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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 247 out of 8,010

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VAERS ID: 1682814 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-05
Onset:2021-09-07
   Days after vaccination:186
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6505 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted with shortness of breath and cough, tested positive for COVID-19. Patient still receiving inpatient treatment.


VAERS ID: 1682819 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FEP597 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chest X-ray normal, Chest pain, Electrocardiogram normal
SMQs:, 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: Adderall 25mg XR Adderall 10mg IR Aleve Back and Muscle Pain
Current Illness: None
Preexisting Conditions: ADHD
Allergies: Augmentin (skin rash)
Diagnostic Lab Data: EKG and Chest X-Ray came back normal on 7 Sept
CDC Split Type:

Write-up: Approximately 1 hr after vaccine (1630), I began to have mild chest pain on the left side of my body. RHR was fairly steady around 70 bpm. Chest pain steadily became worse. Around 1930, RHR peaked at 117 bpm and remained above 90 bpm. Chest pain was at 7/10 and I went to the ER. ER conducted EKG and chest X-Ray, both normal. Given tramadol and aspirin which dulled pain. Prescribed Ibuprofen and released. Follow up with primary care, prescribed naproxen and acetaminophen. Chest pain still persists


VAERS ID: 1682824 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-05
Onset:2021-09-07
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19 pneumonia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient presented to ED after having syncopal episode, denied shortness of breath of cough. Patient admitted for COVID PNA and is still undergoing inpatient treatment.


VAERS ID: 1682838 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-20
Onset:2021-09-07
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Fatigue, Hypoaesthesia, SARS-CoV-2 test positive, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow), 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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Patient had covid test done on 9/7/21 and came back positive.
CDC Split Type:

Write-up: Pt presented to ED with symptoms of fatigue, weakness, fainting, shaking, cough, numbness.


VAERS ID: 1682842 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Headache, Oropharyngeal pain, Pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Collagen with biotin
Current Illness: GERD
Preexisting Conditions: Chronic sinusitis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body ache, headache, sore throat


VAERS ID: 1682846 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

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

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

Write-up: Fainting after vaccination with Pfizer vaccine . Patient was conscious and responded when asked "are you o.k". He laid flat on the floor . Pharmacy called 911 and EMT came .


VAERS ID: 1682847 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Dyspnoea, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (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: No
Current Illness: Hypertension
Preexisting Conditions: No
Allergies: Banana
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 2 min after shot shortness of breath , dizzness. Tightness in middle of chest between breast 2hr later left calf pain lasted 1 min .dizziness


VAERS ID: 1682860 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 RA / IM

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

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

Write-up: Systemic: Dizziness / Lightheadness-Mild, Systemic: Fainting / Unresponsive-Mild, Additional Details: I told parents and pt to have pt to sit for 15 mins after the injection incase of any dizziness/fainting incident. Parent and pt understood. I went to check on mom''s 2nd shingrix date, then i heard a crash on aisle 17 at counseling window aisle. Dad coming running to window and yelled my son went down; he fainted. I ran out to check on situation. Dad said son fell on a shelf and cut the area around his earlobe. The son apparently got up from chair and walked down the aisle and fell. ~5min


VAERS ID: 1682862 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

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

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

Write-up: Dose administered after beyond use time for vaccine. 6 hours and 13 minutes had elapsed since first dose was drawn from vial which exceeds Pfizer recommended time frame of 6 hours.


VAERS ID: 1682884 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-27
Onset:2021-09-07
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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: lisinopril-HCTZ
Current Illness: transaminitis, obesity,
Preexisting Conditions: transaminitis, obesity,
Allergies: pcns- historical
Diagnostic Lab Data:
CDC Split Type:

Write-up: He does mention having shortness of breath along with cough. Admitted for COVID treatment including Remdesivir, dexamethasone, and supplemental oxygen


VAERS ID: 1682885 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

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

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

Write-up: dose administered after beyond use time. Dose given 6 hours and 37 minutes after vial first dose was drawn which exceeds Pfizer recommended time of 6 hours.


VAERS ID: 1682928 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-03
Onset:2021-09-07
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A221A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood creatinine increased, Blood lactic acid, COVID-19 pneumonia, Chest X-ray abnormal, Chest pain, Chills, Dyspnoea, Hypoxia, Leukocytosis, Lung opacity, Painful respiration, Pyrexia, SARS-CoV-2 test positive, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), 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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: HTN,BPH, prostate cancer
Allergies: NKA
Diagnostic Lab Data: 9/1/21: Hypoxic on room air in the 80s. Leukocytosis 24,000, Chest xray with ground-glass opacities bilaterally, lactate 2.5, creatitine 2.7 with unknown baseline
CDC Split Type:

Write-up: Ongoing Hospitalization: Transferred from Medical Center for COVID pneumonia and hypoxia. Began having symptoms 9/2. Tested positive 9/3, continued having shortness of breath. 9/7 worsening chills, fever and shortness of breath with some pain when breathing in his upper chest. Given Rocephin, azithromycin, dexamethasone, lovenox, high flow oxygen.


VAERS ID: 1682945 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-25
Onset:2021-09-07
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Private       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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: hospitalized with covid pna


VAERS ID: 1682954 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-05
Onset:2021-09-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 1 LA / IM

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

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

Write-up: Patient developed a rash on his face Tuesday morning. Rash isn''t spreading and is not itching. Recommended Benadryl to help with the rash. Advised to see a doctor if it spreads/gets worse or if it had not gone away by next week.


VAERS ID: 1682980 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 2 RA / IM

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

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

Write-up: Pt received his COVID-19 Moderna 0.5 ml 2 weeks early .The interval was only 2 weeks from 1st dose .


VAERS ID: 1682986 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-15
Onset:2021-09-07
   Days after vaccination:235
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EL3249 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 LA / IM

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

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

Write-up: Patient had a positive COVID test on 9/7/2021.


VAERS ID: 1682987 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Headache, Injection site swelling, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin 600mg (twice daily) Creon 12000 units (three times daily) Vitamin D3 5000 iu (once daily) Vitamin B12 500mcg (once daily) Centrum Silver Plus for women (twice daily) Super Vitamin B Complex (once daily) Citracal 12.5 mcg (twice d
Current Illness: Lupus Infections
Preexisting Conditions: Lupus Infections Arthritis
Allergies: Morphine Demerol Toradol
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache, left arm is swollen at injection sight, shortness of breath, entire leg arm is hurting


VAERS ID: 1683027 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-03-23
Onset:2021-09-07
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 Sofia antigen test with a positive result.
CDC Split Type:

Write-up: Patient received the Pfizer COVID-19 vaccine on 3/2/21 and 3/23/21 so was fully vaccinated when they tested positive for COVID-19 on 9/7/21.


