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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 25 out of 8,010

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VAERS ID: 1779510 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, 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: n/a
Current Illness: NO
Preexisting Conditions: Type II Diabetes, Hypertension
Allergies: NO
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt was schedule for a 6 month booster dose and after receiving his pfizer vaccine nurse noticed that his original series given was moderna and not pfizer. Pt did not have any reactions at the time of injection and still doing fine.


VAERS ID: 1779611 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 3 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Chills, Contusion, Extra dose administered, Headache, Myalgia, Pain, Peripheral swelling, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd dose Pfizer vaccine on 1/12/21
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: penicillin and sulfa medications
Diagnostic Lab Data:
CDC Split Type:

Write-up: Painful body and muscle aches, fever chills, headache. Swelling of right hand, followed by dark bruising of right hand/wrist.


VAERS ID: 1779632 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-19
Onset:2021-10-07
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amenorrhoea, Dysmenorrhoea, Menstrual disorder
SMQs:, Fertility disorders (broad)

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

Write-up: After my 1st covid vaccine on 9/19/21 I started my menstrual cycle as usual and when I should have started. My cycle was on time but clotting was present. After my 7 day cycle stopped I continued having bad "stomach cramps" that are consistent with a menstrual cycle for a week. No bleeding noted for that week. Then I started bleeding again and clotting is present. I haven''t had any issues with my cycle, it has been normal and consistent for many years. A change took place after my first covid vaccine. My cycle is ongoing at the present time.


VAERS ID: 1779889 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 LA / IM

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

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

Write-up: Patient came in on 10/07/21 to get Pfizer booster. The patient was do for booster dose on the 9th of October. Patient reported having slight body aches for about 2 days. Patient did not report any other symptoms.


VAERS ID: 1779918 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: NKA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: No adverse event. Pt. <12yrs of age and received Pfizer Covid vaccine. Parent''s consent given and was at chairside at time of incident.


VAERS ID: 1779923 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-17
Onset:2021-10-07
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Nasal congestion, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: PCR + for Covid on 10/8/2021
CDC Split Type:

Write-up: Client vaccinated with Pfizer vaccine for Covid on March 17 (approx.) and April 17 (exact) 2021. Developed Covid symptoms on 10/7/2021 - nasal congestion, cough, sore throat, mild SOB. Tested + for Covid on 10/8 with PCR test.


VAERS ID: 1780803 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-04
Onset:2021-10-07
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Lymph Node Swelling-Medium, Additional Details: Pt presented to the pharmacy with swollen lymph nodes on her left underarm and left side of the neck


VAERS ID: 1780817 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Dyspnoea, Echocardiogram, Fibrin D dimer increased, Hepatic enzyme increased, Oxygen saturation decreased, Ventilation/perfusion scan
SMQs:, Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Pepcid 20mg, adderall 20mg, multivitamin, vitamin b-12, vitamin D, calcium citrate, Tylenol, qvar, stilito.
Current Illness: None
Preexisting Conditions: Asthma
Allergies: Levaquin, avelox, corporate, compazine, phentyl, shellfish and iodine.
Diagnostic Lab Data: Cxr, VQ scan, blood work, heart ECHO.
CDC Split Type:

Write-up: Shortness of breath, low oxygen saturation. Admitted to hospital and placed on oxygen. DDimer elevated, liver enzymes elevated.


VAERS ID: 1782285 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Ageusia, Chest pain, Chills, Headache, Pain
SMQs:, Taste and smell disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

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

Write-up: Headache body hurt cant taste chills and chest pains.


VAERS ID: 1782468 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-05
Onset:2021-10-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Neck pain, Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swellness of lymph nodes in armpit, tightness in chest, pain in left leg, left shoulder, left side of neck


VAERS ID: 1782526 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-21
Onset:2021-10-07
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Cardiac resynchronisation therapy, Cerebrovascular accident, Computerised tomogram, Magnetic resonance imaging, X-ray
SMQs:, Cardiac failure (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin 40 mg tablet, MULTI-VITAMINS, EYE CARE HERBAL,
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: CRT''S, CAT SCANS, MRI, BLOOD TESTS (8), XRAY''S RESULTS AVAILABLE FROM HCF
CDC Split Type:

Write-up: STROKE


VAERS ID: 1782554 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Blood pressure increased, Chest discomfort, Joint swelling
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ASA, lisinopril, pantoprazole; Influenza
Current Illness: HTN, HLP
Preexisting Conditions: HTN, HLP
Allergies: Ibuprofen
Diagnostic Lab Data: Sent to Urgent Care
CDC Split Type:

Write-up: Felt a rush of chest heaviness x 1-2 minutes that resolved, increased BP and right wrist swelling


VAERS ID: 1782568 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-29
Onset:2021-10-07
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / UNK LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / UNK LA / IM

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

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

Write-up: COVID-19


VAERS ID: 1782596 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Nurse misunderstood about the third dose of vaccine and was giving patients that came in the third dose of Moderna. After explaining the guide lines for the third dose of Moderna no more was given. It was explained to her that Pfizer was the only vaccine at this time that was cleared to give a booster dose and that Moderna third dose was only for immunocompromised.


VAERS ID: 1782627 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Nurse at Clinic misunderstood about the third dose of vaccine and was giving patients that came in the third dose of Moderna. After explaining the guide lines for the third dose of Moderna no more was given. It was explained to her that Pfizer was the only vaccine at this time that was cleared to give a booster dose and that Moderna third dose was only for immunocompromised.


VAERS ID: 1782643 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-03
Onset:2021-10-07
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arrhythmia, Cardiac stress test normal, Dyspnoea exertional, Electrocardiogram normal, Oropharyngeal pain
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lipitor 20mg Levothyroxine 100 mcg Xarelto 10 mg
Current Illness:
Preexisting Conditions: PE, Hypothyroidism, Hyperlipidemia
Allergies: PCN
Diagnostic Lab Data: Hospitalized and pt reported at least stress test and ekg
CDC Split Type:

Write-up: Pt arrived to be evaluated on 10/13/2021 for sore throat (started 10/9/2021) and SOB (started 10/7/2021) with exertion. Pt reported that she was admitted to hospital on 10/7/2021 for evaluation of SOB. She had a history of PE that caused her to flat line in the past. She was evaluated with various tests like a stress test and ekg and told the provider today that "everything was normal". However when reviewing pt''s meds today, she couldn''t explain the new rx for a beta blocker (Metoprolol) that was added to her med regimen at discharge on 10/10. Pt reports she didn''t think she needed it so she hasn''t been taking it. I then asked her more about it and she then disclosed that she thought she was diagnosed with an heart arrhythmia that she was diagnosed with prior to this hospitalization. I asked if she disclosed that she had her 3rd covid vaccine on 10/3, just days before being admitted and she reported that she had not. Not sure if the two incidences are at all related but due to the proximity of the two, reporting to vaers. Pt is still having the sob symptom, so recommended further evaluation at higher level of care.


VAERS ID: 1782646 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Nurse at Clinic misunderstood about the third dose of vaccine and was giving patients that came in the third dose of Moderna. After explaining the guide lines for the third dose of Moderna no more was given. It was explained to her that Pfizer was the only vaccine at this time that was cleared to give a booster dose and that Moderna third dose was only for immunocompromised.


VAERS ID: 1782664 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nurse at Clinic misunderstood about the third dose of vaccine and was giving patients that came in the third dose of Moderna. After explaining the guide lines for the third dose of Moderna no more was given. It was explained to her that Pfizer was the only vaccine at this time that was cleared to give a booster dose and that Moderna third dose was only for immunocompromised.


VAERS ID: 1782703 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / IM

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

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

Write-up: Patient received Moderna dose that was not given an emergency use approval for this age group.


VAERS ID: 1782775 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: none
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: second Moderna given earlier than due.


VAERS ID: 1782783 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Faeces discoloured, Pain
SMQs:, Retroperitoneal fibrosis (broad), Noninfectious diarrhoea (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: Mitral valve prolapse
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Internal ache..lower back and black stool..


VAERS ID: 1783011 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-21
Onset:2021-10-07
   Days after vaccination:259
Submitted: 0000-00-00
Entered: 2021-10-13
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/07/2021 tested PCR positive for COVID
CDC Split Type:

Write-up: tested positive for COVID $g 14 days after completion of Pfizer vaccine series


VAERS ID: 1783024 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-18
Onset:2021-10-07
   Days after vaccination:262
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 RA / 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: 10/11 Sars/Cov-2, NAAT positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1783046 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-08-27
Onset:2021-10-07
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3182 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Electrocardiogram normal, Headache, Heart rate increased, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Liothyronine 10 mcg once/daily
Current Illness: No
Preexisting Conditions: No
Allergies: Penicillin
Diagnostic Lab Data: EKG by EMT - (10/7/21) - Normal EKG (10/8/21) - Normal 10/22/2021 Scheduled for the heart monitor to be connected.
CDC Split Type: vsafe

Write-up: On 10/7/2021, I started feeling light heading and my heart was racing. I put a pulse odometer on and the heart rate was slightly elevated at 115. I relaxed and laid down at it the heart rate to low 90''s and then as soon as I stood up my head started hurting and felt light headed. I put the pulse odometer went up over 160. I called 911. I laid down and tried to get my heart rate to come down. By the down the EMT left, approx. 30-45 minutes later, my heart rate had come to the low 110s. I elected to make an appt with a cardiologist the next day. The cardiologist ran an EKG which came back normal, and then he recommended an echocardiogram and a heart monitor for 30 days. A similar episode occurred three years ago involving my heart but no diagnosis was given.


