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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 256 out of 8,010

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VAERS ID: 1689138 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER FC3183 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Arthralgia, Chills, Diarrhoea, Dizziness, Fatigue, Feeling cold, Feeling hot, Headache, Hot flush, Immediate post-injection reaction, Musculoskeletal stiffness, Nausea, Neck pain, Pain, Pain in extremity, Paraesthesia, Skin warm
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin ER 500mg
Current Illness: Type 2 Diabetic Shingles
Preexisting Conditions: Type 2 Diabetic Lactose Intolerance IBS Acid Reflux Insomnia Anxiety Asthma Vitamin D deficiency Peripheral Neuropathy Allergic Rhinitis Shingles
Allergies: Penicillin Amoxicillin Aloe Nitrous Erythromycin Milk Lisinopril
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left arm got instantly hot, hand started hurting, shoulder pain, neck pain, dizziness, nausea, headache, face got very hot and felt like a sunburn. About two hours after the shot, I developed diarrhea, stomach cramping, chills, both feet started feeling hot, hurting, tingling and throbbing. Then in two days my right hand started hurting, back of left leg is is hurting, non stop nausea, headache, hot/cold, stiff neck, very tired.


VAERS ID: 1689247 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-22
Onset:2021-09-06
   Days after vaccination:196
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Cough, Dyspnoea, Endotracheal intubation, Lung disorder, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 81mg, Lasix 20 mg, ruxolitinib phosphate (Jakafi), tessalon
Current Illness: Polycythemia Vera, OSA on CPAP, H. pylori, HTN, Microscopic ischemic colitis
Preexisting Conditions: Polycythemia Vera, OSA on CPAP, chronic low back pain, H. pylori gastritis, HTN, Microscopic Ischemic Colitis, JAK2 V6 17F+
Allergies: Penicillins, Hydrocodone
Diagnostic Lab Data: COVID PCR positive 8/31/21 Chest Xray 9/6/21 ET tube tip lies at the level the mid trachea. The heart size and vascularity are within normal limits. Bilateral patchy airspace disease is present, most pronounced in the lung bases. This had an organizing pneumonia pattern on prior CT. There is no pneumothorax or pleural effusion.
CDC Split Type:

Write-up: Patient was fully vaccinated with Pfizer COVID-19 vaccine on 1/29/21 and 2/22/21. Patient admitted to reporting hospital on 9/6/21 as a transfer from Hospital. Admitting diagnosis is worsening COVID pneumonia requiring intubation. Patient was reported to arrive at ER after having 10-14 days of symptoms relating to cough. Over the last 5 to 6 days she then began having progressive difficulty breathing. Pt is still currently admitting at another hospital.


VAERS ID: 1689263 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 RA / IM

Administered by: Other       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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient was given first dose of Moderna on 9/6 after previously receiving J&J Vaccine on 7/16


VAERS ID: 1689309 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 RA / IM

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

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

Write-up: Patient received dose of Moderna on 9/6 . He had received a previous dose of Moderna 8/31/2021


VAERS ID: 1689322 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 RA / IM

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

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

Write-up: Patient received 2nd dose of Moderna on 9/6/2021 after receiving the first dose on 8/15/2021


VAERS ID: 1689397 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-03
Onset:2021-09-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Hordeolum, Periorbital cellulitis
SMQs:, Ocular infections (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: 1. Hordeolum externum of right lower eyelid - amoxicillin-clavulanate (AUGMENTIN) 875-125 mg per tablet; Take 1 tablet by mouth 2 (two) times a day for 10 days. Dispense: 20 tablet; Refill: 0 2. Periorbital cellulitis of right eye - amoxicillin-clavulanate (AUGMENTIN) 875-125 mg per tablet; Take 1 tablet by mouth 2 (two) times a day for 10 days. Dispense: 20 tablet; Refill: 0 -Rest -Hydration -Avoid eye rubbing -Warm compress -Advised to start Polytrim and oral antibiotics to cover for potential periorbital cellulitis -Advised follow-up tomorrow. -ER precautions explained


VAERS ID: 1689421 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-15
Onset:2021-09-06
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cardiovascular disease
Allergies:
Diagnostic Lab Data: 09/06/2021 PCR+ COVID-19 test at Medical Center
CDC Split Type:

Write-up: Breakthrough COVID-19 case and hospitalization (9/6/2021--)


VAERS ID: 1689639 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-04-28
Onset:2021-09-06
   Days after vaccination:131
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 pneumonia, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cyclobenzaprine, Guaifenesin, Levothyroxine, Medrozyprogesterone, Multivitiams, Vitamin D3
Current Illness: None
Preexisting Conditions: Alcohol dependence, Depressive disorder, Hepatitis C antibody test positive, Alcohol abuse, Hypothroidism, Chronic Thoracic back pain, Vitamin D deficiency
Allergies: Amoxicillin
Diagnostic Lab Data: 9.6.21 Covid 19 test detected.
CDC Split Type:

Write-up: Seen at Hospital for Shortness of breath. DX with viral Covid pneumonia. Seen in emergency room only.


VAERS ID: 1689644 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-01
Onset:2021-09-06
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Decreased appetite, Dyspnoea, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Coronary Atherosclerosis disease, CHF, Diabetes, Hypertension, Morbid Obesity
Allergies: NKA
Diagnostic Lab Data: SARS COVID-19 PCR
CDC Split Type:

Write-up: Dyspnea, Fever, decreased appetite. Patient fully Covid-19 vaccinated with Moderna with Covid-19 positive


VAERS ID: 1689662 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-05
Onset:2021-09-06
   Days after vaccination:154
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Coreg, Cardura, Drisdol, Papcid, Lasix, Amaryl, Norco, Flomax, Diovan HCT
Current Illness:
Preexisting Conditions: Diabetes mellitus, GERD, HTN, prostate cancer, hyperlipidemia
Allergies: NKDA
Diagnostic Lab Data: COVID detected swab 09/06/2021
CDC Split Type:

Write-up: Fully COVID vaccinated patient admitted to the hospital through ED for shortness of breath. Hypoxic in ED with O2 at 75% with ambulation. Wears O2 2L/NC at home - returned with home 2 L.


VAERS ID: 1690326 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-25
Onset:2021-09-06
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anti-cyclic citrullinated peptide antibody, Antinuclear antibody, C-reactive protein, Chlamydia test, Ear swelling, Full blood count, HIV test, Hepatitis B virus test, Hepatitis C virus test, Lipids, Peripheral swelling, Red blood cell sedimentation rate, SARS-CoV-2 test negative, Skin burning sensation, Streptococcus test, Treponema test, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Pre diabetic, occasional seasonal allergies
Allergies: Penicillin, sulfa, ragweed pollen
Diagnostic Lab Data: All on 9/9/21Covid 19 test negative CBC Lipids Sedimentation rate C reactive protein CCP Strep Chlamydia Hep B Hvc Hiv Syphillis
CDC Split Type:

Write-up: Full body hives, swollen hands, swollen ears, burning skin. Continues after 2 cortisone shots, prednisone and Benadryl.