VAERS ID: 1683038 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-01-12
Onset:2021-09-07
   Days after vaccination:238
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1283 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Headache, Malaise
SMQs:, Anaphylactic reaction (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: malaise, headache, dry cough


VAERS ID: 1683053 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-02
Onset:2021-09-07
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxin, vitamin d, zinc, meloxicam, aspirin, zyrtec, mirilax
Current Illness: none
Preexisting Conditions: hypothyroidism
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: itchy skin that turned into red, puffy welts on neck and scalp


VAERS ID: 1683072 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Erythema, Induration, Pain, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patients states swelling, redness , pain , hardening and bruised


VAERS ID: 1683109 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia oral, Paraesthesia oral, Periorbital swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Peri-orbital swelling, facial swelling, tongue numbness & tingling


VAERS ID: 1683137 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 4 RA / IM

Administered by: Other       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: Namzaric, Magnesium Oxide, Citalopram HBR, Amlodipine Benazepril ,Atorvastatin, B-1, Centrum Silver, Folic Acid, Risperidone Trazodone, Meloxicam, Loratadine
Current Illness: Alzheimer''s
Preexisting Conditions:
Allergies: No Known Allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: On September 1st, Chief contacted Captain asking if it would be possible to administer a third Moderna dose to the patient. Captain told Chief yes as he had seen the patient''s name on the SOS Booster list from the reverse call back system. Patient was administered his 3rd dose that day. On September 7th, another crew was out giving vaccines and were going down the call in list (a separate list) and came across Patient''s information. His care taker called multiple times and gave two different names on two different program lists. They proceeded to vaccinate the patient unknowingly that he had been vaccinated on September 1st. After investigating why a fourth dose was given, we found that the patients information on a program we use to log in patient information did not show the third dose. It was discovered that on September 1st he was listed as a different name and under a different phone number. On September 7th, on the other list, he was listed as another name with different phone number. Patient suffers from Alzheimer''s and didn''t mention anything about receiving the third dose a week prior. Patient''s caretaker showed up on September 8th and saw another CDC Card on the table with the 3rd dose information from the 7th. She reached out to us today and brought it to our attention. Doses administered as follows: First Dose ? 02/03/2021 Second Dose ? 03/23/2021 Third Dose ? 09/01/2021 Fourth Dose ? 09/07/2021 Captain went to patient''s residence today and spoke with the caretaker and checked in on the patient. The patient was feeling ok and did not appear to be suffering from any adverse reactions at that time. He told the caretaker to keep an eye on him and if any adverse reactions became obvious, to call his doctor or EMTs and then notify administration. Captain states he will stay connected with the caretaker throughout the week to check in on the patient.


VAERS ID: 1683160 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: fatigue, couldnt hold head up from tireness, nausea, light headed


VAERS ID: 1683217 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-06
Onset:2021-09-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Musculoskeletal stiffness, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: Anaphylactic to bees
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bilateral neck stiffness, headache, nausea/vomiting.


VAERS ID: 1683297 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Lethargy, Migraine, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: Synthroid 75 mcg lo loestrin fe Prenatal vitamins Xyzal
Current Illness: N/A
Preexisting Conditions: Hypothyroidism PCOS Endometriosis
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Migraine beginning at 9/7/21 @ 0930. Fever, lethargy, body aches beginning at 1200. For over 24 hours sustained fever of 102.5-103.5* regardless of being packed with ice, cool rags, 4g Tylenol administered q6h. It broke around 1200 on 9/8/21 and now is back at 101.8*


VAERS ID: 1683317 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Balance disorder, Chest discomfort, Dizziness, Dyspnoea, Eye movement disorder, Fall, Feeling cold, Hyperhidrosis, Lacrimation increased, Palpitations, Paraesthesia, Tremor, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Lacrimal disorders (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: RN noted the client''s husband asking the client if she was okay. RN responded to the client. RN noted the client seated in her seat but leaning forward. The client stated that her "heart is racing." The client reported a history of hyperthyroidism and stated that sometimes she feels her heart racing in the middle of the night. EMT responded. O2 was 99%. The client denied any shortness of breath or itching. The client reported shaking. RN noted shaking of the client''s right hand. The client reported feeling "dizzy." RN left the scene to obtain the anti-gravity chair. RN responded with the anti-gravity chair. RN observed the client attempt to stand and fell back into the chair. No injury was noted by RN. RN responded. EMT prepared to assist the client into the anti-gravity chair. The client stood up partially, became unsteady, and EMT supported her into the anti-gravity chair. The anti-gravity chair was reclined to low-fowler''s position. RN noted the client''s eyes rolling back in her head and her head rolling to the side. The client was not verbally responsive for a few seconds. The client''s husband responded. The client''s husband said the client''s current state was abnormal for the client. The client was oriented to person, place, time, but not situation. RN noted the client''s speech was interrupted with periods of non-verbal responsiveness. RN activated EMS at 4:28PM. RN Responded. The client reported chest pressure to RN. The client and her husband denied any history of anxiety. The client reported history of allergy to "something blue." The client''s husband stated the client has an allergy to contrast dye. RN inquired if the client''s current symptoms felt similar to her previous reaction to contrast dye. The client said "no." The client was intermittently squeezing RN hand and telling RN about her day in incomplete sentences. The phrases included "cooked chicken and rice" and "for kids." RN noted the client arching her neck and back intermittently trying to adjust her position in the chair. The client reported chest pressure radiating into her abdomen. Denied feeling nauseas or the urge to defecate or urinate. RN noted tears in the client''s eyes. Vitals obtained at 16:35PM were as follows: HR 104, O2 99%. The client reported tingling all over her face. The client requested to be sat up and reported "I can''t breathe." RN noted the client''s hand on her chest and the client gasping for breath. RN noted the client''s cheek and ear were cold. The client stated she felt like she was sweating. RN recommended administration of Epinephrine per CoSD Emergency Life Support Manual. RN educated the client that she was about administer Epinephrine. The client was not verbally responsive. RN administered Epinephrine Injection, USP Auto-Injector 0.3mg into the anterolateral aspect of the right thigh at 4:37PM. RN noted the client verbally responsive. Client stated her breathing was improving. Chula Vista Fire Department assumed care at 4:38PM. RN was unable to administer Benadryl 50mg prior to the Fire Department assuming care. Client transported to. The exact time the client left the facility was not noted. VAERS completed. VAERS confirmation number.