VAERS ID: 1783049 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blindness, Blood test, Cognitive disorder, Computerised tomogram, Eye pain, Facial paralysis, Hemiparesis, Hypoaesthesia, Magnetic resonance imaging head, Magnetic resonance imaging spinal, Sensory loss
SMQs:, Peripheral neuropathy (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Hearing impairment (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nil
Current Illness: Migraines
Preexisting Conditions: Nil
Allergies: Morphine Maxalon
Diagnostic Lab Data: I have had full Bloods CT and cranial and Spinal MRI. My doctors didn?t know about reporting.
CDC Split Type:

Write-up: Within two hours. My left face went numb likened to having a dental anaesthetic. Within six hours I was in the hospital with loss of sensation on the left side of my body loss of strength. Paralised left side of my face. Loss of vision and severe pain in my left eye and greatly demonised cognitive ability. I was In hospital for one week and am still not much better. Still weak and numb on my left side though some of my cognitive abilities has returned and improved. I w have needed help to fill out this form.


VAERS ID: 1783082 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-24
Onset:2021-10-07
   Days after vaccination:197
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Hyponatraemia, SARS-CoV-2 test positive
SMQs:, Hyponatraemia/SIADH (narrow), Chronic kidney disease (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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol, bumetanide, ELIQUIS,ergocalciferol (VITAMIN D2), losartan, nitroglycerin, pravastatin
Current Illness:
Preexisting Conditions:
Allergies: Doxycycline, Epinephrine, Amlodipine, Bactrim
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted to observation level of care on 10-9 for hyponatremia. Patient is noted to have tested positive for covid on 10-7.


VAERS ID: 1783095 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-09-27
Onset:2021-10-07
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Deafness, Electrocardiogram, Excessive cerumen production, Gait disturbance, Mobility decreased, Vertigo, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular disorders (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: 2nd dose - Singles shot 10/30/2018 - had really bad side affects - symptoms lasted one day - felt worse than I did after the COV
Other Medications: Multivitamin; Lutein; Influenza
Current Illness: No
Preexisting Conditions: Osteopenia - generic for Fosamax for that.
Allergies: No
Diagnostic Lab Data: No - except in the ambulance they did an EKG and vitals.
CDC Split Type: vsafe

Write-up: The first episode - 03:00 am - waking up and the room started going around. Nothing else was going on. I have an apple watch and all the numbers were fine. I felt a little off balance after waking the next morning. I called an Urgent Care that was going to come out 02:15-04:15 - but at 03:45, I was reading a book on the iPad and all of a sudden the whole room was spinning, I started vomiting, I couldn''t get out of the chair due to my balance. We called 9/1/1 and all vitals were fine. They took me in though to Hospital - I couldn''t walk so that is why I had them take me in. The doctor at ER said there was a bunch of wax in my ear and he thought it was causing the problem. They put some drops in the ear. And after about 10 minutes, my hearing went out and then they took a metal thing and dug the wax out - there was a lot of wax. I was still having some walking problems when they discharged me. Said it was normal, and I threw up once more time when I got home. Next morning, I didn''t feel the greatest but by noon time I started feeling normal again. I have never had an issue too much ear wax ever before. I will see an ENT doctor soon (on the 22nd of this month) to see what is going on. I know within the last year, a doctor has looked in my ear and has not said anything. In the ambulance, they gave me something in IV to stop the vomiting. They gave me a pill while in ER but I''m not sure what it was - maybe to stop the vertigo. I brought some ear drops home to use for four days, twice a day - Najar - something to dissolve ear wax. It wasn''t a prescription. I can walk my couple of mile walk without getting vertigo. I have had a couple of times when I am lying down and the room starts spinning a little so I''ll talk to the ENT doctor about that. I did go to my Primary Care doctor for follow up and she had looked in my ears and said everything was fine - Tuesday, the 12th.


VAERS ID: 1783103 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: iron deficiency anemia migraine atrial fibrillation osteoarthritis of spine chronic chest wall pain chronic hoarseness hypothyroidism
Allergies: prochlorperazine - unknown reaction metoclopramide - unknown reaction ergotamine - unknown reaction
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt received Pfizer COVID 19 vax #3 during a vaccine blitz on 10/07/21 on the parking lot. She parked her car for monitoring after the vaccine. She c/o nausea to the staff who then called provider. Pt is alert, oriented x 3. Drinking water. Denies chest pain, shortness of breath, aches, vision changes, headche. BP was wnl 100/80. Pt said she usually runs low BP. HR and O2 saturation were wnl. She left the parking lot after about 30 minutes. Instructed to report to the ER if her symptoms worsen.


VAERS ID: 1783223 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-10-04
Onset:2021-10-07
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bone pain, Cough, Feeling cold, Feeling hot, Injection site pain, Pain in extremity, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Osteonecrosis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Injection pain, bone pain in the left hand, chills/fever for over 4 days, heart felt warming, chronic cough


VAERS ID: 1783233 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / IM

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

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

Write-up: Medication Administration Error - Only Diluent Given: Patient received her first dose of Pfizer COVID-19 mRNA vaccine on 2/11/2021, second dose on 3/4/2021, and third dose on 10/7/2021. After vaccination with the third dose, the medical assistant realized only diluent was administered to the patient. The patient was notified of the error and returned to the clinic on the same day to receive properly diluted Pfizer COVID-19 mRNA vaccine. All COVID-19 vaccine administration halted at clinic until staff training/competency around Pfizer vaccine dilution can be implemented with two-person preparation process/verification to be implemented.


VAERS ID: 1783609 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-19
Onset:2021-10-07
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Bell's palsy, Computerised tomogram head, Facial paralysis, Full blood count, Metabolic function test
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, Elavil, Calcium carbonate, Zetia, levothyroxine, melatonin, magnesium, Protonix, Probiotic, Zanaflex, Effexor, Verapamil
Current Illness: none
Preexisting Conditions: hypothyroid, hyperlipidemia, seizure disorder, interstitial cystitis, GERD, migraines
Allergies: Bactrim
Diagnostic Lab Data: CT head 10/7/21 normal CBC and CMP10/7/21 normal
CDC Split Type:

Write-up: Reported to the emergency room 10/7/2021 with several hours of right facial droop. Diagnosed with Bell''s palsy. Treated with Prednisone and Valtrex. Seen in the office 10/13/21 with near 100% complete resolution of symptoms


VAERS ID: 1783774 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA NDC 80777-0273- / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Ear discomfort, Ear pain, Eye irritation, Glossitis, Glossodynia, Headache, Myalgia, Nasal congestion, Nausea, Ocular discomfort, Oropharyngeal pain, Pruritus, Rash, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test negative, Throat irritation, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Corneal disorders (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, childrens benadryl & chewables, ibuprofen, Tylenol severe sinus, triamcinolone acetone ointment, amlodipine besylate, fluticasone propionate nasal spray, dicyclomine 10mg capsules, estaryalla tablets, excedrin
Current Illness: Sinus and allergies
Preexisting Conditions: IBS, Hypertension and fatty liver
Allergies: Penicillin, amoxicillin, tagamet, sulfa, sudafed, robitussin, mucinex Latex gloves, nitrile, indoor/outdoor allergies, all nuts and seeds, all fruits
Diagnostic Lab Data: October 12 took COVID Test, negative results
CDC Split Type:

Write-up: Symptoms: itching, headache, stuffy ears, earache, sore throat and scratchy, muscle pain, scratchy eyes, pressure front of eyes, face rash, trouble tasting certain foods 1st 3 days, tongue is raw and painful, runny and stuffy nose, nausea and vomiting, stomach feels soar, congested. When to see doctor, prescribed triamcinolone ointment, benadryl and ibuprofen.


VAERS ID: 1783810 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test, Chest pain, Ultrasound scan, X-ray
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: No
Current Illness: None
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data: Completed Blood Test, Sonogram, and Xray
CDC Split Type:

Write-up: Chest pain localised to heart area; Visit to emergency room over heart conditions.


VAERS ID: 1783964 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-03
Onset:2021-10-07
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Full blood count, Generalised tonic-clonic seizure, Urinary incontinence, Urine analysis
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: CBC, Chem, Urine and Urine tox was done. Urine tox came back + for THC. Labs were run on Oct 7th at 0050.
CDC Split Type:

Write-up: Pt had no previous seizure hx and while with friends they said she appeared to have a grand mal seizure. Pt was incontinent of urine.


VAERS ID: 1784604 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / IM

Administered by: Private       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: None
CDC Split Type:

Write-up: Patient had a primary series with Moderna, yet was given a booster of Pfizer. No adverse event, just a vaccine choice error.


VAERS ID: 1784784 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cerebrovascular accident, Vomiting
SMQs:, Acute pancreatitis (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vomiting morning after shot, stroke on 10/08/2021 in the am.


VAERS ID: 1784963 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-10-05
Onset:2021-10-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 325mg, hydrochlorothiazide, vit d3 2000 units, zinc 50mg, pantoprazole, dorzolamide hydrochloride
Current Illness: no
Preexisting Conditions: no
Allergies: xanax
Diagnostic Lab Data: yes
CDC Split Type:

Write-up: Severe case of Bells Palsy. Went to ER


VAERS ID: 1784982 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Neck pain, Palpitations, Pharyngeal swelling, Pyrexia, Subclavian vein thrombosis, Swelling, Ultrasound Doppler abnormal
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol HFA, montelukast 10 mg nightly, escitalopram 20 mg daily, ropinirole 0.5 mg nightly, cholecalciferol 1000 units daily, ondansetron 8 mg daily, zolmitriptan 5 mg prn, loratadine 10 mg daily, biotin 5 mg daily
Current Illness:
Preexisting Conditions: Migraine, depression, asthma, restless leg syndrome, attention deficit disorder without hyperactivity
Allergies: Dimethicone - hives, itching, swelling rash
Diagnostic Lab Data: 10/7/21 - Upper Extremity Venous Doppler (confirmed large subclavian vein DVT)
CDC Split Type:

Write-up: 10/07/21: Patient reports fever (Over 100 degrees F) 10/08/21: Patient calls primary care office and reports swollen throat, headache, swelling of the upper neck area to shoulder. Patient is seen same day by primary care provider. At visit, patient states she felt fine this morning but suddenly noted feeling heart racing and pain in the neck/shoulder area on the right side. Obtained upper extremity venous doppler and confirmed patient has large subclavian vein DVT. Started patient on apixaban 10 mg BID for 7 days then 5 mg BID thereafter. Plan to likely treat for 6 months. Urgent referral placed to vascular surgery same day and appointment made for 10/15/21.