VAERS ID: 1692342 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-04
Onset:2021-09-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: WAL ZYR
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Peanut allergy; Seasonal allergy; Suspected COVID-19 (Could have had Covid-19 In Jan/Feb 2021 as family members had it, but was not tested.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101168900

Write-up: Diarrhea; Soreness at vaccination site of left arm; This is a spontaneous report from a contactable consumer, the parent. A 12-year-old male patient received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FC3182) via an unspecified route of administration in the left arm on 04Sep2021 at 14:30 (at the age of 12-years-old) as a single dose for COVID-19 immunisation. Medical history included seasonal allergies and allergy to peanuts. It was also reported that the patient could have had COVID-19 in Jan/Feb2021 as family members had it, but the patient was not tested. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. Concomitant medications included over the counter cetirizine hydrochloride (WAL ZYR) taken for allergies from an unknown date and unknown if ongoing. On 06Sep2021 at 08:00 in the morning, the patient experienced diarrhea which lasted all day and soreness at vaccination site of left arm. On 07Sep2021 in the morning, the patient still had diarrhea. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events soreness at vaccination site of left arm and diarrhea were not resolved at the time of this report.


VAERS ID: 1692947 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-03
Onset:2021-09-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Lymphadenopathy
SMQs:, Haemorrhage terms (excl laboratory terms) (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen lymph node in left axilla occuring for 4+days Severely heavy menstruation one week following first dose (menses on time, but heavy)


VAERS ID: 1692990 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-03
Onset:2021-09-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Vitreous floaters
SMQs:, Retinal disorders (narrow)

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

Write-up: Floaters in vision, left eye


VAERS ID: 1693021 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-27
Onset:2021-09-06
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: tested positive on 09/07/2021


VAERS ID: 1693073 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-09-05
Onset:2021-09-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Echocardiogram, Echocardiogram normal, Electrocardiogram T wave abnormal, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad), Immune-mediated/autoimmune 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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: No Known Allergies
Diagnostic Lab Data: Troponin: Reported to be 0.84 on 9/6 0.710 on 9/6 0.301 on 9/7 TTE on 9/7: Normal bi-ventricular size and systolic function. The proximal coronary arteries are without ectasia, stenosis, and aneurysm in the areas imaged. Normal pericardium with no effusion. No cardiac disease identified. EKG 9/6: Sinus rhythm Non-specific T-wave changes No previous ECG available for comparison
CDC Split Type:

Write-up: The day following the second COVID vaccine administration, patient reported chest pain. He went to his pediatrician, where troponin was noted to be elevated (reported to be 0.84 on 9/6) and was referred to ED. Troponin was confirmed to be elevated (0.710 on 9/6) and patient was admitted to pediatric cardiology service for suspected vaccine related myocarditis. Troponin on 9/7 was 0.301. Echocardiogram was normal. Was treated symptomatically with ibuprofen and tylenol, and discharged on 9/7. He will get cardiac MRI in the next few weeks.


VAERS ID: 1693169 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-03
Onset:2021-09-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HRSAFE3183 / UNK - / IM

Administered by: Public       Purchased by: ?
Symptoms: Angina pectoris, Asthenia, Dyspnoea, Extra dose administered, Fatigue, Headache, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Other ischaemic heart disease (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: second phizer lead to fever and headache for one day. This was the booster shot (shot #3)
Other Medications: RX: Azathioprine 50 mg ? 1/day Cyclosporine 100 mg - 2/day Carvedilol 3.125 mg ? 2/day Rosuvastin (Crestor) 5 mg ? 1/ alternating days Hydrochlorothiazide 12.5 mg ? 1/day Tadalafil 5 mg ? when needed Famciclovir 125 mg ? when needed V
Current Illness: none
Preexisting Conditions: kidney transplant 6/2000
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: extreme headache, fever over 103 for multiple days, fatigue, weakness, difficulty breathing, pain around heart for two days


VAERS ID: 1693188 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-02-01
Onset:2021-09-06
   Days after vaccination:217
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Myalgia, Pain in extremity, Pain of skin, Paraesthesia, Sleep disorder, Tension
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Premarin, Calcium, Magnesium, Zinc, Vit C, Biotin, Fish Oil, Vitamin B, Claritin, Zertec
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Sore muscles from waist down, no energy, pins and needles jabbing sardonically, tension, aching legs, anxious, disturbed sleep, skin on legs extremely tender to touch.


VAERS ID: 1693212 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-05
Onset:2021-09-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling hot, Rash, Rash erythematous, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Warm, itchy, erythematous, wide-spread facial rash.


VAERS ID: 1693214 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Alaska  
Vaccinated:2021-09-03
Onset:2021-09-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Fatigue, Pain, Pyrexia, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, intense body pain, chills, runny nose, cough, extreme fatigue


VAERS ID: 1693245 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-08-30
Onset:2021-09-06
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Herpes zoster, Pain, Pain in extremity, Pyrexia, Rash, Skin lesion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

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

Write-up: The day after the 2nd shot I was fevered, chilled and achy joints. One week after the 2nd shot I had several sores on my body, mostly the left side..also shooting pain down left leg. A couple day later a rash appeared on my lower leg, which was diagnosed as shingles. I have not had any stressful situations happening, thus making me question if the vaccine lowered my immune system thus triggering shingles.


VAERS ID: 1693251 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-05
Onset:2021-09-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Angina pectoris, Cardiac discomfort, Dizziness, Electrocardiogram normal, Inflammation, Pain, Palpitations
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), 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: None
Current Illness: Borderline lupus autoimmune no medication needed w/follow up every 6 months blood work check markers which are good at time of vaccination
Preexisting Conditions: See above
Allergies: Sulphate/shellfish
Diagnostic Lab Data: Contacted Dr on Tuesday 9/7/21 for continued pain did EKG and exam no irregular EKG but was advised to take ibuprofen was told vax caused inflammation and if cont call back. contacted dr again on 9/8/21 prescribed prednisone for inflammation still Have heart pain/pressure which is concerning
CDC Split Type:

Write-up: No flu like symptoms day of 2nd vax, did regular activities and regular weekly Exercise routine. Following morning 3:00am woke to severe, knife pain in heart/chest only on left side. Heart palpitations and felt faint. Never have experienced this in past


VAERS ID: 1693329 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-05
Onset:2021-09-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Alopecia, Immediate post-injection reaction
SMQs:, Hypersensitivity (narrow)

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

Write-up: Immediate, severe hair loss


VAERS ID: 1693476 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-02-13
Onset:2021-09-06
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM 9809 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 6206 / 2 RA / IM

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

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

Write-up: tested positive for covid after being fully vaccinated


VAERS ID: 1693547 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-08-12
Onset:2021-09-06
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Contusion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (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: low dose naltrexone .5 mg, MP Thyroid 45 g; Vitamin D, Zinc, probiotic, Standard Process brand supplements called; Cataplex C (vitamin C), Catalyn GF, Olpria EPA/DHA, Magnesium Lactate, Livaplex
Current Illness: Long COVID since 3/14/20...symptoms have come and gone about 9 times since then. No symptoms at time of vaccine. May have had COVID symptoms a few weeks prior, not sure.
Preexisting Conditions: Hypothyroid, PMDD, Perimenopause
Allergies: sulfa meds, cats, seasonal allergies, foods in the past have caused an itchy throat
Diagnostic Lab Data: Went to doctor, they had no explanation. Other doctor thinks it could be related to the vaccine or to the vaccine in combo with my naltrexone prescriptions.
CDC Split Type:

Write-up: Crazy amounts of bruising for no reason on my upper right thigh, left thigh and edge of my knee (this one is almost 2 inches in length)


VAERS ID: 1693625 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-22
Onset:2021-09-06
   Days after vaccination:227
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Chills, Cough, Headache, Oropharyngeal pain, Pain, Pyrexia, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? 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: Facility was informed that HCP, tested positive for COVID-19 today 9/10. HCP had called the hotline to report symptoms & schedule a test at 1400. She had a rapid antigen test done this morning today at which resulted Positive. We are currently awaiting results from the drive thru site test. HCP is on quarantine and has been instructed to notify hotline with the results. HCP is a call in EKG Technologist. She was vaccinated on 12/22/20 & 1/11/21 (Pfizer). Last day of work was Monday, August 30. HCP traveled with sister on 9/1 and returned on 9/9. They stayed with a friend who was exhibiting flu like symptoms during their stay. Her friend did not get tested, and just treated her symptoms at home. HCP attended a concert on Sun. 9/5 and began exhibiting symptoms Mon. 9/6. Initial symptoms included a sore throat, runny nose, chills, fever (temp unknown, she ?felt warm?), body aches, and headache. States has lost her sense of smell and taste today and currently has a dry cough with congestion. She denies fatigue, dyspnea, chest pain, difficulty breathing, nausea, vomiting, abdominal pain, or diarrhea. At work, HCP does wear a mask and eye protection for all patient encounters. HCP does eat alone on her breaks. Other than her friend exhibiting flu like symptoms which was unconfirmed as Covid, she has had no contact with recent confirmed COVID positive in the community, staff, or patients. Other than the concert she has not engaged in any other gatherings. She goes to the gym occasionally and had last gone on the 28th/29th prior to her trip. She does not work at any other jobs. HCP lives with her parents, brother, sister, and grandparents and states that she is able to quarantine safely with her own area. No household members are employees. HCP does give consent to disclose her name for contact tracing purposes. However, since symptom onset was 9/6 and last day of work was 8/30, there is no further follow up needed.


VAERS ID: 1693718 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-02
Onset:2021-09-06
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Chest pain, Menstruation delayed
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Fertility 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: None
Current Illness: None
Preexisting Conditions: IBS
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pfizer vaccine Dull and occasionally sharp chest pain in upper left quadrant of chest. When these pain come in they will last 2-4 hours at a time. It is not clear what triggers these episodes of chest pain. This pain was never experienced prior to the Covid vaccine. Late menstrual cycle - 3+ days late and am never late. I track my periods with the flow app. Still have not got my period, this may be longer


VAERS ID: 1693799 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-02-11
Onset:2021-09-06
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fully vaccinated patient tested positive for COVID-19 on 9/6/21 and admitted to hospital for supportive care.


VAERS ID: 1693815 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Dyspnoea, Fatigue, Injection site pain, Joint swelling, Pain, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), 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: Flu vaccin at the end 2020, pain and redness on the arn. Muscles pain
Other Medications: Tylenol
Current Illness: None
Preexisting Conditions: spondylosis
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 9/06/2021: pain on the arm where got the shot, tiredness 9/08/2021 until today: Feel very tired, tie chest and short breath sometimes. Joint pain all the times, specially on the neck, left and right ankle and ball pain the most 9/11/2021 : upper left ankle area start swelling 9/12/2021: instep on left foot is swelling Ankle feel pain more after lay down and get up no matter how long do i lay down. Pain the most after get up in the morning


VAERS ID: 1693829 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-08-30
Onset:2021-09-06
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Menstrual disorder, Vaginal odour
SMQs:

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

Write-up: Menstrual blood had extremely potent odor after receiving vaccine. Odor was specifically coming from menstrual blood. The odor from a single drop of blood could fill the entire bathroom and adjoining bedroom. Smell was foreign and could be described as; toxic, rotten, decay, chemical. Patient had to remove used tampons from the house entirely after each use due to the potent smell as well as disinfect the trash bin and surrounding area near toilet (even if trash bin had plastic liner) to remove the smell. Patient has never experienced menstrual or vaginal odor of any kind before. Patient has never taken any form of birth control. Patient takes no medications, supplements or vitamins. Patient has a perfectly regular menstrual cycle that occurs every 28 days with an almost identical flow/cycle each month.


VAERS ID: 1694051 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-13
Onset:2021-09-06
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

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

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

Write-up: Shingles outbreak right arm


VAERS ID: 1694101 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-03-11
Onset:2021-09-06
   Days after vaccination:179
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Decreased appetite, Diarrhoea, Fatigue, Headache, Laboratory test, Paranasal sinus discomfort, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall XR 30 mg, Vit D3, Vit B
Current Illness: None
Preexisting Conditions: ADD only
Allergies: Penicillin, Shrimp
Diagnostic Lab Data: Lab test 9/7/21 confirmed "positive A" SARS from SARS Antigen FIA rapid test.
CDC Split Type:

Write-up: Monday, 9/6: symptom onset. Persistent headache, fatigue, low-grade fever (1.5 degrees higher than normal). Tues: Persistent headache, fatigue, low-grade fever (1.5 degrees higher than normal). Sinus pressure affecting ears (new). Wed: Persistent headache, fatigue. Diarrhea (new). Thurs: Persistent headache, fatigue. Loss of appetite, taste and smell (new). Fri-Sun: Persistent headache, fatigue, loss of appetite, taste and smell. Monday, 9/13: Loss of taste and smell.


VAERS ID: 1694124 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

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

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

Write-up: Patient reported a fever of 103.7 F twelve hours after her second dose on Monday September 6th, 2021. She immediately took Tylenol and the fever went down to 101 F but it kept spiking back up so she had to take Tylenol around the clock to keep the fever between 100 F and 101 F. She reported that the fever lasted until Thursday morning, September 9, 2021. She also reported a headache for 2 days after vaccination.


VAERS ID: 1694206 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-31
Onset:2021-09-06
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Dermatitis, Erythema, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Severe dermatitis on the eyelids (itchiness, swollen, redness). Still to date.


VAERS ID: 1694255 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-02
Onset:2021-09-06
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Brilinta, entresto, carvedilol, atorvastatin, isosorbide mononitrate, baby aspirin, lantus
Current Illness: No
Preexisting Conditions: Diabetes, high blood pressure, stent
Allergies: No
Diagnostic Lab Data: no
CDC Split Type:

Write-up: Patient is stating that she broke out in severe hives 5 days after receiving the vaccine all over her body


VAERS ID: 1694275 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-09-05
Onset:2021-09-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Heart rate irregular, Pyrexia, Seizure, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiac arrhythmia terms, nonspecific (narrow), Generalised convulsive seizures following immunisation (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: 105.8 fever and seizures for several hours. Woke up the next day at 1am. ER didn''t admit me on 6Sep2021 at 11pm . Shakes and chest is feeling weird. Pain in shoulders, hip and knees. My heart is going weird. Still have fever at 101. About an hour ago , there is pain in my chest. I have a slow heart and its beating at 90.