VAERS ID: 1683329 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-06
Onset:2021-09-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Back pain, Dizziness, Headache, Mobility decreased
SMQs:, Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: When i woke up at 6:30 a.m i felt dizzy, light headed and weak. When i went to brush my teeth i felt that i was going to faint and so i sat down. After sitting for 5 minutes in the bathroom i went back to my bedroom to lay down to sleep again. Once i woke up at around 8.a.m i had joint pain and a strong headache and lower back pain. This entire day i bedridden. The next day i felt great, i had no symptoms.


VAERS ID: 1683341 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Confusional state, Disturbance in attention, Feeling cold, Hypoaesthesia, Hypotension, Lethargy, Mobility decreased, Myalgia, Pain in extremity, Peripheral coldness, Skin discolouration, Tachycardia, Transient ischaemic attack, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad), Sexual dysfunction (broad)

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

Write-up: Hypotension tachycardia numb arms and hands loss of function of arm and hand TIA severe cold and shaking rigors extreme muscle aches resulting in being bedridden for 24 hours color of hands change to white with painful cold confusion and inability to focus or concentrate lethargic and inability to move


VAERS ID: 1683349 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-10
Onset:2021-09-07
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO172 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site inflammation, Injection site pain, Injection site swelling, Joint range of motion decreased, Loss of personal independence in daily activities, Pain
SMQs:, Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupriopion XL 300 mg once daily, famotidine 40 mg once daily, hormonal birth control (Levono-E Estradiol 0.15-0.03-0.01tablets)
Current Illness: none
Preexisting Conditions: GERD
Allergies: None
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Injection site pain and inflammation on 7-8 September 2021, four months after receiving second dose of vaccine. Had very mild pain during first injection that lasted less than 5 minutes and no pain with second injection. Woke up from sleep on 7 September with similar pain as experienced after first injection but much stronger, accompanied with swelling. Pain increased with movement of arm and movement was limited. Responds well to ibuprofen and but has persisted for two days and required frequent re-dosing of ibuprofen. Severe enough to impact daily activities but not severe enough to seek further medical attention.


VAERS ID: 1683358 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-04
Onset:2021-09-07
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DO NOT KNOW ALL OF THESE.
Current Illness: DO NOT KNOW ALL OF THESE.
Preexisting Conditions: DO NOT KNOW ALL OF THESE.
Allergies: DO NOT KNOW ALL OF THESE.
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT CAME TO THE PHAMACY CONCERNED ABOUT HER ARM BEING RED/SWOLLEN/SOFTBALL LIKE RASH NEAR HER INJECTION SITE.


VAERS ID: 1683452 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-05
Onset:2021-09-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

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

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

Write-up: Severe diarrhea


VAERS ID: 1683457 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-03
Onset:2021-09-07
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 2 RA / SYR

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

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

Write-up: pt complained of warmness, reddness and itchy at injection site.


VAERS ID: 1683567 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Florida  
Vaccinated:0000-00-00
Onset:2021-09-07
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Peanut allergy; Seasonal allergy
Preexisting Conditions: Comments: The patient did not have any drug abuse/illicit drug use.
Allergies:
Diagnostic Lab Data: Test Date: 20210907; Test Name: COVID-19 virus test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20210913234

Write-up: COVID-19 POSITIVE; This spontaneous report received from a parent concerned a 19 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included: seasonal allergies, peanuts allergy, and non-alcohol user, and other pre-existing medical conditions included: The patient did not have any drug abuse/illicit drug use. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 1808980, expiry: UNKNOWN) dose was not reported, administered on 07-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 07-SEP-2021, the patient experienced covid-19 positive. Laboratory data included: COVID-19 virus test (NR: not provided) Positive. The action taken with covid-19 vaccine was not applicable. The outcome of covid-19 positive was not reported. This report was non-serious.


VAERS ID: 1683676 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-05
Onset:2021-09-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 3 LA / UN

Administered by: Private       Purchased by: ?
Symptoms: Chills, Erythema, Fatigue, Hyperhidrosis, Immunodeficiency, Pruritus, Skin warm, Somnolence
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Doxycyline (ear infection), Flonase, Budesonide, Nortriptyline, AlgaeCal Plus, D3 (10,000 iu), Ocrevus Infusion for MS (July 28, 2021)
Current Illness: End of Summer Head Cold (started 8/13/21), led to ear infection
Preexisting Conditions: MS, Collagneous Colitis, Menieres, Vestibular Migraines
Allergies: Penicillin, Sulpha, melon
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: 9/5/21 Received the third dose on Sunday morning, 8:30 am 9/6/21 Woke up early Monday morning with chills and sweats, 2:00 am for about two hours Fatigued Monday, sleepy, arm itching 9/7/21 Tuesday evening I noticed my arm itches, is warm and hot with a big red patch. 9/8/21 Wednesday go to Walk In - (not where I got the shot). Diagnosed with Cellulitis, the patch is about 10 cm x 20 cm and had gotten bigger than the night before. Prescribed Clindamycin (stopping Doxycycline), taking Zyrtec for itch and icing arm hourly. We took pictures to compare over the next few days.


VAERS ID: 1683691 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chills, Dizziness, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Women''s One a Day vitamins, Emergen-C Immune Plus
Current Illness: None
Preexisting Conditions: Hoshimoto''s Disease
Allergies: Penicillin, Bactrim
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe chills, light headed, severe muscle aches, chest pressure, headache. Alternated taking 2-500mg Tylenol and 600mg ibuprofen every 4-6 hours starting at 9:00 PM on 9/7/2021 through 9:00 PM on 9/8/2021


VAERS ID: 1683693 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-06
Onset:2021-09-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 - / IM

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

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

Write-up: rash size of patient''s palm, redness, large knot on arm


VAERS ID: 1683707 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-14
Onset:2021-09-07
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, COVID-19, Chills, Decreased appetite, Diarrhoea, Nasal congestion, Pyrexia, Rhinorrhoea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (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: Tested positive today runny and stuffy nose fever chills fatigue no appetite stomach pain diarrhea


VAERS ID: 1683727 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-04
Onset:2021-09-07
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling hot, Injection site erythema, Injection site pain, Injection site pruritus, Injection site warmth, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levetiracetam, Escitalopram, Ibuprofen
Current Illness: Crisis on the frontal lobe with recurring headache and possible absence crisis.
Preexisting Conditions: Crisis on the frontal lobe with recurring headache and possible absence crisis
Allergies: Shrimp
Diagnostic Lab Data:
CDC Split Type:

Write-up: On the day of the vaccination, everything was fine, just a little pain, redness in the area and I felt hot the next day. everything was the same until day 4, when I had a strong swelling in the arm. Itching and the heat of the injected area was hard to handle.


