid-19. There were no concomitant medications. The patient had no other vaccine within four weeks. Prior to the vaccination, the patient was diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. On 08Sep2021 16:00, the patient experienced chest pain, inability to eat food. Very painful to drink any fluid. Inflammation of the esophagus, esophagitis, hospitalization, ER, pediatric GI. The adverse event resulted in doctor or other healthcare professional office/clinic visit, emergency room /department or urgent care. The patient recevied treatment with ECG, chest X-Ray, ER monitoring, pediatric GI. Outcome of the event was not recovered. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1725555 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-14
Onset:2021-09-08
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HUMIRA
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Rheumatoid arthritis
Allergies:
Diagnostic Lab Data: Test Date: 20210731; Test Name: Antigen COVID-19; Test Result: Negative ; Comments: Nasal Swab; Test Date: 20210806; Test Name: Antigen COVID-19; Test Result: Negative ; Comments: Nasal Swab; Test Date: 20201222; Test Name: COVID-19; Test Result: Negative ; Comments: Nasal Swab; Test Date: 20210831; Test Name: qRT-PCR COVID-19; Test Result: Negative ; Comments: Nasal Swab; Test Date: 20210907; Test Name: COVID-19; Test Result: Positive ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC202101219089

Write-up: Breakthrough infection with COVID-19; Breakthrough infection with COVID-19; This is a spontaneous report from a non-contactable consumer or other no-health care professional. An adult female (non-pregnant at the time of vaccination) patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: solution for injection; Batch no: not reported/Lot Number: EP6955) via an unspecified route of administration, administered in Arm Left on 24Mar2021 as dose 1, single and bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: solution for injection; Batch no: not reported/Lot Number: EP9655) via an unspecified route of administration, administered in Arm Left on 14Apr2021 as dose 2, single for covid-19 immunization at Workplace clinic. The patient had medical history of Rheumatoid arthritis from an un-known date and unknown if ongoing. Concomitant medication included other medications the patient received within 2 weeks of vaccination as adalimumab (HUMIRA) taken for an unspecified indication, start and stop date were not reported. Patient did not receive other vaccines within 4 weeks prior to the COVID vaccine. Prior to vaccination, the patient was not diagnosed with COVID-19. Since vaccination patient had been tested for COVID-19. On 08Sep2021, the patient had breakthrough infection with COVID-19 along with vaccination failure. Timeframe between vaccination and starting of symptoms was 5 months 15 days. On 22Dec2020, the patient under-went lab tests and procedures which included Sars-cov-2 test Covid-19 with Nasal swab results negative, on 31Jul2021 patient had Nasal swab with Antigen Covid-19 results negative, on 06Aug2021 patient had Nasal swab with Antigen Covid-19 results negative, on 31Aug2021 patient had Covid-19 with Nasal swab results negative and on 07Sep2021, Covid-19 with Nasal swab results Positive. Patient did not receive any treatment for the event caused. Outcome of the events was recovering.


VAERS ID: 1725644 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Body temperature increased, Chest pain, Cold sweat, Dizziness, Heart rate increased, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FEXOFENADINE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy to animal (Known allergy: cats, dogs); Dust allergy (Known allergy: dust); Fruit allergy (Known allergy: Oranges and mulberry); Pollen allergy (Known allergy: birch, ragweed, oak, elm); Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101240582