VAERS ID: 1694348 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-25
Onset:2021-09-06
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0162 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Breakthrough case. Positive PCR test on 9/6/2021


VAERS ID: 1694619 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-26
Onset:2021-09-06
   Days after vaccination:72
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 207A21A / UNK - / -

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

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

Write-up: Covid positive contact unknown


VAERS ID: 1694709 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-31
Onset:2021-09-06
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / UNK - / -

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

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

Write-up: Covid positive contact unknown


VAERS ID: 1694710 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-19
Onset:2021-09-06
   Days after vaccination:110
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Back pain, COVID-19, Cough, Nausea, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD AND DM
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This case meets vaccine breakthrough criteria . SXS BACK PAI, WEAKNESS, NAUSEA, CHRONIC COUGH


VAERS ID: 1694806 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-03
Onset:2021-09-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood lactic acid, Computerised tomogram, Dyspnoea, Echocardiogram, Electrocardiogram, Full blood count, Hypoxia, Metabolic function test, Scan with contrast
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None.
Current Illness: None.
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data: 9/7-8/2021: CBC, CMP, Lactic q 6hr, EKG, Echo, CT with contract, cardiac ultrasound.
CDC Split Type:

Write-up: Hypoxia and dyspnea with ambulation.


VAERS ID: 1694826 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-09
Onset:2021-09-06
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Malaise, Myalgia, Pyrexia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: POSITIVE SARS-COV-2 BY PCR
CDC Split Type:

Write-up: This case meets vaccine breakthrough criteria . SXS INCLUDE GENERAL MALAISE, FEVER, MUSCLE PAINS, COUGH, SOB


VAERS ID: 1694861 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-02
Onset:2021-09-06
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cardiac monitoring, Dyspnoea, Palpitations, Ventricular extrasystoles
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypokalaemia (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: None
Current Illness: none
Preexisting Conditions: bicuspid aortic valve
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: palpitations and shortness of breath occurred 3 days after receiving 1st dose of vaccine. premature ventricular contractions visualized on cardiac monitor in ER.


VAERS ID: 1694878 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-26
Onset:2021-09-06
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-09-13
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: PCR test @ CVS in Fridley on 9/10/2021
CDC Split Type:

Write-up: EE is fully vaccinated as on 1/26/2021 with Pfizer and contracted COVID, tested positive on 9/10/2021


VAERS ID: 1694903 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-13
Onset:2021-09-06
   Days after vaccination:146
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Cough, Diarrhoea, Malaise, Nausea, Pyrexia, Vaccine breakthrough infection, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: DM2, HTN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This case meets vaccine breakthrough criteria . SXS FEVER, CHILLS, COUGH, MALAISE, N/V/D


VAERS ID: 1694929 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-04
Onset:2021-09-06
   Days after vaccination:186
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Oropharyngeal pain, Pain, Pyrexia, Rhinorrhoea, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: This case meets vaccine breakthrough criteria. SXS SOB, SORE THROAT, RUNNING NOSE, BODY ACHES, FEVER


VAERS ID: 1695054 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New York  
Vaccinated:2021-02-24
Onset:2021-09-06
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Fatigue, Myalgia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Taste and smell disorders (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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? 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: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose02/03/21 2nd dose02/24/21 Diagnosed covid positive:09/06/21 Symptom onset:09/06/21 Exposure:travel Symptoms:fatigue, muscle aches, loss of smell/taste


VAERS ID: 1695055 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-05
Onset:2021-09-06
   Days after vaccination:244
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Myalgia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? 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: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose12/18/21 2nd dose01/05/21 Diagnosed covid positive:09/06/21 Symptom onset:09/06/21 Exposure:TRAVEL Symptoms:FEVER, COUGH, MUSCLE ACHES, LOSS OF SMELL/TASTE


VAERS ID: 1696127 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-08-30
Onset:2021-09-06
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

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

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

Write-up: Developed severe rash (contact dermatitis) of 80% right upper extremity, left upper extremity, face and right thigh.


VAERS ID: 1696202 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-08-29
Onset:2021-09-06
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Fatigue, Headache, Nausea, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Covid positive 9/6 Symptoms: fever, headache, nausea, sore throat, fatigue


VAERS ID: 1696319 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-14
Onset:2021-09-06
   Days after vaccination:145
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037B21A / 2 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Blood creatinine normal, Blood sodium decreased, Bronchogenic cyst, COVID-19, COVID-19 pneumonia, Cardiac assistance device user, Cardiac failure, Cardiac failure congestive, Catheterisation cardiac, Chest pain, Computerised tomogram thorax abnormal, Echocardiogram, Ejection fraction decreased, Hypotension, Intensive care, Lymphadenopathy mediastinal, Percutaneous coronary intervention, Pericardial effusion, Pyrexia, SARS-CoV-2 test positive, Shock, Syncope, Troponin increased
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Congenital, familial and genetic disorders (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hyponatraemia/SIADH (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Other ischaemic heart disease (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (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: aspirin 81 MG tablet atorvastatin (LIPITOR) 80 MG tablet dapagliflozin 10 MG TABS ezetimibe (ZETIA) 10 MG tablet fluticasone (FLONASE) 50 MCG/ACT nasal spray gabapentin (NEURONTIN) 300 MG capsule insulin glargine (LANTUS SOLOSTAR) 100 UNIT/
Current Illness: 8.16.21 - seen for hearing loss and dizziness (wears hearing aids) 8.18.21 - sinusitis, headaches, cough, balance concerns 8.23.21 - ED visit - instent stenosis; unstable angina 9.6.21 - ED to hospital - COVID-19 positive (9.6.21)
Preexisting Conditions: Hx severe multivessel CAD (coronary artery disease), with elevated troponin Hypertension Hyperlipidemia OSA (obstructive sleep apnea) Type 2 diabetes mellitus with hyperglycemia, with long-term current use of insulin Abscess, occipital Nystagmus Vision changes Hyperglycemia Hypothyroidism Recurrent incisional hernia with obstruction Flank hernia Other chest pain Unstable angina PVD (peripheral vascular disease) Pneumonia due to COVID-19 virus CAD (coronary artery disease) Type 2 diabetes mellitus with hyperglycemia, with long-term current use of insulin Tubular adenoma of colon Thyrotoxicosis Pure hyperglyceridemia Obesity Low compliance bladder Hypospadias Hernia of anterior abdominal wall Gastritis Cystoid macular edema
Allergies: Dust Sneezing Tylenol Diarrhea
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized; COVID-19 positive (9.6.21); fully vaccinated Admission Date: 9/6/2021 Discharge Date: 09/11/2021 Discharge disposition: Home; Condition at discharge: Improved Admission Diagnosis: Elevated troponin Congestive heart failure, unspecified HF chronicity, unspecified heart failure type Pneumonia due to COVID-19 virus COVID-19 Shock Syncope and collapse Discharge Diagnosis: COVID-19 Pneumonia Hospital Course: Patient is a 54 year old male with past medical history of severe multivessel coronary artery disease S/p PCI April 2021 to LCx (previous PCI to LAD, uncontrolled diabetes mellitus type 2 (Hgb A1c 11.2), OSA, hypothyroidism, and recent diagnosis of COVID 19 presented to hospital with syncopal episode on 9/6. He reported he had had several syncopal episodes over past few weeks preceded by severe chest pain. Recent LHC 8/24/21- three vessel CAD with prior stent thrombosis, poor targets for revascularization. Echo 9/6- EF down to 32% from 44% in August. He did require 2L NC on presentation. Labs significant for sodium 128, Creat 0.64. Troponin 102 then increased to 668 then back down. He became hypotensive with concern for cardiogenic shock and he was started on norepi for MAP $g65 and transferred to ICU for CTS evaluation for CABG. He was weaned off of vasopressors by AM 9/8. CTS stated patient not a CABG candidate due to distal CAD and COVID pneumonia. Transferred out of ICU 9/8. He was started on dexamethasone and remdesivir for COVID pneumonia. He was hypotensive after transfer out of the ICU so unable to undergo diuresis or restart his home medications. Cardiology and Neurology felt that syncopal episodes were likely vasovagal in nature. Cardiology recommended medical management of CAD, LifeVest placed 9/10, repeat TTE in 3 months On CT thorax patient was found to have "A lobulated right lower paratracheal structure measures 2.5 x 3.2 cm and has gradually increased in size compared with 2009. This appeared to measure fluid density on the noncontrast portion of the comparison examination from 8/4/2017 and this may represent fluid in a pericardial recess or a bronchogenic/foregut cyst. However an abnormal mediastinal lymph node could also have this appearance. Recommend further assessment with MRI of the chest with and without contrast." Will defer repeat imagine of this to PCP. PT evaluated the patient and recommended discharge home with outpatient PT. At discharge he is aware of 10 days isolation requirements for COVID-19, through 9/16 unless still having fevers. He has outpatient appointments established with PCP and Cardiology for follow-up. Home ACE-I and IMDUR held at discharge for hypotension. He is encouraged to monitor BP at home and report to outpatient physicians. He has referral to outpatient cardiac rehab. Diabetes followed through hospital stay and home medications were resumed at discharge.