VAERS ID: 1684242 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Headache, Pain, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular 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: NA
Current Illness: NA haven?t been sick since I had covid July 2020
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: NA-I figured these are side effects and haven?t reported to my doctor only my work.
CDC Split Type:

Write-up: Several hours later I started to shake due to horrible chills, than my fever spiked to 102.8, my whole body became extremely painful to the point even laying down was horrible. Now the following day I can?t get up without becoming dizzy, and my head hurts to the point that it feels as if it will pop.


VAERS ID: 1684458 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Diarrhoea, Extra dose administered, Interchange of vaccine products
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), 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: Effexor Buspirone Vyvanse Escitalipram Black cohosh Klonopin
Current Illness: None
Preexisting Conditions: None
Allergies: Erythromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 30-45 minutes of the booster I began having abdominal cramps and felt the onset of diarrhea. Within an hour, I had to rush home from work because of intense diarrhea. After it passed from my system, I took an Imodium and did not have further problems.


VAERS ID: 1684472 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Fainting / Unresponsive-Severe, Additional Details: patient does tend to faint during bloodwork/vaccines, but this time it was much more severe, she was unresponsive and i had to give her chest compressions, i believe she had a pulse the whole time, she was down about 2-3 min and came to, ambulance came and picked her up


VAERS ID: 1684477 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Chills, Diarrhoea, Dizziness, Pain
SMQs:, Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow)

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

Write-up: Chills, diarrhea, upset stomach, dizzy, aches


VAERS ID: 1684479 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypertension
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow)

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

Write-up: Systemic: Hypertension-Severe


VAERS ID: 1684503 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-17
Onset:2021-09-07
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Patient developed COVID-19 requiring hospitalization post-vaccination.


VAERS ID: 1684509 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pruritus, Neck pain, Pain
SMQs:, Arthritis (broad)

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

Write-up: Site: Itching at Injection Site-Mild, Additional Details: Pressure radiating up the neck to occipital ridge to forehead


VAERS ID: 1684675 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA FF2588 / 1 LA / IM

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

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

Write-up: Fainted; did not fall or sustain any injury. Awoke within less than a minute and felt fine. Observed closely for 30 minutes after.


VAERS ID: 1684676 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure fluctuation, Chest pain, Dizziness, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: flu vaccine causes hives yearly
Other Medications: Benadryl, Zyxal, and hydroxyzine
Current Illness: idiopathic anaphylaxis Mastocytosis POTS
Preexisting Conditions: idiopathic anaphylaxis Mastocytosis POTS
Allergies: Idiopathic anaphylaxis Allergies to: Nystatin Powder, Penicillin, orthonovum, citric acid,
Diagnostic Lab Data:
CDC Split Type:

Write-up: erratic blood pressures, as low as 70/30, orthostatic hypotension, chest pain, light headedness, itchiness


VAERS ID: 1684698 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: NO ADVERSE EVENT. Patient was given Pfizer for her 2nd dose instead of Moderna. Pt is extremely afraid of needles and was asking that we hurry and give the vaccination while her coworkers held her. I asked her for her card but she wanted us to hurry because she was afraid. Others had received Pfizer at that location and I assumed that was what she got as well. However, after she got the shot she asked was it Moderna, and I said no it was Pfizer. She then handed me her card and it was Moderna that she should have received.


VAERS ID: 1684704 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-24
Onset:2021-09-07
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Fatigue, Oral herpes, Pain in extremity, SARS-CoV-2 antibody test positive
SMQs:, Oropharyngeal infections (narrow), Tendinopathies and ligament disorders (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? No
Previous Vaccinations: joint imflamation
Other Medications: Zinc 25 mg , Quercetin 250mg, Vit D3 5,000 U, vit C 500 mg, ASA 81 mg. symbicort inhaler
Current Illness: 6 weeks prior to vaccine I had COVID positive and was sick with Covid for 48 hours. Lab test Aug 20th results for Covid antibodies HIGH and REACTIVE. Because I work at a hospital my employer wanted me vaccinated even though I had positive antibody test and CDC recomendation is vaccine.
Preexisting Conditions: Asthma dx Feb 2021. osteo arthritis hands and feet.
Allergies: Codeine and hydrocodone
Diagnostic Lab Data: Had COVID 19 on July 9th COVID antibody test July 20th results HIGH and REACTIVE COVID Jansen vaccine July 24th
CDC Split Type:

Write-up: Pain in left arm from shoulder to wrist during the first 24 hours. Waves of severe fatique for 4 days 2 weeks later herpes on Right lower lip which has not occured for over 2 years and is now painfull despite anti herpes cream


VAERS ID: 1684723 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Headache
SMQs:

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

Write-up: Client was given his second dose of the Pfizer vaccine and 10 to 15 minutes following the injection the client c/o a headache an the left and right side of his head. He stated that he did not have an reaction to the first dose. he said that he thought it would just past but it didn''t. So I took vitals immediately and asked if he had any pre-existing conditions to which he answered no. His vitals were normal and remained normal throughout the incident (144/92, 71, 20, 98% o2, 97.1. He denied any allergies. His breathing and safety was maintained throughout the event. He did say he had not eaten anything so we gave him some cracker and water. After 10-15 minutes he stated that he felt much better and the headache was just about gone. He denied any dizziness or nausea. I kept him for another 15 minutes and he answered all question appropriately and I had him stand and ambulate without incident. So I discharged him and advised him to follow-up with his doctor. Retook vitals (136/88, 68, 18, 98% o2). He ambulated himself out of the clinic without incident.


VAERS ID: 1684750 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Pain, 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever began 12 hours after shot. Was 101.6 for 12-15 hours. Aches, pains, headache


VAERS ID: 1684795 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-01
Onset:2021-09-07
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Pfizer on 2/8 and 3/1. Positive on 9/8 admitted 9/7 to current


VAERS ID: 1684796 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Discomfort, Dizziness, Fatigue, Gait disturbance, Headache
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Following the second dose of Pfizer client c/o dizziness, weakness and a headache. Client denied any pre-existing condition prior to vaccine being given, but admitted to a history of Myasthenia Gravis and arthritis. 10 minutes after the vaccination client expressed her discomfort and I immediately took her vitals (118/88, 20, 77, 98% o2, 96.8 temp). Her breathing was regular and unlabored and her safety was maintained throughout the incident. So , I applied and ice pack to the rear of her neck and forehead. 10-15 minutes later she said she felt better but weak, she asked for a drink of water. I assessed her swallowing and it went without incident. I then gave her some water to drink. She stated again that she felt weak and then admitted to the pre-existing conditions mentioned above. After resting for another 10-15 minutes she stated that she was feeling much better. I then had her stand but her gait was unsteady then I had her sit. The Husband and daughter then expressed that her gait is sometimes off due to her illness. She did have a cane to assist with her ambulation. So I re-took her vitals (122/84, 16, 84, 99%o2). She said that she was feeling much better and her head ache was mild but she was fatigue but had no dizziness. I then decided to discharge the client to her family and have them follow up with her primary doctor. So I asked her husband to pull the car up to the door so she would have a shorter distance to walk. We pushed her to the door in a chair with wheels and had her stand and did stand by assist until she was in the car. Her daughter did all of the translating. It went with and problems and I did call to follow up and the daughter stated she was in bed resting and felt much better.