Write-up: Chest pain; Increased heart rate; Blurred/dark vision; Light headedness; Weakness; Increased temperature; Cold sweats; This is a spontaneous report from a 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: UNKNOWN) via an unspecified route of administration in the left arm on 07Sep2021 at 14:45 (at the age of 36-years-old) as a single dose for COVID-19 immunisation. Medical history was reported as not applicable and the patient''s had allergies to oranges, dust, birch, elm, mulberry, ragweed, oak, cats, dogs. 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 fexofenadine (MANUFACTURER UNKNOWN) for an unknown indication from an unknown start date and unknown if ongoing. On 08Sep2021 at 21:30, the patient experienced chest pain, increased heart rate, blurred/dark vision, light headedness, weakness, increased temperature followed by cold sweats. The events did not result in doctor or other healthcare professional office/clinic visit, and 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 events chest pain, increased heart rate, blurred/dark vision, light headedness, weakness, increased temperature and cold sweats was unknown at the time of reporting. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1726419 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-30
Onset:2021-09-08
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Chest pain, Chills, Cough, Dyspnoea, Fatigue, Headache, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension, Cardiovascular disease
Allergies:
Diagnostic Lab Data: Tested positive for Covid on 09/12/2021
CDC Split Type:

Write-up: Pt developed fever (99.5), sore throat, chills, cough, loss of taste and smell, headache, fatigue, shortness of breath and chest pain on 09/08/2021.


VAERS ID: 1726473 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-24
Onset:2021-09-08
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstrual disorder
SMQs:

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

Write-up: Period after COVID vaccine was very light and then passed large blot clot. This has never happened before and I have regular periods.


VAERS ID: 1726781 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 RA / IM

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

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

Write-up: NONE: PROVIDED EXPIRED VACCINE (EXPIRED 2 DAYS PRIOR); DETERMINING IF PATIENT NEEDS TO BE REDOSED OR NOT.


VAERS ID: 1726817 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 2 - / IM

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

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

Write-up: Patient received 1st Moderna vaccine on 8/11/2021 at 16 years and 10 months. Patient stated she was 18 and born in 2001. After completing A VAERS report was completed at this time for the first dose. Patient returned on 8/11/2021 for second vaccine. Our translator was present and explained to the father and patient in their language the recommendation from CDC to receive 2nd dose. They both expressed understanding and had no further questions. Patient was given vaccine and had no reaction while waiting the required time.


VAERS ID: 1726996 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-19
Onset:2021-09-08
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 03457 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Blood test, Cardiomyopathy acute, Dyspnoea, Echocardiogram, Ejection fraction decreased, Endotracheal intubation, Hypoxia, Illness, Lung infiltration, Lung opacity, Lymphadenopathy, Respiratory failure, Therapy non-responder, Ultrasound Doppler
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Lack of efficacy/effect (narrow), Interstitial lung disease (narrow), 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), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol
Current Illness: reportedly none
Preexisting Conditions: COPD secondary to wood stove cooking
Allergies: none
Diagnostic Lab Data: CT angio chest 9/8 echocardiogram 9/13 LE venous doppler 9/13 several blood tests throughout course of illness
CDC Split Type:

Write-up: on date of admission, patient awakened very short of breath, found to be hypoxemic and intubated for respiratory failure. Since 9/8 patient has remained severely hypoxemic and intubated. She was discovered to have an acute cardiomyopathy, EF 10%. A CT angio of the chest on admission showed extensive b/l infiltrates, some ground glass, scattered nodules, adenopathy and no pulmonary embolism. An infectious or inflammatory source has not been identified. Condition has not responded to steroids, antibiotics or diuresis. She does not have active covid-19 infection either


VAERS ID: 1727184 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia
SMQs:, Arthritis (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: Allopurinol, Metformiin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Joint pain lasting more than 2 weeks now. Hurt all the time more when using.


VAERS ID: 1727250 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dyspnoea, Dysstasia, Fatigue, Injection site erythema, Injection site mass, Injection site pruritus, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (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)