VAERS ID: 1696328 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-08
Onset:2021-09-06
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Back pain, Cervical radiculopathy, Condition aggravated, Exposure to SARS-CoV-2, Hypoaesthesia, Imaging procedure, Intervertebral disc degeneration, Magnetic resonance imaging head normal, SARS-CoV-2 test positive
SMQs:, Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 MG tablet apixaban (ELIQUIS) 5 MG tablet baclofen (LIORESAL) 20 MG tablet doxycycline (VIBRAMYCIN) 100 MG capsule gabapentin (NEURONTIN) 100 MG capsule lacosamide (VIMPAT) 100 MG tablet levETIRAcetam (KEPPRA) 750
Current Illness: oral thrush COVID-19 positive 9.6.21
Preexisting Conditions: Chest pain History of paraplegia Essential hypertension Hyperlipidemia LDL goal <70 Class 1 obesity in adult Paraplegia Acute metabolic encephalopathy History of seizure disorder Urinary tract infection Hypokalemia Allergic rhinitis Anemia Arthritis of wrist Chronic pain Cystitis cystica Disorder of bone and articular cartilage Gastroesophageal reflux disease Generalized osteoarthritis Gross hematuria History of UTI Hypothyroidism Neurogenic bladder Onychomycosis due to dermatophyte Osteopenia Osteoporosis Overactive detrusor Recurrent urinary tract infection Renal insufficiency syndrome Right hemiplegia Shoulder pain OSA Spinal cord injury at C5-C7 level without injury of spinal bone Thyroid lump Urinary incontinence Full code status Pulmonary embolism Acute deep vein thrombosis (DVT) of femoral vein of right lower extremity Pressure ulcer of unspecified buttock, unstageable Epileptic seizure Osteonecrosis due to drug Chicken pox Genitourinary syndrome of menopause Hematuria Osteoarthrosis Seizures Wears glasses TIA (transient ischemic attack) Neurogenic bladder Idiopathic hypotension Pressure injury of buttock, stage 2 COVID-19
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized; COVID-19 positive (9.6.21); fully vaccinated. Admission Date: 9/5/2021 Discharge Date: 09/07/2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: TIA (transient ischemic attack) [G45.9] Chronic anticoagulation [Z79.01] HOSPITAL COURSE: Presents to the hospital with left upper extremity numbness and back pain, admitting provider suspected TIA, workup included an MRI, MRI of the brain was negative, based on the presentation which appears to be subacute and persistent this is more likely consistent with cervical radiculopathy. Given that family member had positive COVID test before patient''s admission she was also tested for COVID, she came back positive therefore respiratory isolation placed, she was however asymptomatic, imaging of the chest was negative for pneumonia, she did not require supplemental oxygen. She was discharged home in stable condition. She will need to self quarantine for a total of 10 days post diagnosis of COVID. TIA diagnosis while present on admission was worked up and ruled out Cervical radiculopathy with left upper extremity numbness is the diagnosis that the patient was considered to have when discharged COVID 19 infection positive without respiratory distress nor other manifestations Other diagnosis as above Discharge Disposition:home or self care Active Issues Requiring Follow-up: Suspected cervical radiculopathy with pain and numbness and multilevel degenerative disc disease of back


VAERS ID: 1696421 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2020-12-17
Onset:2021-09-06
   Days after vaccination:263
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted to hospital with COVID symptoms and positive test 9/6/21-9/14/21.


VAERS ID: 1696436 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-05
Onset:2021-09-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30130BA / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Anosmia, Asthenia, Eye pain, SARS-CoV-2 test negative, Sensory disturbance, Tension headache
SMQs:, Peripheral neuropathy (narrow), Taste and smell disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Glaucoma (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Eosinophilic Esophagitis
Allergies: None
Diagnostic Lab Data: I received both a rapid COVID test and a more in depth COVID test that they sent to a lab. These tests were conducted on September 9th where the rapid test came back negative that same day. The other test results from the more in depth test came back on September 13th and was also negative.
CDC Split Type:

Write-up: On 4:29 AM Monday morning September 6th I woke up with a severe tension headache in my temples behind my eyes and also realized I couldn''t smell anything or taste anything. The headache lasted for over 48 hours. My body was also extremely weak and it is also numb in a way to where I can feel things to a point but it''s like the sensitivity is mostly gone as well.


VAERS ID: 1696526 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-02
Onset:2021-09-06
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary 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: Levothyroxine, albuterol, symbicort, singulair, flonase, xyzal
Current Illness: Na
Preexisting Conditions: Asthma, seasonal allergies
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen/painful axillary lymph nodes on right side, started approximately 4 days after injection and has proceeded to worsen for the past week.