VAERS ID: 1684802 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-19
Onset:2021-09-07
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Pfizer on 1/29 and 2/19. Positive on 9/7 admitted 9/7 to now


VAERS ID: 1684829 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Rash on left arm


VAERS ID: 1684853 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pain, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 100 mg; Mirapex 1 mg; Wellbutrin 150 mg; Buspirone 10 mg; Omeprazole 40 mg
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 6 hours after receiving shot symptoms started. Headache, muscle aches, fatigue, pain at injection site.


VAERS ID: 1684917 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Pt. was given her Pfizer COVID vaccine 2 months too early. As of 9/9/21 Pt. has not experienced any adverse effects.


VAERS ID: 1684928 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-16
Onset:2021-09-07
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / IM

Administered by: Work       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: 9/7/21 SARS/COV-2, NAAT positive
CDC Split Type:

Write-up: Covid positive $g14 days post vaccine series.


VAERS ID: 1685018 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-08-31
Onset:2021-09-07
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cough, Fatigue, Nausea, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

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

Write-up: became very tired, coughing and leg pains, fill the need to vomit but cant


VAERS ID: 1685066 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-05
Onset:2021-09-07
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 9/8/21 SARS/COV-2, NAAT Positive
CDC Split Type:

Write-up: Covid positive $g14 days post vaccine series.


VAERS ID: 1685067 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-03
Onset:2021-09-07
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: NO
Preexisting Conditions: Unknown
Allergies: No
Diagnostic Lab Data: Nothing
CDC Split Type:

Write-up: No Treatment / no adverse event / vaccine was administrated outside Monera''s storage and handing recommendation as outlined in the fact sheet for health care providers


VAERS ID: 1685103 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-09-03
Onset:2021-09-07
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 1 LA / SYR

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

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

Write-up: No Treatment / no adverse event / vaccine was administrated outside Moderna''s storage and handing recommendation as outlined in the fact sheet for health care providers


VAERS ID: 1685133 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-03
Onset:2021-09-07
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 RA / SYR

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

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

Write-up: No Treatment / no adverse event / vaccine was administrated outside Monera''s storage and handing recommendation as outlined in the fact sheet for health care providers


VAERS ID: 1685150 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-23
Onset:2021-09-07
   Days after vaccination:107
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asymptomatic COVID-19
SMQs:, 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: No medications documented
Current Illness: Surgery in March for cancer of descending colon
Preexisting Conditions: Hypertension diverticular disease rosacea malignant tumor of descending colon
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was diagnosed with COVID-19 after being fully vaccinated - asymptomatic preoperative testing.


VAERS ID: 1685164 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041CZ1A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Fatigue, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever of 101. for 48 hours, extreme fatigue, muscle aches, nausea and lighheadedness.


VAERS ID: 1685174 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-03
Onset:2021-09-07
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034C21A / 2 RA / SYR

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

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

Write-up: No Treatment / no adverse event / vaccine was administrated outside Monera''s storage and handing recommendation as outlined in the fact sheet for health care providers


VAERS ID: 1685199 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-09-02
Onset:2021-09-07
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Fatigue, Feeling abnormal, Headache, Hyperhidrosis, Hypoaesthesia, Injected limb mobility decreased, Malaise, Nausea, Pain, Pain in extremity, Respiratory tract congestion, Rhinorrhoea, Sneezing, Throat irritation, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

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

Write-up: Friday 9/3. Symptoms the day after vaccine were normal - left arm very sore to the point where I couldn''t lift it and very fatigued. Felt as though a cloud covered my eyes and head. Saturday 9/4. Arm still very sore, no better than the day before. Still feeling fatigued but not as bad as the day prior. Sunday 9/5. Arm starting to get better but woke up with a tickle in my throat. Still a bit fatigued but better. Monday 9/6. Arm is back to normal. Not fatigued. Tickle in my throat is a bit worse. Allergy symptoms start coming on (sneezing, runny nose, congestion) ***Tuesday 9/7. Felt the same as Monday until about 8pm. My legs went numb and and whole body started shaking uncontrollably. This didn''t let up for the entire night. I was sweating profusely, with shooting pains up and down my body. Puked violently twice. Couldn''t sleep all night and developed a headache that didn''t let up until the next morning after taking Advil. Wednesday 9/8. Developed a cough. Whole body aches and congestion. Headache and nausea. Thursday 9/9. Same symptoms as Wednesday. Tuesday felt as though I was on my deathbed. I feel that is odd since it was 5 days after receiving the vaccine, and I''m still feeling very ill.


VAERS ID: 1685208 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Computerised tomogram, Magnetic resonance imaging, Transient ischaemic attack
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (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: cymbalta, protonix, sufasucralfate, claritin, chromium picolinate, co Q 10, vitamin C, vitamin D3, acetaminophen, multivitamin, B complex, B12, magnesium fish oil, probiotics, tramadol, aobuerol inhaler
Current Illness:
Preexisting Conditions: lymphoma in remission, autologous stem cell transplant
Allergies: terbinfine, atrovastatin, allopurinol, levofaoxacin
Diagnostic Lab Data: CT, MRI
CDC Split Type:

Write-up: TIA 3 hours after vacciine


VAERS ID: 1685262 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-03
Onset:2021-09-07
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Computerised tomogram, Dyspnoea, Myocardial infarction, X-ray
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: arthritis left ankle
Allergies: none
Diagnostic Lab Data: Xray, CT scan
CDC Split Type:

Write-up: I experienced shortness of breath that escalated to chest/lung pain and the sensation that the lungs are compressed by some one''s hands. I ended up transported to Hospital by Fire Department suspecting a heart attack. That was cleared by several tests. While in the Hospital the pain increased and was unbearable. I was given Tramadol and discharged later with heartburn diagnosis. I have been dealing with heartburn and acid reflux for years and did not experience any such symptoms on the above date and time. later that night the pain increased again and Diclofenac would not help. I used Excedrin and the pain subsided to a bearable level and was able to sleep early in the morning. Throughout this experience, the pain was located specifically in the lungs and I could feel the the bronchia tensed up. I did not feel pain or discomfort anywhere else in my body. The following day, I kept on taking Excedrin a couple of times. Now the pain decreased but did not go away.