VAERS ID: 1784991 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Lethargy, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Fever 101, vomiting, lethargic


VAERS ID: 1785131 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-01
Onset:2021-10-07
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202, ER8733, / 3 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, Chills, Cough, Hyperhidrosis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Fever, chills, sweats, loss of taste and smell as well as cough. Received her booster. Patient was not around anyone that has been sick and has not traveled.


VAERS ID: 1785230 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 3 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram, Electrocardiogram, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient stated that he had a seizure 13 hours after receiving Moderna booster vaccine. Patient stated that he went to ER for treatment.


VAERS ID: 1785317 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Facial pain, Hypoaesthesia, Magnetic resonance imaging head normal, Paraesthesia, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: oxycodone, zoloft
Current Illness: none
Preexisting Conditions: restless legs, anxiety
Allergies: phenergan, ceclor
Diagnostic Lab Data: mri brain normal
CDC Split Type:

Write-up: Patient received her pfizer booster. The next day she began to experience itching on the left side of her face. Then she developed numbness and tingling on the left side of her face . She went to ER and had mri of her brain which was normal. I saw her in follow up. she has continued to experience constant numbness on the left side of her face. She reported that she will get a random occasional more painful "zing" in the same area.


VAERS ID: 1785373 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cellulitis, Infection, Injection site erythema, Injection site pain, Injection site pruritus, Injection site rash, Injection site swelling, Injection site warmth
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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Itching at Injection Site-Medium, Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Error: Infection / Cellulitis (diagnosed by MD)-, Additional Details: rash, redness, some swelling and heat around injection site. unclear whether reaction to vaccine or cellulitis from improper injection technique . patient went to urgent care to obtain an antibiotic and has recovered.


VAERS ID: 1785378 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature decreased, Cold sweat, Confusional state, Fatigue, Hyperhidrosis, Injection site haemorrhage, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: nothing notable
Preexisting Conditions: Diabetes Type 2
Allergies: Food allergies: peach, strawberry (many fruit drinks result in hives)
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient bled rather severely at administration due to likely hitting a blood vessel during administration. Patient reports one day after vaccination: fatigue, profuse sweating, very low-grade fever, cold sweats, low temperature. This progressed several days to day 4 (Sunday evening) fire department responded to patient reported unable to recognize surroundings and severe fatigue. They surveyed house for CO2 poisoning and did not find evidence of that. Patient declined hospitalization. Symptom improvement by 10/12/21 (got flu shot on 10/13/21 so must have felt much better).


VAERS ID: 1785399 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Disorientation, Fatigue, Hallucination, Hyperhidrosis, Nausea, Pyrexia, Weight decreased
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: 1 day post vaccination: severe fatigue, nausea, sweating, cold sweats, low-grade fever. Loss of 29 lbs in 1 week. Hallucinations, fire department responded to both he and his wife not being aware of surroundings and did CO2 house check. No signs of carbon monoxide poisoning. Patient refused hospitalization.


VAERS ID: 1785400 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Extra dose administered, Fall, Fatigue, Gait disturbance, Headache, Nausea, Pain, Pyrexia, Vertigo
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline - 150mg/day Trazodone - 50mg/day Multivitamin Vitamin D Fish Oil
Current Illness: None
Preexisting Conditions: Anxiety ASD
Allergies: Cow''s Milk Protein
Diagnostic Lab Data:
CDC Split Type:

Write-up: I received the vaccine on 10/6/21. In the early morning of 10/7/21 I woke up with nausea. I walked to the bathroom, then the kitchen holding onto walls and counters due to dizziness. When I reached the kitchen, vertigo began and I fell over as the room continued to spin. My spouse found me on the floor and helped me return to bed. During the day I experienced body aches, fever of 101.1, nausea, dizziness, headache, and extreme fatigue. It is now 8 days since the vaccine, and I still have intermittent dizziness, headache, and fatigue. (I did not experience any adverse effects from the first COVID vaccine, and I only experienced soreness at the injection site and a mildly elevated temperature, 99, from the second vaccine.)


VAERS ID: 1785445 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-30
Onset:2021-10-07
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood magnesium, Blood thyroid stimulating hormone, Chills, Dizziness, Feeling abnormal, Full blood count, Laboratory test, Metabolic function test, Migraine, Pain, Thyroxine, Vertigo, Vitamin B12
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prescriptions: levothyroxine for hypothyroidism, trazodone for sleep Over-the-Counter/Dietary Supplements/Herbal Remedies: Metamucil, Align probiotic, herbal equilibrium for hormonal imbalance, zinc, vitamin D3, fish oil, vitamin C, gluco
Current Illness: None
Preexisting Conditions: hypothyroidism, irritable bowel syndrome, arthritis
Allergies: None
Diagnostic Lab Data: 10/7/21 - Orthostatic vitals. Labs to include sedimentation rate, CBC with differential, comprehensive metabolic panel, magnesium, vitamin B12, TSH, T4 free.
CDC Split Type:

Write-up: Dose #1 - experienced vertigo symptoms for approximately 2 hours and then brain fog which resolved in 24 hours Dose #2 - The following day after second dose of COVID vaccine, experienced chills, body aches, and severe migraine (sensitive to light and sound). Six days after vaccine, began to experience moderate dizziness without nausea. Sought medical attention on day #7. No explainable reason for dizzy symptoms. Prescribed meclizine for dizziness. Now, two weeks after 2nd dose of vaccine, still experiencing dizziness on a daily basis.


VAERS ID: 1785601 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-02
Onset:2021-10-07
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Anion gap, Anticoagulant therapy, Atypical pneumonia, Blood bicarbonate normal, Blood glucose increased, Blood ketone body increased, Blood pH decreased, Breath sounds abnormal, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Condition aggravated, Diabetic ketoacidosis, Diarrhoea, Dyspnoea, Exposure to SARS-CoV-2, Fatigue, Feeling abnormal, Fibrin D dimer increased, Hypophagia, Inflammatory marker test, Insulin therapy, Muscle spasms, Myalgia, Nausea, Oedema peripheral, Pneumonia viral, Pyrexia, SARS-CoV-2 test positive, Type 2 diabetes mellitus, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Lactic acidosis (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (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 (broad), Pseudomembranous colitis (broad), Dystonia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: PMHx of HTN, DM2, asthma, depression admitted for acute hypoxic respiratory failure in setting of COVID-19 Pneumonia
Allergies: Ceclor, milk product, synvisc
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chief Complaint Patient has been having nausea and vomiting for the last 5 days. Has not eaten in three days. "started running a temp saturday night". No tylenol or ibuprofen today. Exposed to covid 2 weeks ago, tested neg on a rapid. History of Present Illness Patient is a 69 year old female with pmh DM2, HTN, depression, hypothyroidism, sleep apnea and asthma presenting to the ED today with complaints of fevers, nausea and diarrhea. In the ED patient was saturating at 87% on room air, improved to 95% with 2L NC. Found to be covid positive, although patient is vaccinated. She received 1L bolus of NS and reglan for nausea. Labwork revealing elevated D-dimer, and glucose of 445 with anion gap w/o acidosis. She received 10U insulin in ED with improvement of glucose to 391, received an additional 5U insulin. Beta hydroxybutyrate Upon interview, patient reports that 5 days ago she started to feel bad. Describes have fatigue, myalgias, fevers, nausea and diarrhea. Denies any emesis. Has has poor oral intake due to the nausea and has subsequently missed taking some of her home medications. Has been feeling short of breath which has been worsening over the past day or so which promoted her presentation to the hospital today. Notes that she is vaccinated against covid, but was exposed by her daughter who is also admitted with covid currently. Denies any chest pain, headache, sore throat or leg pain. Review of Systems All systems reviewed, and is negative except as noted in the HPI. Physical Exam Vitals & Measurements T: 36.5 ?C HR: 72 RR: 18 BP: 151/71 SpO2: 94% WT: 108.7 kg General: NAD Head: Normocephalic, Atraumatic Eyes: EOM intact, sclera clear Mouth: mucous membranes moist Respiratory: Diminished breath sounds in the bases, mild coarse breath sounds upper lobes, unlabored, symmetric chest rise Cardiovascular: RRR, no murmurs, normal S1/S2, +2/4 peripheral pulses bilaterally. Trace pitting edema bilateral LE Abdomen: soft, nontender, nondistended MSK: no gross deformities Neuro: alert and oriented, CN intact grossly, no focal neurologic deficits grossly Psych: normal affect and mood, cooperative Assessment/Plan Pt is a 69 year old F pmh HTN, DM2, asthma, depression admitted for acute hypoxic respiratory failure in setting of covid-19 pneumonia. Pt is vaccinated against covi-19, +recent exposure. Requiring 2L NC in ED, will draw inflammatory markers and start Remdesivir and Dexamethasone while titrating oxygen to maintain spO2 $g 92%. Also noted to have elevated glucose at 445 as pt missed medications at home, AG of 23 without acidosis. Glucose improved to 381 in ED after 10U insulin, given an additional 5U. Pt''s BHB returned elevated at 2.9, suspect in early DKA - will send to PCU for close monitoring/ possible need for insulin drip if glucose fails to downtrend. COVID-19 Pneumonia: - symptom onset: 10/2; Date positive 10/7 - CXR showing findings consistent with multifocal atypical/viral pneumonia. - elevated d-dimer 0.58 - doppler US b/l ordered - Inflammatory markers ordered and pending - Start Dexamethasone 6mg daily x10 days (10/7-10/17) - Start Remdesivir x 5 days (10/7-10/12) - Continue home inhalers - Albuterol, Advair and Incruse - requiring 2L NC, titrate as needed to maintain saturations $g 92% Diabetes Mellitus type 2 - home regimen metformin + insulin 70/30 50-55U BID - Glucose elevated on arrival 445, received 10U insulin ED with improvement to 381 - AG of 23, not acidotic on VBG - pH 7.33, HCO3 21.9 - BHB elevated 2.92 - Start Insulin Drip and DKA protocol - Hgb A1c ordered Asthma: - continue home inhalers: albuterol, Advair and Incruse HTN: - continue home amlodipine 10mg daily - continue home losartan 100mg daily Hypothyroidism - continue home levothyroxine Depression - continue home escitalopram, buspirone and amitriptyline - also takes minalciprin (Savella) at home, although not on formulary here so not continued Other chronic medical conditions: Muscle spasms - continue home tizanidine Code Status: Full Code Diet: Diabetic DVT ppx: Lovenox Disposition: PCU - likely downgrade in the morning if glucose controlled Patient staffed with attending physician Doctor.