VAERS ID: 1696643 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-08-17
Onset:2021-09-06
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 3 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: allopurinoL, amLODIPine,atorvastatin, calcitRIOL, carvediloL, cholecalciferol, VITAMIN D3,cyanocobalamin, Ferrous Sulfate,mycophenolate mofetil,mycophenolate mofetil , torsemide
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted as inpatient on 9/6 due to acute respiratory failure with hypoxia 2/2 COVID pneumonia. Patient was tested for COVID-19 and was positive on 8/29.


VAERS ID: 1696705 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-10
Onset:2021-09-06
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / UNK RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain, Pain in extremity, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: RX for high blood pressure and RX for high cholesterol
Current Illness:
Preexisting Conditions: High BP and High Cholesterol
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderna COVID?19 Vaccine EUA Breaking out in hives started on middle of back of neck, moved higher into hairline, then started on both hands and wrists, then went to his chin, then one in his throat. Then one on each arch of both feet making it impossible to walk without pain in both feet. Now he has more on the back of his neck on the right side. Has been taking Benadryl, went to the doctor today and received an RX.


VAERS ID: 1696731 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-15
Onset:2021-09-06
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0158 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Diarrhoea, Presyncope, SARS-CoV-2 test positive
SMQs:, Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), 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? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted for persistent diarrhea and presyncopal episodes. Patient tested positive for COVID and is still undergoing inpatient treatment.


VAERS ID: 1696766 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-08-26
Onset:2021-09-06
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 LA / IM

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

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

Write-up: Mild case of varicella zoster reactivation (Shingles) accompanied by lymphadenopathy.


VAERS ID: 1696845 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-20
Onset:2021-09-06
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Malaise, 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: onset of covid symptoms on 8/29/21, tested COVID + on 9/6/21, received Regeneron on 9/8/21, worsened symptoms - admitted to hospital on 9/13/21, requiring 2L nasal canula oxygen. started on steroids.


VAERS ID: 1696849 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-05
Onset:2021-09-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

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

Write-up: Headache in odd place and felt incredibly sleepy for 4 days


VAERS ID: 1696954 (history)  
Form: Version 2.0  
Age: 0.67  
Sex: Female  
Location: California  
Vaccinated:2021-09-03
Onset:2021-09-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Breast feeding, Cough, Malaise, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test negative, Sneezing
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: Covid-19 test results Negative on 09/07/21
CDC Split Type:

Write-up: Breastfeed 8 month daughter got sick (coughing, sneezing, runny nose, congestion) 3 days after mother''s first series of COVID-19 vaccination.


VAERS ID: 1696964 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-26
Onset:2021-09-06
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 9/14/21 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1697169 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC 3182 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Head discomfort, Headache, Musculoskeletal discomfort, Orthostatic hypotension, Pain in extremity, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: I have not seen the doctor yet I have an appointment next week
CDC Split Type:

Write-up: Within minutes of getting the vaccine I had a head rush not long after and up with a headache it has now been over a week I can not get rid of the headache my head is so full of pressure at times it feels like it is too much pressure. It?s causing neck discomfort. I have tried excedrin Tylenol midol and tramadol and nothing helps. As soon as I wake up in the morning and stand up it comes right back. The only thing that relieves pressure is laying down. I am getting a tingly type feeling in my face and random chill type feelings in my face. I have also been just feeling over all blah and some weird pains behind my arm like shooting pains.


VAERS ID: 1697213 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Incorrect dose administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Received a 7th dose that was taken from a single reconstituted vial of Pfizer-BioNTech COVID19 vaccine. At the time of vaccine, it was not identified as a 7th dose. Did not have an adverse reaction. Report submitted to document 7th dose given states is not considered a valid dose of the vaccine.


VAERS ID: 1697586 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-19
Onset:2021-09-06
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Epstein-Barr virus antibody positive, Fatigue
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes type 2
Allergies:
Diagnostic Lab Data: Blood drawn. Positive for Epstein-Barr antibodies.
CDC Split Type:

Write-up: Extreme fatigue. Positive for Epstein-Barr antibodies.


VAERS ID: 1700140 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-01
Onset:2021-09-06
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Moderna 2/25 and 4/1. Positive on 9/14.


VAERS ID: 1700159 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-25
Onset:2021-09-06
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, COVID-19, Condition aggravated, Cough, Depression, Diarrhoea, Drug screen, Electrocardiogram, Headache, Nausea, SARS-CoV-2 test positive, Self-injurious ideation, Suicidal ideation, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Suicide/self-injury (narrow), Pseudomembranous colitis (broad), Drug abuse and dependence (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (narrow), Noninfectious diarrhoea (narrow), 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? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hospital Medications acetaminophen (TYLENOL) tablet 1,000 mg acetaminophen (TYLENOL) tablet 1,000 mg acetaminophen (TYLENOL) tablet 500 mg acetaminophen (TYLENOL) tablet 500 mg bisacodyl (DULCOLAX) suppository 10 mg magnesium hydroxide (MIL
Current Illness: ED 9.6.21 and 9.13.21 Headache, vomiting COVID-19 positive 9.6.21
Preexisting Conditions: Hospital Suicidal ideation Non-Hospital Chronic low back pain Back pain Chronic pain Overuse syndrome Elbow pain, right Headache Gastritis Fracture of wrist Migraine headache Contusion Pain at surgical incision Pain due to any device, implant or graft Dermatitis Wrist pain, right Wrist swelling Opioid use disorder, severe, on maintenance therapy (HCC) Bipolar II disorder (HCC)
Allergies: Benadryl Crea Penicillins Propoxyphene GI Upset Tramadol GI Upset Ketorolac Tromethamine Nausea Only
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized 9.14.21 ; COVID-19 positive 9.6.21; fully vaccinated HISTORY OF PRESENT ILLNESS: HPI and hx obtained from patient and chart review. Patient is a 35 y.o. male with pmhx of depression and anxiety who presented with a chief complaint of suicidal ideation. Patient reports worsening symptoms of depression and feeling hopeless facility thoughts of harming himself for the past week. He reports that the past a year he has had multiple stressors in his life. Stressors include being in jail the common going to rehab not being able to see his children, and the death of his brother 2 years ago due to suicide. His depression symptoms include not being able to stay asleep poor appetite, feeling down depressed and hopeless. He has taken multiple medications in the past for his depression he does not remember which ones he has tried. He reports that last week after he was tested positive for COVID-19 his depression symptoms got worse. Yesterday he took a half a tablet of Suboxone because he was anxious, after he took it he to the rest of the bottle out. He reports being on Suboxone in the past but has not taken it in a year. He reports a history of alcohol use and heroin use but has not consumed in 4 years. Today he had thoughts of harming himself, but did not have a plan. He wants help for his depression. In regards to his COVID symptoms he reports having a headache, nausea, cough, diarrhea that started on 09/05. He went to the emergency department and that is where he tested positive for COVID on 09/07. He now denies any fevers, chills, difficulty breathing. He reports having some mild nausea. Brief ED course: Vitals were stable on arrival to the emergency department. Spoke with social Work . General medicine will admit patient for further evaluation and workup. CHIEF COMPLAINT: Suicidal ideation ASSESSMENT/PLAN: Patient is a 35 y.o. male with PMH of depression/anxiety . He presented to the emergency department due to suicidal ideation. # Suicidal ideation Patient reports that the last year has been hard for him. He has multiple stressors including being in jail, being in rehab, not being able to be there for his children, as well recent death his brother 2 years ago due to suicide. He reports that this week his depression has gotten significantly he thinks due to recent diagnosis COVID. He reports today that she have follow-up ending his life, but did not have a specific plan. He reports not wanting to take any medications. Plan: - video monitoring - social work consult- Plan for him to touch base with network, patient agreeable to inpatient psych treatment but no facility open for covid patients. - urine drug screen - EKG given his recent Suboxone use # COVID-19 positive Patient tested positive for SARS-CoV-2 on 9/6/2021. He reports some nausea, mild cough, and headache but no other symptoms. Symptoms started on 9/5. He does not qualify for remdesivir or steroids. - Continue to monitor