VAERS ID: 1685271 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Feeling cold, Somnolence, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Customer got light headed , then vomited x 2 . Got real sleepy and cold and clammy for about 10-15 minutes. Call EMS and customer was fine by the time they arrived. She had color back to her skin and laughing. She went home with her mother


VAERS ID: 1685303 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Interchange of vaccine products
SMQs:, Medication errors (broad)

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

Write-up: Patient came into the office for 2nd dose for the covid vaccine. It was scheduled for Moderna, but patient had Pfizer for the first dose. Patient was given moderna for the 2nd dose.


VAERS ID: 1685312 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Discomfort, Hypoaesthesia, Pain
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Chest Tightness / Heaviness / Pain-Severe, Systemic: Numbness (specify: facial area, extremities)-Severe


VAERS ID: 1685322 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 3 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: in July 2021 she recieved a month of bupropion 150mg XL one QD prednisone 5mg 2 QD x 15 days naproxen 500mg 1 BID prn with meals due to start Humira whenever she picks it up
Current Illness: unknown
Preexisting Conditions: rheumatoid arthritis, seropositive chronic pain tenosynovitis prediabetes anxiety
Allergies: ibuprofen - unknown reaction
Diagnostic Lab Data: none
CDC Split Type:

Write-up: this patient is immunocompromised and presented for the 3rd COVID vaccination. Past 2 doses were Moderna: dose 1, 1/15/2021, dose 2, 2/15/2021. Unknown lot as they were given at the local department of health. Received Pfizer in error for 3rd dose.


VAERS ID: 1685329 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-05
Onset:2021-09-07
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, COVID-19, Confusional state, Dementia, General physical health deterioration, Hypernatraemia, Lethargy
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: 80 years old female who has past medical history significant for history of advanced dementia, COVID-19 infection and afterwards has declined significantly, completely confused most of the days, significantly lethargic and was sent to the hospital where she was noted to have significant hypernatremia and also acute kidney injury and was recommended admission. Patient is however unable to give any further details of the history and daughter does not know exactly the details of her last few days of history. Patient is completely confused and demented and unable to give any review of system Vitals & Measurements (Last Charted) T: 97.9 ?F(Oral) TMIN: 96.5 ?F(Oral) TMAX: 97.9 ?F(Oral) HR: 68 RR: 11 BP: 129/69 SpO2: 98% WT: 43.6 kg BMI: 18.15


VAERS ID: 1685386 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-08-31
Onset:2021-09-07
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site rash
SMQs:, Hypersensitivity (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: Levothyroxine Liothyronine B12 D3 Ozempic
Current Illness: No
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash at injection site


VAERS ID: 1685389 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid 19 1st dose
Other Medications: aurovela 24 fe tablets
Current Illness: none
Preexisting Conditions: lower back pain
Allergies: morphine, some nasaids,
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever, body aches, chills, fatigue, arm soreness


VAERS ID: 1685403 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chills, Cough, Fatigue, Musculoskeletal chest pain, Myalgia, Nausea, Pain in extremity, Somnolence
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: low dose aspirin 81 mg, Ezetimibe 10 mg, Valsartan 320 mg, Furosemide 40 mg, Carvedilol 6.25 2 times a day
Current Illness: High blood pressure and high cholesterol
Preexisting Conditions: High blood pressure and high cholesterol
Allergies: hydrochlorothiazide, atorvastatin, sucralfate, rosuvastatin, pravastatin, cephalexin, verapamil
Diagnostic Lab Data:
CDC Split Type: 424389

Write-up: chills very bad pain in left arm from shoulder down to left muscle, coughing, tiredness, sleepiness, nauseous, muscle pain in both legs, pain in both ribs.


VAERS ID: 1685404 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-16
Onset:2021-09-07
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Computerised tomogram abdomen, Culture urine, Dehydration, Diarrhoea, Differential white blood cell count, Electrocardiogram, Essential hypertension, Full blood count, Gastroenteritis, Headache, Hyperkalaemia, Influenza A virus test, Influenza B virus test, Lipase, Metabolic function test, Nausea, Respiratory syncytial virus test, SARS-CoV-2 test, Scan with contrast, Troponin I, Urine analysis
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Dehydration (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COMPREHENSIVE METABOLIC PANEL performed 2 times LAB ONLY-COMPLETE BLOOD COUNT WITH DIFFERENTIAL performed 2 times LAB ONLY-URINE MICROSCOPIC REFLEX LACTIC ACID performed 2 times LIPASE SARS-COV-2, INFLUENZA A+B, AND/OR RSV NUCLEIC ACID TESTING PANEL TROPONIN I URINE DIP, REFLEX TO MICROSCOPIC, REFLEX TO CULTURE CT ABDOMEN PELVIS WITH CONTRAST EKG XRAY CHEST PORTABLE -
CDC Split Type:

Write-up: Gastroenteritis Dehydration Nausea Diarrhea, unspecified type Essential hypertension Other headache syndrome Hyperkalemia


VAERS ID: 1685440 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-01
Onset:2021-09-07
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Unknown lot numbers. patient hospitalized with diagnosis of COVID-19 breakthrough


VAERS ID: 1685534 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-27
Onset:2021-09-07
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH SA6780 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH SC3181 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Did not have a reaction to vaccine but did test positive for COVID on 09/07/2021.


VAERS ID: 1685538 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-06
Onset:2021-09-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: metoprolol 100mg, eliquis 5mg,
Current Illness: acute respiratory virus
Preexisting Conditions: afib
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient is experiencing a low grade headache since receiving the vaccine. In addition, she feels tired and flu-like. She reports that her left arm is red and slightly swollen.


VAERS ID: 1685592 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Decreased appetite, Fatigue, Hyperhidrosis, Injection site pain, Injection site swelling, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: pain and muscular aches, fever, chills, sweats, loss of appetite, fatigue, soreness and saelling at site of injection


VAERS ID: 1685598 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-02-04
Onset:2021-09-07
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Pneumonia, Respiratory distress, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID PCR test done, on9/7/21 and was positive.
CDC Split Type:

Write-up: Patient presented to facility with respiratory distress, SOB. Patient admitted from nursing home. Has left sided Pneumonia.