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: ?Nexplanon(Etonogestrel) 68 MG Implant Subcutaneous ?Albuterol Sulfate HFA 108 (90 Base) MCG/ACT Aerosol Solution 2 puffs as needed Inhalation every 4 hrs as needed for coughing, wheezing, Notes: prn ?Ibuprofen 800 MG Tablet 1 tablet with
Current Illness: none
Preexisting Conditions: Allergic rhinitis, unspecified seasonality, unspecified trigger Asthma, unspecified asthma severity, unspecified whether complicated, unspecified whether persistent Morbid (severe) obesity due to excess calories Body mass index (BMI) of 40.0-44.9 in adult Chiari malformation type I Abnormal weight gain Tinnitus of right ear
Allergies: artifical cinnamine: throat burn and rash around mouth
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient notes that on 9/8 she had her first dose of Pfizer COVID vaccine. Two hours later she felt totally drained and it lasted 48 hours. She couldn''t stand up for long periods because she was exhausted. Within the first 4 hours she had brief heart racing that lasted for 30 minutes off and on and then it resolved and hasn''t returned. The patient states she started with SOB right after the vaccine and this has persisted. She has a history of asthma that is controlled except for seasonal changes. The SOB is sometimes at rest, but mostly with exertion. Going up stairs she feels SOB. The first week after the vaccine she was having to use her albuterol inhaler. She is not having to use the inhaler as much now. She last used the inhaler on Friday. No wheezing or coughing. She hasn''t noticed any change in her allergies since before the vaccine. She also notes she has R upper arm itching and heat where she had the injection. She had a lump in her R upper arm a few days ago along with redness. She took benadryl.


VAERS ID: 1727328 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

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

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

Write-up: "Moderna COVID-19 Vaccine EUA"


VAERS ID: 1727468 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E2114 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site mass, Injection site rash, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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 vaccination, patient''s arm had a small knot at injection site. The knot turned into a small, red rash. The red rash is now a pinkish color and is approximately the size of a softball (5.5 inches by 3 inches).


VAERS ID: 1728767 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Fatigue, Feeling abnormal, Tinnitus
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hearing impairment (narrow), Vestibular disorders (broad)

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

Write-up: Shortness of breath, fatigue, dizziness, ringing in ear, fogged thinking. Shortness of breath, dizziness are not getting better.


VAERS ID: 1729304 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-23
Onset:2021-09-08
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 UN / UN

Administered by: Public       Purchased by: ?
Symptoms: COVID-19 pneumonia
SMQs:, 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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted for COVID pneumonia. Vaccinated August 2021


VAERS ID: 1730204 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Ohio  
Vaccinated:0000-00-00
Onset:2021-09-08
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Menstruation delayed, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Fertility 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: TRI-SPRINTEC
Current Illness:
Preexisting Conditions: Comments: Patient had no change in lifestyle or medications.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210944169

Write-up: DELAYED MENSTRUAL CYCLE; TIRED; BODY SORENESS; FEVER; This spontaneous report received from a patient concerned a 19 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: Patient had no change in lifestyle or medications. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 201A21A and expiry: 21-SEP-2021) dose was not reported, administered on 08-SEP-2021 for prophylactic vaccination. Concomitant medications included ethinylestradiol/norgestimate. On 08-SEP-2021, the patient experienced body soreness. On 08-SEP-2021, the patient experienced fever. On 09-SEP-2021, the patient experienced tired. On 21-SEP-2021, the patient experienced delayed menstrual cycle. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from body soreness, and fever on 09-SEP-2021, and had not recovered from tired, and delayed menstrual cycle. This report was non-serious.


VAERS ID: 1730429 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-01
Onset:2021-09-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Computerised tomogram, Dyspnoea, Pulmonary embolism, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: LIALDA; MERCAPTOPURINE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Crohn''s disease
Allergies:
Diagnostic Lab Data: Test Date: 20210908; Test Name: CT scan; Result Unstructured Data: Test Result:pulmonary embolism; Comments: CT scan showed a pulmonary embolism in my left lung.; Test Date: 20210908; Test Name: Nasal Swab; Test Result: Negative
CDC Split Type: USPFIZER INC202101189831