VAERS ID: 1785618 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-19
Onset:2021-10-07
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Blood glucose normal, Breath sounds abnormal, COVID-19, COVID-19 pneumonia, Central obesity, Chills, Computerised tomogram thorax abnormal, Cough, Decreased appetite, Diarrhoea, Dyspnoea, Glycosylated haemoglobin, Headache, Hyperglycaemia, Inflammatory marker test, Laboratory test normal, Lung opacity, Myalgia, Nausea, Oropharyngeal pain, Oxygen saturation decreased, Pyrexia, SARS-CoV-2 test positive, Tachycardia, Ultrasound Doppler, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Lipodystrophy (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: pmh DM, HTN, HLD, bipolar and schizoaffective disorder
Allergies: seroquel
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chief Complaint pt seen in ER today for SOA, fever, sore throat, HA, N/D. Given fluids and d/c, pt has had no relief, took tylenol pta History of Present Illness Patient is a 43 year old Female with pmh DM, HTN, HLD, bipolar and schizoaffective disorder presenting for fevers, shortness of breath. In ED patient was put on 2L O2 via NC to maintain saturations. Found to be covid positive, despite being vaccinated. Patient was tachycardic so CT PE was obtained, negative for PE but showed findings consistent with COVID pneumonia. Labwork otherwise unremarkable with exception of elevated glucose at 199. Patient was admitted for new oxygen requirements. Upon interview, patient reports that 2-3 days ago she started to feel feverish/chills, reports headache, sore throat, myalgias. Also reporting cough and increasing shortness of breath over the last day, for which she presented to the ER today. She is nauseous and has been having diarrhea, but denies emesis. States she has not eaten much of anything in the last 2-3 days. Denies any She has taken her home medications as prescribed. She is vaccinated against covid, completed the series months ago. Denies any known sick contacts/exposure. Review of Systems All systems reviewed, and is negative except as noted in the HPI. Physical Exam Vitals & Measurements T: 36.8 ?C TMIN: 36.0 ?C TMAX: 36.8 ?C HR: 96 RR: 30 BP: 128/92 SpO2: 92% WT: 121.8 kg General: NAD Head: Normocephalic, Atraumatic Eyes: EOM intact, sclera clear Mouth: mucous membranes moist Respiratory: Dimished breath sounds throughout, no wheezes, rhonchi or rales, unlabored, symmetric chest rise Cardiovascular: RRR, no murmurs, normal S1/S2, +2/4 peripheral pulses bilaterally Abdomen: obese abdomen, soft, nontender, nondistended MSK: no gross deformities. No calf tenderness on palpation. No LE edema or redness. Neuro: alert and oriented, CN intact grossly, Psych: normal affect and mood, cooperative Assessment/Plan Patient is a 43-year-old female with DM, HTN, HLD, bipolar/schizoaffective admitted for acute hypoxic respiratory failure in setting newly diagnosed COVID-19 pneumonia. CT PE done negative for pulmonary embolism, findings consistent with Covid pneumonia. Labwork otherwise unremarkable, mildly hyperglycemic at 199. Inflammatory markers ordered and pending. Pt requiring 2-4 L oxygen via nasal cannula, may have component of underlying undiagnosed sleep apnea as desaturated while sleeping. Will start on dexamethasone, and titrate oxygen to maintain saturations greater than 92%. Acute Hypoxemic Respiratory Failure COVID 19 Pneumonia - sx onset 10/5; date positive 10/8. Is vaccinated against covid-19 - CT PE negative for PE but showing few bilateral patchy groundglass airspace opacities consistent with covid-19 pneumonia. - doppler US bilateral LE ordered - WBC wnl, Inflammatory markers ordered and pending - Requiring 2L via NC, initially requirement increased to 4L while sleeping (may have component of undiagnosed sleep apnea) - titrate supplemental oxygen to maintain sPO2 $g 92% - Continue home inhalers - albuterol, Fluticasone-salmetereol - Bronchodilator protocol - Start Dexamethasone 6mg daily - could consider initiating Remdesivir DM2: - on home regimen metformin 500mg once daily - Glucose elevated 199 on arrival, no evidence of AG or metabolic acidosis - will start SSI - hgb A1C ordered HTN: - continue home lisinopril 10mg daily Asthma: - continue home inhalers albuterol and fluticasone-salmeterol Bipolar/Schizoaffective Disorder: - continue home risperidone, Lamotrigine, Diazepam Code Status: Full Code Diet: Diabetic DVT ppx: Lovenox Disposition: Floor Patient to be staffed with attending physician.


VAERS ID: 1785664 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-27
Onset:2021-10-07
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Chills, Cough, Eye pruritus, Nasal congestion, Oropharyngeal pain, Sneezing
SMQs:, Anaphylactic reaction (narrow), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: sore throat, nonproductive cough, chills, loss of taste, , loss of smell, nasal congestion, sneezing, itchy eyes. Patient denies headache, fever, shortness of breath, diarrhea, ear pain, sinus congestion, postnasal drainage, chest congestion, chest tightness, chest pain, wheezing, ear fullness. starting 10/7/21


VAERS ID: 1785687 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-06
Onset:2021-10-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Nausea , body aches, redness to arm at the site


VAERS ID: 1785775 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-14
Onset:2021-10-07
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Dyspnoea, Headache, Nasal congestion, Pain, Paranasal sinus discomfort, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D; Calcium; Zinc; Vitamins B complex; Kelp Supplements; Turmeric; Omeprazole; Coalase; Flonase allergy relief; Fish Oil; Azelastine; Melatonin; Premarin vaginal cream; Larginale; CBD Oil
Current Illness: None
Preexisting Conditions: Acid Reflex; TMJ; Arthritis; Sleep apnea
Allergies: Vicodin; Gluten intolerance
Diagnostic Lab Data: Tested positive to COVID-19 test
CDC Split Type: vsafe

Write-up: Nasal congestion, sinus pressure, burning in my sinus, loss of taste, loss of smell. Headache, body ache, shortness of breath. Tested positive to COVID-19 test.


VAERS ID: 1785804 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Throat irritation
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, metformin, QVar , albterol
Current Illness:
Preexisting Conditions: HTN, DM, asthma, Bell''s Palsy, morbid obesity
Allergies: shrimp, iodine
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient received a J&J vaccine at 3pm, being observed for 30mins after the dose. Around 325pm, patient stated that she felt like something was stuck in her throat. Clinic RN reported she had none of the following: angioedema, swelling, SOB, CP. VSS. SBP 120s Sp02 98% RA. Patient was walked to ER for precaution checkout, confirmed negative for angioedema, patent oropharynx, A/O x3 with unclear etiology. Benign PE and VSS. Patient received dexamethasone 12mg PO X1. and famotidine 20mg x1 then BID x3 days, and was discharged uneventfully at 17pm on that day.


VAERS ID: 1785957 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-03-11
Onset:2021-10-07
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anticoagulant therapy, Blood test, Computerised tomogram thorax abnormal, Deep vein thrombosis, Echocardiogram, Electrocardiogram, Peripheral swelling, Pulmonary thrombosis, Ultrasound Doppler abnormal
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Flomax, Ibuprophin
Current Illness: none
Preexisting Conditions: enlarges prostate
Allergies: keflex
Diagnostic Lab Data: ultrasound of left calf, ct scan of lungs, ct scan of abdomen, ekg, echo cardiogram, extensive blood work all performed at hospital from Saturday October 9, 2021 to Monday October 11, 2021. Test results and records can be provided upon request,
CDC Split Type:

Write-up: my husband woke up on Thursday, October 7 with an extremely swollen left calf. It remained this way until Saturday, October9, 2021 at which time we went to the ER where he was diagnosed with a very large blood clot in his left calf and two clot in each of his lungs. Subsequently he was admitted to a hospital, was put on a Heparin drip. He remained hospitalized and was discharged on Monday, October 11, 2021. He is on a course of Eliquis 20 mg per day and blood pressure medication.


VAERS ID: 1785967 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness, Headache, Immunodeficiency, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu, shingles, and COVID vaccine
Other Medications: blood pressure medication
Current Illness:
Preexisting Conditions: Weakened immune system (SLE), Chemotherapy: Arasept once a month, post left knee full replacement eight weeks ago
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient reported experienced increased blood pressure as high as 200/100 within 15 min of any vaccine administration. Blood pressure increased in the past after flu vaccine and shingles vaccine. advised by PCP to double dose of blood pressure medication on day of vaccine. advised by PCP to receive third dose of COVID vaccine due to weakened immune system (SLE). patient experiencing bad headache, dizzy, nauseous within 10 min of vaccine administration, COVID vaccine administered at 1:13pm. 1:22pm BP 151/52, pulse 65 bpm, head pounding 1:34 pm BP 187/76, Pulse 68bpm O2 sat 100%, headache 1:45pm BP 180/67, Pulse 64, headache improving Patient declined EMS call and states this always happens and she will go home and rest.