VAERS ID: 1685652 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-02
Onset:2021-09-07
   Days after vaccination:189
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Dyspnoea, Ear pain, Headache, Nasal congestion, Pain, Sinus congestion
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Alprazolam; Metoprolol, Melatonin, Aspirin, Valcyclovir; Tadalafil, Zolpidem
Current Illness: none
Preexisting Conditions: anxiety, insomnia; benign prostatic hyperplasia, atrial fib
Allergies: trazodone
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache, cough, shortness of breath, body aches, ear pain, sinus congestion, nasal congestion, post nasal drainage starting on 9/7/21


VAERS ID: 1685665 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-11
Onset:2021-09-07
   Days after vaccination:88
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 UN / IM

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

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

Write-up: PT VACCINATED USING MODERNA 5/14/2021 (045B21A) + 6/11/21 (025C21A). S/O BEGAN 9/3/21, TESTED + 9/7/21


VAERS ID: 1685669 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Amnesia, Arthralgia, Chest pain, Condition aggravated, Constipation, Dizziness, Dry mouth, Dysgeusia, Ear pain, External ear pain, Fatigue, Feeling abnormal, Headache, Immediate post-injection reaction, Insomnia, Memory impairment, Musculoskeletal chest pain, Myalgia, Nightmare, Oropharyngeal pain, Pain, Pain in extremity, Tinnitus
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (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: Omeprazole
Current Illness: None
Preexisting Conditions: In my chart
Allergies: All Sulfa medications, (Can''t remember the rest. I Am having brain fog and trouble thinking)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Strange taste in mouth immediately, pain in injection arm, stinging pain in lower part of injection arm and in calf muscle, dizziness, tinnitus, abdominal pain, constipation, brain fog, memory loss, chest pain, forgetfulness, headache, earache in both inside and outside of both ears, ribs hurt, dryness in mouth, sore throat, nightmares, trouble sleeping, joint pain, muscle pain, fatigue


VAERS ID: 1685746 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-06
Onset:2021-09-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time prolonged, Back pain, C-reactive protein increased, Chest X-ray, Computerised tomogram thorax, Dizziness, Dyspnoea, Echocardiogram, Electric shock sensation, Electrocardiogram, Fatigue, Full blood count, International normalised ratio normal, Metabolic function test, Neck pain, Pain, Painful respiration, Pyrexia, Red blood cell sedimentation rate, SARS-CoV-2 test negative, Sleep disorder, Troponin
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: sronyx, ASA, Vit D3, Vit C, Zinc, Multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 9/8/21 ER visit CRP 3.6mg/dL, Troponin 0 x 2, PTT 23.4, PT 12, INR 0.87, LA 1.10, CBC, CMP, BNP, Chest xray, CTA, Sed Rate, COVID swab negative, EKG, Echocardiogram
CDC Split Type:

Write-up: COVID Vaccine adverse reaction 9/6/21 Received second dose pfizer vaccine 1300. Night of receiving vaccine began having electrifying zips of chest pain. Lasting seconds at a time. 9/7/21 Woke up with severe back, hip, neck pain, flu like feeling, body aches, fatigue, febrile. Throughout the day began having constant chest pain with increased pain upon inspiration and exhalation along with shortness of breath during activity. Was not able to lye flat or on left side without severe increased chest pain and difficulty breathing. Slept in recliner on right side as it was the only position to get relief. 9/8/21 Back, hip and neck pain, flu like feeling, body aches, fever were gone but the chest pain and shortness of breath continued with worsening shortness of breath. Two events of dizziness. Made doctor appointment at 1315. Concern for PE or pericarditis and was sent to the ER from doctors office. ER visit concluded inflammation and placed on 600mg ibuprofen 3x day for 2 weeks. 9/9/21 Continue to have chest pain and shortness of breath


VAERS ID: 1685793 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin, Adderall, Seroquel, Finasteride, Duloxetine.
Current Illness: None.
Preexisting Conditions: Fibromyalgia, Chronic Bilateral Dacryocystitis,.
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Skin rash/reddish welts that resembles hives, almost entirely concentrated on my scalp, some on my chest, neck, and arms. Very itchy and bothersome. It feels hot/warm.


VAERS ID: 1685804 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-03
Onset:2021-09-07
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / SYR

Administered by: Unknown       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: Levothyroxine 125mcg
Current Illness: None
Preexisting Conditions: Hypothyroid
Allergies: Fertilizers
Diagnostic Lab Data:
CDC Split Type:

Write-up: Menstrual bleeding when I have not had a period in over 6 months. Early menopausal pre-menopause.


VAERS ID: 1685809 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Atrial fibrillation, Blood magnesium, Blood thyroid stimulating hormone, Electrocardiogram abnormal, Full blood count, Glycosylated haemoglobin, Lipids, Metabolic function test, Palpitations, Sleep disorder
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Cardiomyopathy (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: Atorvastatin, Metformin
Current Illness: none
Preexisting Conditions: Chronic hip pain related to spondylosis, menopause, pre-diabetes, chronic sinusitis, hyperlipidemia
Allergies: CITALOPRAM, WELLBUTRIN, BROMFENAC, CELEBREX, NONSTEROIDAL ANTI-INFLAMMATORY PROLENSA
Diagnostic Lab Data: A1C, Magnesium, TSH reflex, lipid panel, CBC, CMP, EKG. Waiting on results
CDC Split Type:

Write-up: patient reports pounding in chest. Palpitations. EKG shows a-fib and a heart rate of 138. Palpitations kept patient up at night, and she did not rest well because laying on her side increased the feeling of pounding in her chest. By 1130 on 9/8/21, she had converted to normal sinus rhythm per EKG.


VAERS ID: 1685960 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO171 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Hypersensitivity, Pruritus, Skin reaction, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Anthrax, 30 years old at time of injection
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: tri ortho cyclen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Allergic reaction, red skin, hives, severe itchiness starting at mainly scalp area, face and neck. Difficulty breathing. Given IM injection of benedryl


VAERS ID: 1685967 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-05
Onset:2021-09-07
   Days after vaccination:186
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Cough, Infection, Myalgia, Nasal congestion, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: PCR + for Covid 9/8/2021
CDC Split Type:

Write-up: Client was vaccinated for Covid with Pfizer vaccines on March 5 and March 23, 2021. Covid symptoms developed 9/7/2021 - cough, nasal congestion, myalgia. Tested positive for Covid 9/8 with PCR. Reported as a case of breakthrough Covid illness in a previously vaccinated person


VAERS ID: 1685986 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Blood pressure increased, Cold sweat, Condition aggravated, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (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: Unknown
Current Illness: Unknown
Preexisting Conditions: Anxiety and high cholesterol
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client reported "sweating" to EMT. RN responded. The client ambulated and sat down in the anti-gravity chair. The client denied any other s/s of anaphylaxis. The client stated he "started sweating cold." RN provided the client with two cold packs, which the client placed underneath his arms in his armpits. Vitals obtained at 4:18PM were as follows: BP 168/99, HR 96, O2 98%. RN educated the client regarding elevated blood pressure. The client stated he was "feeling better." The client reported a history of anxiety and high cholesterol. The client was unsure the name of the medication he takes for high cholesterol. The client stated that when he experiences anxiety he "just tries to stay calm." The client denied a history of hypertension. The client was unsure of his normal blood pressure. At 4:21 the client requested water, RN provided him with a water bottle, and the client began drinking water. Repeat vitals obtained at 4:24PM were as follows: BP 171/99 and HR 92. The client denied any current symptoms. RN checked in with the client around 4:27PM. The client denied any current symptoms. The client stated he wanted to stay sitting in the anti-gravity chair for a little while longer. The client ambulated unassisted with a steady gait. The client was alert and oriented to person, place, time, and situation. Approximately around 6:45 PM RN asked the client if he was experiencing any symptoms. The client reported "sweating" and stated that he was "anxious for his wife." The client denied any other signs or symptoms at this time.