VAERS ID: 1700186 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-08-09
Onset:2021-09-06
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 RA / IM

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

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

Write-up: SORE ARM


VAERS ID: 1700245 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-26
Onset:2021-09-06
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EC3183 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Asthenia, Bed rest, Bell's palsy, Confusional state, Eye discharge, Feeling cold, Feeling hot, Headache, Hypogeusia, Hyposmia, Memory impairment, Neck pain, Pyrexia, Stress
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hearing impairment (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
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: Valacyclovir 20mg , Predinisone 1 mg, ibuprofen 800 mg
Current Illness: Low energy, stress, headaches front to back of head down into neck area, not focus, memory problems, no taste for some foods vision problems more on right eye and most recent Right Face Bell Palsy.
Preexisting Conditions: Diabetes type 2
Allergies: None
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Fever, feeling hot or cold. 3 days bed rest, smell and taste diminished, memory, confusion, stress, right side head pains from front of head to back of head down to neck, runny right eye and right face Bell Palsy. low energy constantly worried.


VAERS ID: 1700253 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-03
Onset:2021-09-06
   Days after vaccination:95
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EQ0172 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test, Heavy menstrual bleeding, Oligomenorrhoea, Smear cervix
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: PCOS
Allergies: Latex
Diagnostic Lab Data: Pap smear and general blood work (08/25/21)
CDC Split Type:

Write-up: Prolonged menstrual bleeding. The bleeding lasted the entire month of June with one week of exceptionally heavy bleeding that made it difficult to go about my everyday tasks. Though I have a PCOS diagnosis, I have never experienced bleeding like this.


VAERS ID: 1700306 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-24
Onset:2021-09-06
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, COVID-19, Cough, Diarrhoea, Dyspnoea, Oedema peripheral, Oxygen saturation decreased, Pyrexia, SARS-CoV-2 test positive
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), 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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine, ASA, Atorvastatin, Ezetimibe, Iron, Gabapentin, Gl
Current Illness: unknown
Preexisting Conditions: COPD, DM, CHF, CAD, HTN,
Allergies: PCN
Diagnostic Lab Data: 09/06/2021 SARS COV2 COVID 19 PCR (DETECTED)
CDC Split Type:

Write-up: 09/06/2021 The patient presents with 3 week hx of intermittent worsening shortness of breath with mid back pain, cough, fevers, diarrhea, peripheral edema. EMS services were called as symptoms were worsening. At arrival, pt was 83% room air, placed on nonrebreather and went up to 93%. Reported hx of COPD and CHF per EMS but pt denies. Back pain currently 10/10.


VAERS ID: 1700316 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-04-09
Onset:2021-09-06
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Fall, SARS-CoV-2 test positive
SMQs:, 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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine, ASA, Atorvastatin, Dexamethasone, Fenofibrate, Finasteride, HCTZ-Losartan, Jardiance, Magic Mouthwash, Metformin, Metoprolol ER, Sertaline, Tamsulosin, Temazepam, Topiramate, Tradjenta, Tramdol, Trazodone, Venlafaxine, Zeita
Current Illness: Unknown
Preexisting Conditions: Acid reflux, anxiety, CABG, depression, Hypercholesterolemia, HTN, Prostate carcinoma
Allergies: Sulfadiazine
Diagnostic Lab Data: 09/06/2021 SARS COV2 COVID 19 PCR (POSITIVE)
CDC Split Type:

Write-up: 09/06/2021 The patient presents with Fall, just prior to arrival. Per EMS report, pt experienced an unwitnessed fall reported by care taker. At ED bedside, pt has no complaints but further hx is limited due to dementia. Per report pt also had recent eye surgery. . COVID-19 positive (incidental finding)


VAERS ID: 1700432 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-16
Onset:2021-09-06
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Abdominal pain upper, Back pain, COVID-19, Pain, SARS-CoV-2 test positive, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: DUloxetine, Fenofibrate, HCTZ-Losartan, Letrozole, Metformin, Nexium, Omeprazole, Ozempic, Simvastatin, Tresiba
Current Illness: Unknown
Preexisting Conditions: Arthritis, Breast CA, DM, Hypercholesterolemia, Hyperlipidemia, HTN, Osteoporosis, tobacco abuse, TB
Allergies: Codiene
Diagnostic Lab Data: 09/06/21 SARS COV2 COVID 19 PCR (POSITIVE)
CDC Split Type:

Write-up: 09/06/21 The patient presents with vomiting x2 days ago with associated abdominal pain radiating to the back. Pt states that Saturday afternoon, she drank an old prune juice and had multiple vomiting episodes. Afterwards, she felt relief. She woke on Sunday with vomiting and epigastric pain that radiates to her back, bringing her to the ED. Denies fever, chills, sore throat, cough, SOB, CP, diarrhea, dizziness, HA, dysuria, and hematuria. The onset was 2 days agoAssociated symptoms: abdominal pain, back pain, denies diarrhea, denies fever, denies chills, denies chest pain, denies shortness of breath, denies headache, denies dizziness and denies blood in stool.


VAERS ID: 1700509 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-20
Onset:2021-09-06
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Hypoxia, SARS-CoV-2 test positive
SMQs:, Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient tested positive for COVID-19 on 9/6, presented to Flaget ED on 9/14 and found to be hypotic. Patient transferred here and is currently undergoing inpatient treatment.


VAERS ID: 1700523 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-21
Onset:2021-09-06
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Dyspnoea, Pain, Pyrexia, SARS-CoV-2 test negative, SARS-CoV-2 test positive, Throat irritation
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), 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: Zoloft.
Current Illness:
Preexisting Conditions: Exercise induced asthma.
Allergies:
Diagnostic Lab Data: Rapid COVID-19, negative. PCR COVID, positive.
CDC Split Type: vsafe

Write-up: It started with tickle in my throat that Monday and a dry cough. I went into doctor''s office to do a rapid test and a PCR, rapid came back negative. I wore a N95 to work and I kept getting worse on Wednesday I woke up fever chills, and body aches, I lost my taste and smell. My PCR came back positive. Morning day 7, I popped another fever, still getting shortness of breath. I''m on day 9 my oxygen has remained good. I have been taking zinc and vitamin C.