VAERS ID: 1785975 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: PMH: Brain tumor @ 19yo; Asthma
Allergies: Allergies: Erythromycin, Oxycodone (itching), PCN (Itching)
Diagnostic Lab Data:
CDC Split Type:

Write-up: "Pt c/o dizziness 15mins post vaccination. Vitals: BP 138/80, HR 97, RR 18, Sat 100% Pt stable and released from the vaccination site PMH: Brain tumor @ 19yo; Asthma Medications Unkown Allergies: Erythromycin, Oxycodone (itching), PCN (Itching)"


VAERS ID: 1786350 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / UNK - / IM

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

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

Write-up: third dose of Pfizer was given 2 months after the 2nd dose


VAERS ID: 1786362 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-30
Onset:2021-10-07
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adenovirus test, Angiogram cerebral normal, Arteriogram carotid, Asthenia, Bordetella test negative, COVID-19, Cerebral ventricle dilatation, Chest X-ray normal, Chlamydia test negative, Computerised tomogram head abnormal, Coronavirus test negative, Cough, Enterovirus test negative, Gait disturbance, Human metapneumovirus test, Human rhinovirus test, Hypophagia, Inflammatory marker test, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Loss of personal independence in daily activities, Mental status changes, Mycoplasma test negative, Perfusion brain scan normal, Respiratory syncytial virus test negative, Respiratory viral panel, SARS-CoV-2 test positive, Scan with contrast, Viral test negative
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Outpatient Medications acetaminophen (TYLENOL) 500 mg tablet amLODIPine (NORVASC) 5 mg tablet atorvastatin (LIPITOR) 10 mg tablet carbidopa-levodopa (SINEMET) 25-100 mg per tablet cholecalciferol (VITAMIN D3) 1,250 mcg (50,000 unit) ca
Current Illness:
Preexisting Conditions: Non-Hospital Abdominal mass Headache(784.0) Hiatal hernia High risk medication use Hyperlipidemia Insomnia Learning disability Left leg DVT Lipoma Lumbago Memory loss Obesity Parkinson''s disease Post-thrombotic syndrome of left lower extremity Subcutaneous mass Vivid dream Sepsis, due to unspecified organism Arteriosclerosis of artery of extremity Onychomycosis Dystrophia unguium Impaired cognition
Allergies: VancomycinHives / Urticaria
Diagnostic Lab Data: 10/09/2021 1826 Respiratory virus detection panel Collected: 10/09/21 1826 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result Detected Critical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected 10/09/2021 1624 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 10/09/21 1624 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result Detected Critical CT angiogram head with and without contrast Result Date: 10/9/2021 CT ANGIOGRAM HEAD W WO CONTRAST, CT ANGIOGRAM NECK W WO CONTRAST, CT BRAIN PERFUSION W WO CONTRAST IMPRESSION: 1. No evidence of significant stenosis or other acute abnormality within major branch vessels of the Circle of Willis. 2. No arterial or other acute abnormality in the neck. 3. No perfusion deficit in the brain. If symptoms persist, consider MRI. END OF IMPRESSION: INDICATION: Stroke TECHNIQUE: CT angiography of the neck and brain was performed from the vertex to the lung apices with images reconstructed. Sagittal and coronal reformatted MIP images were additionally performed. 3D volume rendered images were created on an independent workstation and permanently recorded. CT perfusion imaging was performed utilizing perfusion mapping including cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP). CONTRAST: 150mL of IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION administered INTRAVENOUS. COMPARISON: None FINDINGS: CTA head: Right internal carotid: Petrous, cavernous, and intracranial segments normal in course and caliber. Left internal carotid: Petrous, cavernous, and intracranial segments normal in course and caliber. Anterior circulation: Normal course and caliber of bilateral middle and anterior cerebral arteries. No aneurysmal dilation of the anterior communicating artery. Posterior circulation: Normal course and caliber of intracranial segments of the bilateral vertebral, posterior inferior cerebellar, superior cerebellar, and basilar arteries. Normal course and caliber of the bilateral posterior cerebral arteries. CTA neck: Ascending aorta/arch: No significant aortic atherosclerotic disease. Brachiocephalic: Normal course and caliber with standard branching into the right common carotid and subclavian arteries. Right subclavian: Normal in course and caliber. Right vertebral: Normal in course and caliber. Left subclavian: Normal in course and caliber. Left vertebral: Normal in course and caliber. Right common carotid: Normal in course and caliber. Right internal carotid: Normal in course and caliber. Right external carotid: Normal in course and caliber. Left common carotid: Normal in course and caliber. Left internal carotid: Normal in course and caliber. Left external carotid: Normal in course and caliber. Mediastinum: Thyroid and thoracic inlet normal. No enlarged mediastinal lymph nodes. Esophagus normal. Lungs/pleura: Mild diffuse motion artifact with a mosaic attenuation pattern consistent with air trapping. No effusions or pneumothorax. Bones/soft tissues: Moderate spondylotic changes of the cervical spine without acute fracture or subluxation. CTP: The cerebral blood flow, cerebral blood volume, time to peak and mean transit time maps and curves are symmetric and unremarkable. No evidence of focal ischemia or infarction.. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray chest 2 views Result Date: 10/9/2021 XR CHEST 2 VW IMPRESSION: No significant findings or interval change. END OF IMPRESSION: INDICATION: Cough, weakness. TECHNIQUE: PA and lateral views of the chest were obtained. COMPARISON: Two-view chest of 11/29/2018. FINDINGS: Two views of the chest demonstrate normal cardiac and mediastinal contours. There is no evidence of infiltrate or consolidation. There is no pneumothorax noted. The bone and soft tissue structures are unremarkable. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. CT angiogram neck with and without contrast Result Date: 10/9/2021 CT ANGIOGRAM HEAD W WO CONTRAST, CT ANGIOGRAM NECK W WO CONTRAST, CT BRAIN PERFUSION W WO CONTRAST IMPRESSION: 1. No evidence of significant stenosis or other acute abnormality within major branch vessels of the Circle of Willis. 2. No arterial or other acute abnormality in the neck. 3. No perfusion deficit in the brain. If symptoms persist, consider MRI. END OF IMPRESSION: INDICATION: Stroke TECHNIQUE: CT angiography of the neck and brain was performed from the vertex to the lung apices with images reconstructed. Sagittal and coronal reformatted MIP images were additionally performed. 3D volume rendered images were created on an independent workstation and permanently recorded. CT perfusion imaging was performed utilizing perfusion mapping including cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP). CONTRAST: 150mL of IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION administered INTRAVENOUS. COMPARISON: None FINDINGS: CTA head: Right internal carotid: Petrous, cavernous, and intracranial segments normal in course and caliber. Left internal carotid: Petrous, cavernous, and intracranial segments normal in course and caliber. Anterior circulation: Normal course and caliber of bilateral middle and anterior cerebral arteries. No aneurysmal dilation of the anterior communicating artery. Posterior circulation: Normal course and caliber of intracranial segments of the bilateral vertebral, posterior inferior cerebellar, superior cerebellar, and basilar arteries. Normal course and caliber of the bilateral posterior cerebral arteries. CTA neck: Ascending aorta/arch: No significant aortic atherosclerotic disease. Brachiocephalic: Normal course and caliber with standard branching into the right common carotid and subclavian arteries. Right subclavian: Normal in course and caliber. Right vertebral: Normal in course and caliber. Left subclavian: Normal in course and caliber. Left vertebral: Normal in course and caliber. Right common carotid: Normal in course and caliber. Right internal carotid: Normal in course and caliber. Right external carotid: Normal in course and caliber. Left common carotid: Normal in course and caliber. Left internal carotid: Normal in course and caliber. Left external carotid: Normal in course and caliber. Mediastinum: Thyroid and thoracic inlet normal. No enlarged mediastinal lymph nodes. Esophagus normal. Lungs/pleura: Mild diffuse motion artifact with a mosaic attenuation pattern consistent with air trapping. No effusions or pneumothorax. Bones/soft tissues: Moderate spondylotic changes of the cervical spine without acute fracture or subluxation. CTP: The cerebral blood flow, cerebral blood volume, time to peak and mean transit time maps and curves are symmetric and unremarkable. No evidence of focal ischemia or infarction.. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. CT head stroke without contrast Addendum Date: 10/9/2021 An addendum was created to complete the call report process. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. Result Date: 10/9/2021 CT HEAD STROKE WO CONTRAST IMPRESSION: No acute intracranial pathology. END OF IMPRESSION: INDICATION: stroke. TECHNIQUE: Spiral CT scan through the head from the skull base through the vertex was performed with 5 mm axial reconstructions. Images obtained without contrast. CONTRAST: No contrast was administered. COMPARISON: November 29, 2018 FINDINGS: No acute hemorrhage, mass or mass effect is seen. No abnormal extra-axial fluid collections are identified. There is preservation of gray-white differentiation. The ventricles, cisterns, and other CSF containing spaces demonstrate stable mild ventriculomegaly, most consistent with central volume loss. Mild periventricular white matter hypoattenuation is seen consistent with chronic small vessel ischemic changes. Basal cisterns are patent and symmetric. The calvarium is intact. The visualized portions the aerated paranasal sinuses demonstrate mucoperiosteal thickening in the ethmoid sinuses. No air-fluid levels are seen. Mastoid air cells are clear. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. CT brain perfusion with and without contrast Result Date: 10/9/2021 CT ANGIOGRAM HEAD W WO CONTRAST, CT ANGIOGRAM NECK W WO CONTRAST, CT BRAIN PERFUSION W WO CONTRAST IMPRESSION: 1. No evidence of significant stenosis or other acute abnormality within major branch vessels of the Circle of Willis. 2. No arterial or other acute abnormality in the neck. 3. No perfusion deficit in the brain. If symptoms persist, consider MRI. END OF IMPRESSION: INDICATION: Stroke TECHNIQUE: CT angiography of the neck and brain was performed from the vertex to the lung apices with images reconstructed. Sagittal and coronal reformatted MIP images were additionally performed. 3D volume rendered images were created on an independent workstation and permanently recorded. CT perfusion imaging was performed utilizing perfusion mapping including cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and time to peak (TTP). CONTRAST: 150mL of IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION administered INTRAVENOUS. COMPARISON: None FINDINGS: CTA head: Right internal carotid: Petrous, cavernous, and intracranial segments normal in course and caliber. Left internal carotid: Petrous, cavernous, and intracranial segments normal in course and caliber. Anterior circulation: Normal course and caliber of bilateral middle and anterior cerebral arteries. No aneurysmal dilation of the anterior communicating artery. Posterior circulation: Normal course and caliber of intracranial segments of the bilateral vertebral, posterior inferior cerebellar, superior cerebellar, and basilar arteries. Normal course and caliber of the bilateral posterior cerebral arteries. CTA neck: Ascending aorta/arch: No significant aortic atherosclerotic disease. Brachiocephalic: Normal course and caliber with standard branching into the right common carotid and subclavian arteries. Right subclavian: Normal in course and caliber. Right vertebral: Normal in course and caliber. Left subclavian: Normal in course and caliber. Left vertebral: Normal in course and caliber. Right common carotid: Normal in course and caliber. Right internal carotid: Normal in course and caliber. Right external carotid: Normal in course and caliber. Left common carotid: Normal in course and caliber. Left internal carotid: Normal in course and caliber. Left external carotid: Normal in course and caliber. Mediastinum: Thyroid and thoracic inlet normal. No enlarged mediastinal lymph nodes. Esophagus normal. Lungs/pleura: Mild diffuse motion artifact with a mosaic attenuation pattern consistent with air trapping. No effusions or pneumothorax. Bones/soft tissues: Moderate spondylotic changes of the cervical spine without acute fracture or subluxation. CTP: The cerebral blood flow, cerebral blood volume, time to peak and mean transit time maps and curves are symmetric and unremarkable. No evidence of focal ischemia or infarction.. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. 10/09/2021 1624 COVID-19 PCR - Asymptomatic screening for admission Collected: 10/09/21 1624 | Final result | Specimen: Swab from
CDC Split Type:

Write-up: ED to Hosp-Admission to Current 10/9/2021 - present (5 days) Ambulatory dysfunction Principal problem Hospital Problem List Early-onset Parkinson''s disease Generalized weakness Ambulatory dysfunction COVID-19 Patient was brought to the hospital due to worsening weakness -Found to have COVID-19 positive?not hypoxic -?Cough at home, no fever or chills -Continue to monitor for any worsening symptoms, oxygen saturation, inflammatory markers #Parkinson disease -#Generalized weakness -We will increase Sinemet to 4 times a day -PT/OT evaluation?will need placement #Hypertension -Currently controlled -Continue with amlodipine with holding parameters Benign prostatic hypertrophy: Continue with Flomax Family is not sure whether patient is on therapeutic anticoagulation or not?stated she gets medication from. I have advised patient''s mom to take picture office medications and send the information to RN on the floor tomorrow Will hold off on Xarelto for now?we will keep on heparin for DVT prophylaxis CTA of the brain did not show any significant blockage shortness signs of stroke. Discussed with ED attending Discussed with patient''s mother at bedside # VTE Prophylaxis: heparin DNR (Do Not Resuscitate) # Disposition: ECF Primary Emergency Contact: (redacted) History of Present Illness Chief Complaint Patient presents with ? Weakness - Generalized ? Altered Mental Status Patient is presenting with generalized weakness that is worsening over the last couple of days. Patient was diagnosed with Parkinson disease and currently on Sinemet. He is getting home health services twice a day. Family has been noticing his gait is getting more stiff and he has hard time doing activities of daily living. Getting up from sitting position in bathroom is getting challenge. Also his oral intake has been decreasing. He did not had his breakfast or lunch today. Mother had noticed that he has been having cough for the last few days but no fever. No nausea vomiting or diarrhea. Patient is not able to answer properly whether he is has any change in his food taste--likely causing decrease in oral intake.


VAERS ID: 1786366 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-02-25
Onset:2021-10-07
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM98909 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain lower, Adenovirus test, Aortic arteriosclerosis, Bladder catheterisation, Bladder hypertrophy, Bladder trabeculation, Bordetella test negative, COVID-19, Chest X-ray abnormal, Chest pain, Chlamydia test negative, Computerised tomogram abdomen abnormal, Condition aggravated, Confusional state, Constipation, Cystitis, Delirium, Electrocardiogram, Hiatus hernia, Human metapneumovirus test, Hypoxia, Influenza B virus test, Influenza virus test negative, Lung hyperinflation, Prostatomegaly, Renal cyst, Renal impairment, Respiratory viral panel, SARS-CoV-2 test positive, Scan with contrast abnormal, Urinary tract infection, Vascular calcification
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TylenoL) 325 mg tablet albuterol HFA (PROVENTIL;VENTOLIN) 90 mcg/actuation inhaler ascorbic acid, vitamin C, (VITAMIN C) 500 mg tablet aspirin 81 mg tablet atorvastatin (LIPITOR) 80 mg tablet blood sugar diagnostic (ONET
Current Illness:
Preexisting Conditions: Nervous Cerebrovascular accident (CVA) due to thrombosis of precerebral artery Nonintractable epilepsy with complex partial seizures Lumbar pain Type 2 diabetes mellitus with ophthalmic complication, with long-term current use of insulin Occlusion and stenosis of precerebral artery with cerebral infarction Acute CVA (cerebrovascular accident) Seizure Stroke-like symptoms Acute metabolic encephalopathy Abdominal pain Chest pain Respiratory OSA (obstructive sleep apnea) Pulmonary nodules Circulatory Essential hypertension Venous insufficiency Peripheral vascular disorder due to diabetes mellitus Chronic diastolic heart failure Bilateral carotid artery stenosis Symptomatic stenosis of right carotid artery Digestive Gastroesophageal reflux disease without esophagitis Vitamin D deficiency Morbid obesity Genitourinary Diabetic nephropathy associated with diabetes mellitus due to underlying condition Diabetic nephropathy associated with type 2 diabetes mellitus Stage 3b chronic kidney disease AKI (acute kidney injury) Urinary retention Catheter-associated urinary tract infection Acute cystitis with hematuria Acute prostatitis Obstructive uropathy UTI (urinary tract infection) UTI (urinary tract infection) Urinary tract infection in male Other microscopic hematuria Musculoskeletal Acquired lipodystrophic diabetes Onychomycosis Endocrine/Metabolic Hyperlipidemia, mixed Dysmetabolic syndrome X Lactic acidosis Hyperglycemia Azotemia Infectious/Inflammatory COVID COVID-19 Immune Psoriasis Severe sepsis Sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present Sepsis Other Maladaptive health behaviors affecting medical condition Male erectile disorder of organic origin Microalbuminuria Mental status alteration Weakness MRSA bacteremia Hematuria
Allergies: LisinoprilCoughing
Diagnostic Lab Data: Collected Procedure 10/07/2021 2330 Respiratory virus detection panel Collected: 10/07/21 2330 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result Detected Critical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected IMAGING: ECG 12-lead: HOSPITAL or TEST FACILITY Once Chest pain Result Date: 10/11/2021 Measurements Intervals Axis Rate: 69 P: 47 PR: 137 QRS: 68 QRSD: 99 T: 108 QT: 392 QTc: 422 Interpretive Statements Sinus rhythm with occasional ventricular premature complexes Nonspecific T-wave abnormality Electronically Signed On 10-11-2021 13:43:20 EDT ECG 12-lead: HOSPITAL or TEST FACILITY Once Chest pain Result Date: 10/8/2021 Measurements Intervals Axis Rate: 69 P: PR: -1 QRS: 50 QRSD: 105 T: 165 QT: 392 QTc: 420 Interpretive Statements ECTOPIC ATRIAL RHYTHM NONSPECIFIC ST & T-WAVE ABNORMALITY Electronically Signed On 10-8-2021 7:10:43 EDT ECG 12-lead: HOSPITAL or TEST FACILITY Once History of heart disease Result Date: 10/5/2021 Measurements Intervals Axis Rate: 56 P: 13 PR: 156 QRS: 43 QRSD: 109 T: 118 QT: 430 QTc: 418 Interpretive Statements SINUS BRADYCARDIA INFERIOR Q WAVES Electronically Signed On 10-5-2021 17:58:23 EDT X-ray chest 2 views Result Date: 10/7/2021 XR CHEST 2 VW IMPRESSION: 1. Stable chest compared with 10/2/2021. 2. Hyperinflated lungs. No edema or pneumonia. END OF IMPRESSION: INDICATION: cp. TECHNIQUE: PA and lateral projections of the chest are acquired. COMPARISON: 10/2/2021 FINDINGS: Lungs are hyperinflated and clear. Stable heart, mediastinum, pleural space. Loop recorder noted in the anterior chest wall. Stable diffuse age-related degenerative changes in the spine. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray chest 2 views Result Date: 10/2/2021 XR CHEST 2 VW IMPRESSION: No acute abnormality of the chest. END OF IMPRESSION: INDICATION: +worsening renal function, daughter concerned of patient seeming winded. TECHNIQUE: Frontal and lateral projections of the chest are acquired. COMPARISON: 8/27/2021 FINDINGS: Recording device anterior left chest stable. No acute pleural-parenchymal or cardiovascular abnormality is seen. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. CT abdomen pelvis with contrast Result Date: 10/2/2021 CT ABDOMEN PELVIS W CONTRAST IMPRESSION: Malpositioned Foley catheter with balloon inflated within an enlarged prostate gland. Repositioning is recommended. Diffuse bladder wall thickening suggestive of infection and/or trabeculation. Recommend correlation with urinalysis. END OF IMPRESSION: INDICATION: Left lower quadrant abdominal pain. Constipation. Recent history of urosepsis. TECHNIQUE: Helical CT scan of the abdomen and pelvis with contrast was performed with 3 mm axial reconstruction. MPR coronal and sagittal images were also created. CONTRAST: 80mL of IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION administered INTRAVENOUS. COMPARISON: CT of the abdomen and pelvis of 8/27/2021. FINDINGS: Lung bases are clear. No pleural or pericardial effusions demonstrated. There is a small hiatal hernia. The liver, gallbladder, pancreas, spleen and adrenal glands are unremarkable. There is a 2.4 cm parapelvic cyst of the right kidney. Additionally there is a probable cortical cyst of the lower pole the right kidney. The kidneys are otherwise unremarkable. There is no hydronephrosis. There is a diffuse thickening of the bladder wall. There is a malpositioned Foley catheter. The balloon is inflated within an enlarged prostate gland. Repositioning is recommended. There are no dilated bowel loops. There is sigmoid diverticulosis without evidence of diverticulitis. There is no evidence of an inflammatory process in left lower quadrant. There is extensive calcified plaque throughout the abdominal aorta and iliac arteries. There is no aneurysmal dilatation of the abdominal aorta. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient.
CDC Split Type:

Write-up: ED to Hosp-Admission Discharged 10/7/2021 - 10/13/2021 (6 days) COVID-19 Principal problem Hospital Course Hospital Course: 80-year-old male past medical history significant for type 2 diabetes mellitus BPH stage III CKD was admitted to the hospital because of mild hypoxemia secondary to COVID-19 infection. He was initially started on Decadron remdesivir however he has been saturating well on room air therefore Decadron remdesivir was discontinued. He was found to have urinary tract infection present on admission for which she completed a course of antibiotics during this hospitalization. He came to the hospital with a Foley catheter. His Foley catheter was discontinued and bladder scans were done. Patient was able to urinate on his own with the help of finasteride and Flomax. His Foley catheter has been discontinued. If he has urinary problems please have him reevaluated by urology on outpatient basis. He developed confusion and hospital-acquired delirium during his hospitalization which has been resolved. Physical Occupational Therapy evaluated the patient and recommended home with home health care services. He is being discharged instruction to follow-up with his family doctor within 1 week.


VAERS ID: 1786681 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Chills, Dizziness, Headache, Immediate post-injection reaction, Injection site pain, Migraine, Nausea, Night sweats, Pain, Pain in extremity, Pyrexia, Vision blurred, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Immediate headache Soreness in arm Nausea within 1 hour Fever lasting 48 hours, spiking to 103f & breaking 10/9/21 Violent Vomiting- 12 hours after receiving jab Persistent Headache- migraine status to 72 hours Chills, aches, night sweats to 72 hours post jab Nausea past 72 hours post jab Unsteady when standing -- 24 to 60 hours Dizzy, blurred vision-- immediately to 60 hours post jab Extreme soreness at injection site-- lasted beyond a week post jab


VAERS ID: 1787746 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-07
Onset:2021-10-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Back pain, Diarrhoea, Dyspnoea, Fatigue, Injection site pain, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Tiredness, difficulty breathing, soreness at injection site, diarrhea, muscle soreness, back pain, joint pain, fatigue, fever. This vaccine was worse/harder on my body then actually being tested positive for COVID-19.


VAERS ID: 1782191 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-10-07
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211007; Test Name: COVID-19 virus test; Result Unstructured Data: Positive
CDC Split Type: DEJNJFOC20211015950

Write-up: CONFIRMED VACCINATION FAILURE; CONFIRMED COVID-19 INFECTION; This spontaneous report received from a patient concerned a 29 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: XD985 expiry: UNKNOWN) dose was not reported, 1 total, administered on 17-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 04-Oct-2021, the patient experienced COVID related complaints. On 07-OCT-2021, COVID was confirmed (confirmed covid-19 infection, confirmed vaccination failure). Laboratory data included: COVID-19 virus test (NR: not provided) Positive. On 07-OCT-2021, at the time of report, patient had mild cough, no fever, sore throat, low voice like a slight cold. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from confirmed covid-19 infection, and the outcome of confirmed vaccination failure was not reported. This report was serious (Other Medically Important Condition). This report was associated with a product quality complaint.; Sender''s Comments: V0: 20211015950-covid-19 vaccine ad26.cov2.s- Confirmed vaccination failure. This event is considered not related. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1763694 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2nd dose, heart racing, increase bp, onset of GAD
Other Medications: Losartan, setraline, crestor, garlique
Current Illness: Elevated blood pressure, headache
Preexisting Conditions: High blood pressure, high cholesterol
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Racing heartbeat at 12 hours post vaccine


VAERS ID: 1764301 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram abnormal, Anticoagulant therapy, Chest pain, Computerised tomogram thorax abnormal, Dyspnoea, Pulmonary embolism
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Loryna, venlafaxine
Current Illness: COVID in August
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CT angiogram chest 10/6/21
CDC Split Type:

Write-up: Dyspnea and Chest pain, Pulmonary Emboli, Apixaban, admitted to hospital for further workup


VAERS ID: 1764533 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-09-30
Onset:2021-10-06
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC-3184 / 2 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Erythema, Neck pain, Pain of skin, Pruritus, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamictal 150mg BID, tri-sprentec tablet daily, zolfot 50mg daily
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Woke up on morning of 10/6/2021 at 0645 with redness and swelling of neck, primarily left sided. Itchy and painful feeling like blistering sunburn. No new products were used, no new exposures, no history of allergic reactions. Temperature 97.3, neck warm to touch.


VAERS ID: 1764562 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-09-30
Onset:2021-10-06
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Humalog Vitamin D Toprol XL atorvastatin
Current Illness: Newly diagnosis of SVT July 2021
Preexisting Conditions: Type 1 diabetic
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heart rate 163 beats per min. at 01:00 am on 10/6/2021.


VAERS ID: 1764576 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 LA / SYR

Administered by: Other       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: None
CDC Split Type:

Write-up: Fever, headache body aches


VAERS ID: 1764594 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA FE3592 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion Buspirone Dulera Janumet Levothyroxine Montelukast Ventolin Allegra Biotin Nasalcrom Vitamin C Vitamin D
Current Illness:
Preexisting Conditions:
Allergies: Penicillin Benadryl Darvocet
Diagnostic Lab Data:
CDC Split Type:

Write-up: ipsilateral supraclavicular lymphadenopathy


VAERS ID: 1764611 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / -

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

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

Write-up: Patient had wanted Janssen vaccine and was given Pfizer in error. No treatment, but explained she would now need to get a 2nd dose of Pfizer in 21 days.


VAERS ID: 1764623 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Extra dose administered, Lymphadenopathy, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: similar lymphadenopathy with Pfizer covid vaccine #2 - forgot to report to VAERS. Resolved in approx one week. no further issu
Other Medications: daily multivitamin only
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: swollen, tender supraclavicular and infraclavicular lymphadenopathy


VAERS ID: 1764678 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 3 RA / IM

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

Write-up: Patient received two of the same vaccine - Pfizer dose 3 (booster). Patient intended to receive one COVID booster and one influenza vaccine, but after getting the first vaccine he sat down at another COVID vaccine table instead of the influenza table.


VAERS ID: 1764733 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Interchange of vaccine products
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: Developmental Disabled
Allergies: Amoxicillin, Pedizole
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received Moderna as primary series. Received Pfizer vaccine as a booster. Did not have vaccine card present.


VAERS ID: 1764780 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 LA / IM

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

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

Write-up: Patient started feeling dizzy after receiving the second dose. He was given water and asked to sit for a while. He felt somewhat better and went home.


VAERS ID: 1764797 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-11
Onset:2021-10-06
   Days after vaccination:209
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / UNK LA / -

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest pain, Echocardiogram, Electrocardiogram ambulatory, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: vit c iron
Current Illness: none
Preexisting Conditions: epstein-barr
Allergies: elderberry penicillin codeine demerol Benadryl morphine
Diagnostic Lab Data: blood work chest xray echocardiogram Holter monitor
CDC Split Type:

Write-up: chest pain BP 250/195 pulse rate 40''s blacking out


VAERS ID: 1764823 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-04
Onset:2021-10-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan, Lo Loesterin, Famitodine, Mucinex, methotrexate, ashwagandha, probiotic, collagen, multivitamin, vit. D, zinc, magnesium, fish oil, ginko
Current Illness: None
Preexisting Conditions: Granulomatosis with polyangiitis (Wegener''s Granulamatosis), hypertension.
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Swollen area near clavicle (lymph node maybe). Appx the size of a pingpong ball but flattened and not fully round. Sore, tender to the touch in area on and around the swelling.


VAERS ID: 1764825 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0716C21A / 2 - / SYR

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

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

Write-up: Massive headache, everything hurts, nausea, throwing up, stuffed up head


VAERS ID: 1764867 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-04
Onset:2021-10-06
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1764868 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

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

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

Write-up: pt received 3rd dose of covid 19 vaccine. Pt lost consciousness in chair and was placed on floor by 2 corpsmen. Feet were elevated. Pt woke up about 10 seconds later, A&O x4. Pt stated this has happened before with venipuncture but never a vaccine. VSS. RRT arrived and transported patient to ED in stable condition.