Write-up: chest pain on left side; shortness of breath; left shoulder pain; showed a pulmonary embolism in my left lung; This is a spontaneous report from a contactable consumer (patient). A 30-year-old female patient (non-pregnant) received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot Number: EW0172), via an unspecified route of administration at the age of 30-year-old administered in arm left on 01Sep2021 13:00 at single dose for covid-19 immunisation. Medical history included crohn''s disease. There was no covid prior vaccination and no known allergies. Concomitant medications included mesalazine (LIALDA); mercaptopurine in two weeks. There was no other vaccine in four weeks. The patient previously received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot Number: EW0172) at the age of 30-year-old administered in arm left on 11Aug2021,01:00 PM for covid-19 immunisation. Woke up at 3am 08Sep2021 with chest pain on left side, shortness of breath and left shoulder pain. Went to (name) ER in (place name), a CT scan showed a pulmonary embolism in her left lung. She was admitted to hospital and put on blood thinners and pain meds. The events were resulted in Emergency room/department or urgent care and hospitalization. Days hospitalization was reported as one. The patient underwent lab tests included Nasal Swab: negative on 08Sep2021. The patient was treatment with Heparin, Morphine, Fetanol, Torodol. The outcome of events was recovering. No follow-up attempts are needed. No further information is expected.


VAERS ID: 1730436 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Chills, Decreased appetite, Diarrhoea, Disturbance in attention, Headache, Influenza like illness, Malaise, Mental impairment, Nausea, Somnolence, Thirst, Vaccination site pain
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (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), Arthritis (broad), Noninfectious diarrhoea (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Acid reflux (esophageal); Allergy; Asthma; Rheumatoid arthritis
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101190840

Write-up: Difficulty thinking/concentrating/Caller states that she can''t think straight, she is feeling spacy, like not focused; Difficulty thinking/concentrating/feeling spacey like she isn''t focused; Flu like symptoms; Chills; Pain in joints; Nausea; Diarrhea; No appetite; Headaches; Extremely thirsty; Very sleepy; Feeling Sick; Feels Flu Like Symptoms; Not Been Feeling Well; Pain at the injection site/Left Arm Pain; feels tight like when she has a cyst and it is about to pop and it feels a little bit hot and tender to the touch; This is a spontaneous report received from a contactable consumer (patient). A 44-year-old female patient received second dose of BNT162B2 (lot number: FE3592) on 08Sep2021 14:00 (at age of 44-year-old) on left arm at single dose for COVID-19 immunization. Medical history included Asthma, Allergies, Rheumatoid Arthritis and Acid Reflex. Heart Problems in Mom and Pacemaker. Concomitant medications were none. Historical vaccine included first does of BNT162B2 on 09Aug2021 (at age of 44-year-old, lot number: EW0185) for COVID-19 Immunization. Vaccination Facility Type was Other, At her employer. Vaccine Administered at Military Facility was No. Additional Vaccines Administered on Same Date of the Pfizer Suspect was None. Patient is now experiencing flu like symptoms such as chills, pain in joints, nausea, diarrhea, no appetite, headaches, extremely thirsty, very sleepy, pain at the injection site, difficulty thinking/concentrating, and feeling spacey like she isn''t focused. She is still experiencing them. Caller states she has asthma and allergies, RA, and acid reflux, and has not been to the doctor or ER. Caller states she has been feeling sick since the day she got the shot, well she didn''t get sick until the next day. Caller states she has not been feeling well, and she was told if she still feels sick to call this hotline to see if these are side effects from shot. Caller clarifies she feels flu like symptoms of chills, pain in her joints, nausea, diarrhea, she has no appetite, headaches, she is extremely sleepy, and very thirsty. Caller states she had pain on her left arm that night before she went to sleep. Caller states the arm pain is ongoing, it feels tight like when she has a cyst and it is about to pop and it feels a little bit hot and tender to the touch. Caller states her husband had to wake her up to eat soups and tea and then she ends up with diarrhea. Caller states her side effects are ongoing. but they come and go. Caller states the diarrhea keeps happening every time she eats. Caller states she is afraid to eat because she doesn''t want to go to the bathroom, even water causes her to have diarrhea because she has nothing in her stomach. Caller states that she can''t think straight, she is feeling spacy, like not focused. Caller states it is off an on. Caller states she like has to force herself to stay focused. Treatment: Tylenol and Water with Electrolytes, Gatorade. The events Arm Pain occurred in Evening. Event Flu Like Symptoms occurred in Morning. Events not result in Emergency Room or Physician Office. Prior Vaccinations (within 4 weeks) was None. AE(s) following prior vaccinations was None. Patient had Left Arm Pain; feels tight like when she has a cyst and it is about to pop and it feels a little bit hot and tender to the touch on 08Sep2021. Other events occurred on 09Sep2021. The outcome of the events was not recovered.