VAERS ID: 1686428 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F1A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal distension, Arthralgia, Chills, Dizziness, Dyspnoea, Feeling hot, Headache, Insomnia, Mobility decreased, Myalgia, Night sweats, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tramadol, Gabapentin, Meloxicam, Atorvastatin, Tylenol, vit B12, vit B2, D3, Mg, Miralax
Current Illness: Idiopathic pulmonary fibrosis
Preexisting Conditions: Idiopathic pulmonary fibrosis
Allergies: doxycycline, Sulfa drugs, augmentin, grasses
Diagnostic Lab Data: No medical tests or laboratory studies were conducted. Two (2) full days later still have mild headache and feel sweaty (clammy)
CDC Split Type:

Write-up: - Severe headache - behind my eyes, temples, down the back of the neck and into the shoulders - Severe muscle and joint pain and aches all over my body. - Severe chills and shivering. - The feeling of being "hot" but without an abnormal temperature - mine usually runs about 97.6 and that is what I measured. - Totally "stuffed up" with some breathing difficulty - like you had a really bad cold that included your lungs. - Bloating or "fullness" in the stomach but no nauseousness. - Dizziness to the point of not being able to get out of bed or walk without hanging on to something - extreme "unbalance" and some "spaciness." - An elevated pounding heart-rate - running over 110 bpm all night and sometimes spiking at 125 bpm - - today, at about 8pm - after slowly declining all day - this has pretty much returned to normal which for me is about 60 bpm +- when resting. - Insomnia followed by night sweats - By 4:30 the next day most symptoms were gone except for a lingering mild headache


VAERS ID: 1686431 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-07
Onset:2021-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Hypotension, Paraesthesia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

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

Write-up: Client reported a history of syncope after vaccinations to RN prior to receiving the vaccine today. The client was vaccinated while seated in the anti-gravity chair. At 7:35 PM the client reported feeling lightheaded. RN responded. RN reclined the anti-gravity chair to a low-fowler''s position. RN noted the client close her eyes and her body relax for about one second. The client opened her eyes and RN provided the client with an alcohol swab to smell. The client reported "dizziness, tingling on ears, and seeing spots." The client stated all of these symptoms are normal for her after receiving and injection. Vitals obtained at 7:35PM were as follows: automatic BP 93/58, HR 68, O2 99%. The client reported a history of hypotension. The client stated that her systolic blood pressure is usually under 100. Repeat vitals obtained at 7:45 PM were as follows: BP 111/66, HR 70, O2 99%. The client denied any symptoms at that time. RN provided education regarding s/s of anaphylaxis and when to seek EMS. The client voiced understanding of this education. RN adjusted the anti-gravity chair to a high fowler''s position. Repeat vitals obtained at 8:01PM were as follows: BP 105/70, HR 75, O2 99%. The client denied any symptoms at that time. The client left the vaccination site at 8:05PM. The client ambulated unassisted with a steady gait.


VAERS ID: 1686438 (history)  
Form: Version 2.0  
Age: 103.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-02-18
Onset:2021-09-07
   Days after vaccination:201
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Dyspnoea, Exposure to SARS-CoV-2, Hypoxia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine, glimepiride, losartan
Current Illness:
Preexisting Conditions: Hypertension, type 2 diabetes mellitus, hyperlipidemia
Allergies: Penicillin, Tetanus Toxoid
Diagnostic Lab Data: COVID status positive on 9/3/21.
CDC Split Type:

Write-up: Patient received Pfizer COVID vaccine on 1/23/21 and 2/28/21 and has been living in adult family home resident with recent COVID-19 outbreak. Patient developed symptoms and tested positive for COVID-19 on 9/3/21. On 9/7/21, patient''s had rapidly progressive shortness of breath, was found to be hypoxic, and was admitted to our facility for acute hypoxic respiratory due to COVID-19. As of 9/9/21, patient is still admitted in the med/surg unit.


VAERS ID: 1686456 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-27
Onset:2021-09-07
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058EZIA / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Agitation, Blood test, Chest X-ray, Chest pain, Chills, Coordination abnormal, Decreased appetite, Dizziness, Electrocardiogram, Fatigue, Lethargy, Myalgia, SARS-CoV-2 test negative, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Chest xray, EKG, and bloodwork performed at Emergency Room on 9/9/21, and were normal. Body temperature was normal at the same time. Covid test negative.
CDC Split Type:

Write-up: Acute onset of lethargy, extreme fatigue, chest pain, agitation, tremors, chills, lack of appetite, muscle aches, mild dizziness and lack of coordination 11 days after vaccination (9/7/21) Symptoms were somewhat intermittent and have improved after 2 days. Fatigue was consistent. I visited the emergency room the morning of the 13th day after the vaccination (9/9/21) due to the chest pain and fatigue/lethargy being very concerning. Symptoms persisted throughout the day today (9/9) but seem to have improved this evening. No fever was noted during the event (oral thermometer used). No respiratory involvement.


VAERS ID: 1686593 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-19
Onset:2021-09-07
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 RA / IM

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

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

Write-up: Tingling in arms and legs which started 2 week after receiving the vaccine. The patient was advise to see PCP or health care provider.


VAERS ID: 1686594 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-27
Onset:2021-09-07
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Anticoagulant therapy, Blood test, Dyspnoea, Dyspnoea exertional, Electrocardiogram, Pain, Pulmonary embolism, Ultrasound Doppler, Ventilation/perfusion scan
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Duloxetine fluticasone levothyroxine Lisinopril Tizanidine
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Pulmonary embolism both lungs. Blood tests. ECG. CT pulmonary angiogram. Ventilation perfusion scan. Ultra sound for DVT. Blood thinners.
CDC Split Type:

Write-up: Severe pain, can?t breathe. Blood thinners. Home on sep.8 Still gets winded after walking 20 feet or so


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