VAERS ID: 1764870 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Muscular weakness, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: LEVOTHYROXINE PROZAC
Current Illness:
Preexisting Conditions:
Allergies: PENN SULFA GLUTEN
Diagnostic Lab Data:
CDC Split Type:

Write-up: FATIGUE, FEVER OF GREATER THAN 101.5 FOR APPROX 9 HOURS, CHILLS, MUSCLE WEAKNESS


VAERS ID: 1764908 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: SULFA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt felt nauseated and dizzy after the Janssen vaccination; pt was sitting in the observation area and confronted by RN; pt placed on gurney to be evaluated; vitals taken q5 mins; pt relieved of nausea and dizziness after consuming nutrients and fluids (240ml of apple juice, 240 ml of water); Vitals: 10/06/21 0823 10/06/21 0830 10/06/21 0835 BP: 124/77 100/60 115/74 BP Patient Position: SITTING SITTING STANDING BP Location: RA-RIGHT ARM RA-RIGHT ARM RA-RIGHT ARM Pulse: 84 85 89 Resp: 18 18 18 Temp: 97.2 ?F (36.2 ?C) 97.2 ?F (36.2 ?C) SpO2: 98% 97% 99% Height: 5'' 3" (1.6 m) 5'' 3" (1.6 m)


VAERS ID: 1764953 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / -

Administered by: Military       Purchased by: ?
Symptoms: Extra dose administered, Rash, Rash erythematous, Swelling, Vaccine positive rechallenge
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VITAMINE D3
Current Illness: DENIES
Preexisting Conditions: HTN
Allergies: NKDA
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PATIENT REPORTS RASH BILATERAL ARMS AND LEGS THAT STARTED AT 0400 AFTER HER THRID DOSE. RASH HAS SLIGHT REDNESS WITH SWELLING, BUT PATIENT DENIES ITCHING. SHE REPORTED SAME RASH AFTER HER FIRST AND SECOND DOSE. DENIES SHORTNESS OF BREATH OR CHEST PAIN. EDUCATATED PATIENT THAT RASH MAY OCCUR AFTER THE VACCINE. ADVISED PATIENT TO TAKE OTC BENADRYL FOR RASH AND ACETAMINOPHEN FOR PAIN. PATIENT DENIES EMERGENCY AND WILL CONTINUE TO MONITOR.


VAERS ID: 1764956 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect 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: not applicable
Current Illness: not applicable
Preexisting Conditions: not applicable
Allergies: not applicable
Diagnostic Lab Data: not applicable
CDC Split Type:

Write-up: Vaccine was reconstituted with less than the required amount of sterile dilutant. Patient was given the vaccine at a higher concentration than recommended.


VAERS ID: 1764976 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 RA / IM

Administered by: Pharmacy       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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Lung issues
Allergies: Unknown
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The patient received Moderna for the first two doses of the COVID-19 vaccine series and presented to the pharmacy to receive a booster dose of Pfizer BioNTech COVID-19 vaccine. Patient received the Pfizer BioNTech COVID-19 vaccine for the 3rd dose, so this form is being submitted due to the error of not receiving the primary series of the Pfizer BioNTech COVID-19 vaccine prior to receiving the Pfizer BioNTech COVID-19 booster.


VAERS ID: 1764994 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia, Nausea, Tinnitus
SMQs:, Acute pancreatitis (broad), Taste and smell disorders (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (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: Within 24 hours felt nauseous, tinnitus in both ears, metal taste in my mouth


VAERS ID: 1765001 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Feeling jittery, Headache, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: Patient started feeling lightheaded, reported feeling fast heart rate, jittery, headache.


VAERS ID: 1765006 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flank pain, Migraine, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Retroperitoneal fibrosis (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: Naltrexone 4.5 mg, Nystatin 1,000,000 iu BID TERBINAFINE 250 mg q d Melatonin 120 mg q Hs Amphotericin B 200 mg BID FISH OIL VIT C
Current Illness: NONE
Preexisting Conditions: CVID Mold biotoxin illness Hashimotos Thuroiditis
Allergies: Diflucan?$g hives
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Hives on chin Moderate bilateral flank pain Migraine headache


VAERS ID: 1765007 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-07
Onset:2021-10-06
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

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

Write-up: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1765025 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / SC
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / SC

Administered by: Private       Purchased by: ?
Symptoms: Dysgeusia, Paraesthesia oral
SMQs:, Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: FLU VACCINE - SAME ADVERSE RESPONSE AS TODAY
Other Medications: LIPITOR, ZOLOFT
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: XYVOX
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: METALLIC TASTW, TINGLING OF LIPS


VAERS ID: 1765039 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dyspnoea, Rales
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: flu
Other Medications: Keppra - weaning off
Current Illness: none noted
Preexisting Conditions: history of seizures
Allergies: flu vaccine, eggs, peanut, almond, Propofol, fentanyl
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was given the Pfizer Covid vaccine at 0938 and was placed to be observed. She started showing signs of SOB at 0950 and was placed in an Exam room. O2 was applied at 0953 at 2 L 911 was called at 0953 Patient was communicating and never lose conscious. HR 147, O2 stat was 97 Epi 0.3 ml given at 0955 RN and NP were in the room with me assisting. EMS arrived at 1002. O2 was increased and Nebulizer applied due to reported Rails in lungs Additional Epi was given by EMS 1010 patient said her brother was outside in the car. She produced her phone and found his number and Her Brother was called who was waiting outside the building and instructed that she was going to be taken to Medical Center and directions were given.


VAERS ID: 1765057 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-04
Onset:2021-10-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D3 125mcg Omeprazole Dr 40 mg Escitalopram 20mg Carisoprodol 350mg Oxycodone-Acetaminophen 5-325mg Gabapentin 400mg Melatonin 10mg Methylprednisolonb 4mg dose pack
Current Illness: no
Preexisting Conditions: Asthma Microscopic colitis
Allergies: all melons sulpha Dilaudid Demerol Dicloxacillin
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Patient report that after speaking with the cdc this morning she was adv that by her being on steroids she should not have been given the vaccine...She stated that after the vaccine she gets rapid increase of heart beat


VAERS ID: 1765078 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, Dyspnoea, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: anaphylaxis
Other Medications: Wellbutrin, Claritin, Ibuprofen as needed, possibly Q-Symvia
Current Illness: None
Preexisting Conditions: Anxiety
Allergies: Moderna Vaccine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient planned to wait for 60 minutes post vaccination due to prior allergic reaction to Moderna. At 45 min, she began having throat swelling, difficulty swallowing, and labored breathing. Epi pen given, albuterol started, and 6 L of 02 placed. EMS arrived within 5 min and transported to the ED.


VAERS ID: 1765117 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-04
Onset:2021-10-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Folic acid, 1000mg Methotrexate (suspended for vaccination a week before vaccination) Stelara (suspended for vaccination and have not had a shot for 10 weeks)
Current Illness: Psoriatic arthritis
Preexisting Conditions: Psoriatic arthritis
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph nodes, ipsilateral to vaccination site. Pain around lymph nodes.


VAERS ID: 1765144 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-10-04
Onset:2021-10-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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: N/a
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: N/a
Diagnostic Lab Data: None provided
CDC Split Type:

Write-up: Fatigue , nausea, skin pale, headache, dizziness


VAERS ID: 1765150 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, Fatigue, nausea


VAERS ID: 1765181 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-26
Onset:2021-10-06
   Days after vaccination:133
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Fall, Rhabdomyolysis, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Rhabdomyolysis/myopathy (narrow), Neuroleptic malignant syndrome (broad), Accidents and injuries (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vitamin D, Vitamin C, Zinc, B12, Metoprolol, Aspirin, donepezil, rosuvastatin
Current Illness: None
Preexisting Conditions: Dementia, arthritis, HTN, HLD, AAA s/p stent repair
Allergies: Penicillin
Diagnostic Lab Data: COVID PCR test +
CDC Split Type:

Write-up: Breakthrough COVID-19 infection on 10/06/2021 found on admission to the hospital s/p unwitnessed fall and rhabdomyolysis


VAERS ID: 1765192 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Consciousness fluctuating, Fall, Syncope, Urinary incontinence
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received his first dose of Pfizer Covid-19 vaccine. He seemed fine other than being a little nervous and reluctant to receive the shot. The screening questionnaire we conduct with all patients looking to receive vaccination checked out fine - no abnormalities, no prior reactions to any vaccines, no allergies, etc. A few minutes after administering the vaccine, the patient came up to the pharmacy counter and was leaning on it, then proceeded to faint and fall to the floor. He went in and out of consciousness for about a minute before he was able to sit himself up. He also involuntarily urinated. Once he regained consciousness, I gave him a bottle of orange juice and another team member activated EMS. EMS arrived within about 5 to 10 minutes, and checked his vitals. Everything checked out fine. The patient refused to leave with EMS to be admitted to the hospital. After EMS left, he stayed in the pharmacy waiting room and waited for his girlfriend to come picked him up. He was here about 45 minutes total, and seemed fine when he left with her.


VAERS ID: 1765236 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 1 LA / IM

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

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

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


VAERS ID: 1765249 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, chills, headache,fatigue, joints ache


VAERS ID: 1765275 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dizziness, Lethargy
SMQs:, Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: dizziness, lethargic


VAERS ID: 1765296 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-27
Onset:2021-10-06
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6995 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Feeling abnormal, Oxygen saturation decreased, Pyrexia, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: hospitalized 10/6 - fully vaccinated for COVID19, has yet to get booster, with PMH of HTN, HLD who presented to the ED with complaints of SOA. Pt reports that he started feeling poorly 4 days PTA on 10/2/21 with congestion, dry cough, low grade fever and fatigue. He went to the pharmacy for a rapid COVID test and was diagnosed on 10/3/21. He reports that he has since been monitoring his O2 and his O2 was 88% today, so he came in for evaluation.


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