VAERS ID: 1730440 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101191086

Write-up: passed out; convulse; dizziness; This is a spontaneous case from a contactable consumer (patient). A 16-year-old male patient received BNT162B2 (COMIRNATY), dose 1 via unspecified route in arm left on 07Sep2021 at 14:30 PM at patient age of 16-year-old, as single dose for COVID-19 immunisation. Medical history included COVID prior vaccination. No other medical history. The patient had no known allergies. The patient did not receive any medication within 2 weeks of vaccination. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. On 08Sep2021 at 12:30 PM, it started with dizziness, then the patient passed out and when he fell to the ground he began to convulse. The event resulted in doctor or other healthcare professional office/clinic visit. The patient received ibuprofen as treatment. Since the vaccination, the patient has not been tested for COVID-19. The outcome of the events was recovered. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.


VAERS ID: 1730751 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-09
Onset:2021-09-08
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003F21A / 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: Not receiving 2nd dose on time; This spontaneous case was reported by a consumer and describes the occurrence of PRODUCT DOSE OMISSION ISSUE (Not receiving 2nd dose on time) in a 50-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 003f21a) for COVID-19 vaccination. 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 08-Sep-2021, the patient experienced PRODUCT DOSE OMISSION ISSUE (Not receiving 2nd dose on time). On 08-Sep-2021, PRODUCT DOSE OMISSION ISSUE (Not receiving 2nd dose on time) had resolved. No concomitant medication reported. No treatment information was provided. The patient missed to attend the second dose appointment on 08-Sep-2021.


VAERS ID: 1730944 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-09-08
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

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

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

Write-up: several health conditions; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION COMPLICATION (several health conditions) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Diabetes and COPD. Concomitant products included BUDESONIDE for an unknown indication. On an unknown date, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 08-Sep-2021, the patient experienced VACCINATION COMPLICATION (several health conditions). At the time of the report, VACCINATION COMPLICATION (several health conditions) outcome was unknown. No treatment medication was mentioned.


VAERS ID: 1730965 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNK / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Joint swelling, Rash
SMQs:, Anaphylactic reaction (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Arm rash following pneumococcal vaccine
Other Medications: Levothyroxine, Metformin, Meloxicam, Atorvastatin
Current Illness:
Preexisting Conditions: Meniere''s Disease, Sjogren''s Syndrome T2 Diabetes, high cholesterol
Allergies: Allergic to Bactrim
Diagnostic Lab Data:
CDC Split Type:

Write-up: Intense joint swelling, most significant at knees and elbows with some involvement of the wrists, ankles, and fingers. Arm rash that spread to upper left chest


VAERS ID: 1731244 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 1 RA / IM

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

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

Write-up: PATIENT WAS PROVIDED WITH AN EXPIRED VACCINE (2 DAY POST EXPIRATION); NO EFFECTS ?Moderna COVID-19 Vaccine EUA?


VAERS ID: 1731250 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 - / IM

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

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

Write-up: ?Moderna COVID-19 Vaccine EUA? PATIENT GIVE EXPIRED VACCINE - TWO DAYS POST EXPIRATION


VAERS ID: 1731254 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 1 RA / IM

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

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

Write-up: ?Moderna COVID-19 Vaccine EUA? PATIENT GIVE EXPIRED VACCINE - TWO DAYS POST EXPIRATION


VAERS ID: 1731262 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-06
Onset:2021-09-08
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization. Treated with dexamethasone 6 mg IV daily.


VAERS ID: 1731267 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / UNK LA / IM

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

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

Write-up: ?Moderna COVID-19 Vaccine EUA? PATIENT GIVE EXPIRED VACCINE - TWO DAYS POST EXPIRATION


VAERS ID: 1731430 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 1 LA / IM

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

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

Write-up: Patient falsified DOB when registering for vaccination. Guardian, consented to the vaccination. Department of Health verified with statistical records that the patients actual DOB made the vaccine a contraindication. No known adverse reactions noted.


VAERS ID: 1731432 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 1 LA / IM

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

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

Write-up: Patient falsified DOB when registering for vaccination. Guardian consented to the vaccination. Department of Health verified with statistical records that the patients actual DOB made the vaccine a contraindication. No known adverse reactions noted.


VAERS ID: 1731441 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Decreased appetite, Erythema, Fatigue, Headache, Induration, Nausea, Pain, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: large, hard, red, and hot welt the size of a baseball on the vaccination arm. Chills, nausea, fatigue, severe body aches, headache, no appetite


VAERS ID: 1731497 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 4 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN, PATIENT DOES NOT USE OUR PHARMACY
Current Illness:
Preexisting Conditions: ***PATIENT DID NOT HAVE AN ADVERSE EFFECT, BUT RECIEVED A 4TH DOSE OF PFIZER VACCINE ON 9/8/21****
Allergies: UNKNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: ***PATIENT DID NOT HAVE AN ADVERSE EFFECT, BUT RECIEVED A 4TH DOSE OF PFIZER VACCINE ON 9/8/21****


VAERS ID: 1731755 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-30
Onset:2021-09-08
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 2 LA / IM

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

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

Write-up: Vaccinated patient hospitalized with COVID-19.


VAERS ID: 1732181 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-07
Onset:2021-09-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dizziness, Dyspnoea, Echocardiogram, Laboratory test, Pain, Pericarditis
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: levonorgestrel(Mirena) IUD
Current Illness: unknown
Preexisting Conditions: Asthma - exercise induced Headaches Vision abnormalities
Allergies: NKDA
Diagnostic Lab Data: labs, Echocardiogram
CDC Split Type:

Write-up: Pt had CP and shortness of breath , dizziness started 24hr after moderna #1, 2 weeks ago now. Treated with steroids x 2 weeks but still having pain. Worse when lying down - Acute idiopathic pericarditis - Primary


VAERS ID: 1732272 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, Pain, Pain in extremity, Product storage error
SMQs:, Neuroleptic malignant syndrome (broad), Tendinopathies and ligament disorders (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: Ortho Micronor 0.35 mg oral tab Prenatal Vitamin
Current Illness: No
Preexisting Conditions: none
Allergies: NKDA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: The vaccine was drawn up in syringe the day prior to event on 9/7/21. It was in proper syringe , labeled with date and time of expiration and in vaccine refrigerator but was not discarded when it it timed out on 9/7/2021. The following morning on 9/8/2021 it was accidently administered prior to the new vaccines for the day arriving. It was administered 26.25 hours after being drawn up. The patient has done well. She noted that she had what appear to be typical side effects from the vaccine - temp 100.4, body aches and sore arm which started appx 24 hours following the vaccine . She felt back to usual self on 9/10/21.


VAERS ID: 1732302 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-08
Onset:2021-09-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / UNK LA / IM

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

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

Write-up: Patient received Moderna booster when two previous vaccine doses were Pfizer vaccines. No major ADR. Mild fatigue afterward


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