VAERS ID: 1700612 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-05
Onset:2021-09-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Confusional state, Diplopia, Extra dose administered, Gait disturbance, Impaired driving ability, Migraine, Myalgia, Pain in extremity, Paraesthesia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Ocular motility disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vit D, spironolactone, dutasteride, ClimaraPro, Adderal, welbutrin
Current Illness: None
Preexisting Conditions: Ehlers Danlos Syndrome, mast cell activation disorder, parasthesia
Allergies: No known allergies
Diagnostic Lab Data: To follow
CDC Split Type:

Write-up: 18 hours after injection, fever, acute pain, in joints and muscles, migraines, paresthesia, pain in extremities. Continued 4 day. Felt somewhat better, drove to buy groceries (I live alone), experience actor diplopia with mental confusion (drove wrong side down familiar 1 way street), acute paresthesia. Day of reporting symptoms have improved but are not close to resolved. Can''t drive, move about w/o risk of falls. Hoping to recover fully, but still experiencing symptoms 10 days post vaccine. Oddly, had NO reaction at all to first two doses, not even minor symptoms


VAERS ID: 1700689 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-09
Onset:2021-09-06
   Days after vaccination:150
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Received call from EE about known COVID + community exposure. EE and her son, with whom she lives, were exposed on 9/3 at the game. EE states that she found out today, that her friend tested COVID +. Started having s/s on 9/6 of HA, fatigue, and feverish. Which then progressed to cough, chills, dizziness, loss of smell and taste, today while at work.


VAERS ID: 1701308 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-30
Onset:2021-09-06
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood alkaline phosphatase increased, Blood bilirubin increased, Extra dose administered, Jaundice, Platelet count decreased, Thrombocytopenia
SMQs:, Liver related investigations, signs and symptoms (narrow), Cholestasis and jaundice of hepatic origin (narrow), Acute pancreatitis (narrow), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Biliary system related investigations, signs and symptoms (narrow), Biliary tract disorders (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin, calcium, vitamin d3, coq10, colace, norco, lactulose, losartan, metoclopramide, metoprolol succinate, omeprazole, ondansetron, probiotic, restasis, tamsulosin, ursodiol, vitamin b12
Current Illness: stage IV gastric adenocarcinoma on immunotherapy with pembrolizumab
Preexisting Conditions: stage IV gastric adenocarcinoma on immunotherapy with pembrolizumab
Allergies: none
Diagnostic Lab Data: 9/13/2021 Tbili=6.7, AST/ALT=57/46, alk phos=301, PLT=31K
CDC Split Type:

Write-up: within 1 week of 3rd moderna vaccination, this previously stable patient in clinical remission from her gastric cancer on immunotherapy developed painless jaundice, significant thrombocytopenia and elevations in Tbili/AST/ALT/alk phos


VAERS ID: 1703538 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-09-06
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Suspected COVID-19, 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:
CDC Split Type: USJNJFOC20210920261

Write-up: SUSPECTED CLINICAL VACCINE FAILURE; SUSPECTED COVID-19 INFECTION; This spontaneous report received from a patient via social media concerned a patient of unspecified age and sex, race and ethnicity. 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: Unknown) dose, start therapy date were not reported, 1 total administered for prophylactic vaccination. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 06-SEP-2021, the patient was diagnosed with suspected covid-19 infection (it had not been too bad) and suspected clinical vaccination failure. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the suspected covid-19 infection and suspected clinical vaccine failure was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0. 20210920261-COVID-19 VACCINE AD26.COV2.S- Suspected clinical vaccine failure. This event is considered not related. The event has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the events than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1703917 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-02
Onset:2021-09-06
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Electrocardiogram normal, Scan with contrast normal
SMQs:, Anaphylactic reaction (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xarelto 20 mg
Current Illness: none
Preexisting Conditions: Hashimoto''s Hypothyroiditis
Allergies: none
Diagnostic Lab Data: EKG normal CAT Scan with contrast normal
CDC Split Type:

Write-up: Three days after second Pfizer shot, extreme chest pain, tightness. PCP Seen and PCP sent to cardiologist for full workup. EKG normal. Patient sent for urgent CAT scan with contrast to check for pulmonary emboli. None found. Results normal, but patient on day 10 of severe chest pain and tightness. Doctor suggested it is inflammation brought on by vaccine.


VAERS ID: 1703970 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-09-01
Onset:2021-09-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Heart rate increased, Hypoaesthesia, Paraesthesia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Dehydration (broad), Sexual dysfunction (broad)

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

Write-up: My hands feet legs and arms was burning numb and tingling like they have pins and needles in them the left side of my face was doing the same thing my heart rate is staying up high and it felt like someone had 2 fingers on each side of my throat squeezing it together this all didn?t start till day 5 up till then I felt fine ?..I went to my dr and he said to keep and eye on it?.. I?m feeling some what better note hands are what?s staying numb with pins and needles now my legs and feet do it every now and again but my heart rate is still staying up high so he?s doing a ekg on me in a few days and sending me to a heart doctor


VAERS ID: 1704136 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-30
Onset:2021-09-06
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Atelectasis, COVID-19, Cerebral atrophy, Cerebral small vessel ischaemic disease, Chest X-ray abnormal, Computerised tomogram head abnormal, Facial paralysis, SARS-CoV-2 test positive, Transient ischaemic attack
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hearing impairment (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hearing loss, hypertension
Allergies: avelox IV, penicillins, shellfish, sulfadiazine
Diagnostic Lab Data: COVID test for SNF transfer + 9/9/2021
CDC Split Type:

Write-up: 98 y o woman with essential HTN, dementia, PVD brought to hospitat for concern of stroke with left facial droop. Since admission, BP initialy showed SBP of 215. Work up showed CT of brain confirming no acute process, chronic small vessel ischemia changes and diffuse cerebral atrophy. Working impression now is just TIA. As part of transfer eligibility, repeat COVID 19 pCR done and showed positive. Does not require oxygen supplementation and xray shows LLL atelectasis r/o new infiltrate. First dose 1/9/2021


VAERS ID: 1704275 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-16
Onset:2021-09-06
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

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

Write-up: breakthrough case, hospitalization


VAERS ID: 1704355 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-15
Onset:2021-09-06
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Headache, Pyrexia, Respiratory tract congestion
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen 500mg q8hr Vitamin D2 15,000IU Benadryl 25mg TID PRN for itching Ibuprofen 400mg HS Ashwaganda Collagen Garlique Hawthorn Berry Qunol Triple complex magnesium
Current Illness: None documented
Preexisting Conditions: history of adenomatous polyp of colon hemorrhoids back pain diverticulosis
Allergies: Dairy digest - Sinus congestion, itching, upset stomach, hives egg-containing compound - upset stomach Percocet - itching sulfa drugs - hives tramadol - headache tylenol with codeine - gastritis vicodin - itching
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated 9/6/2021 - Headache, Congestion, fever


VAERS ID: 1704387 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-28
Onset:2021-09-06
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Diarrhoea, Fatigue, Headache, Myalgia, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose01/07/21 2nd dose01/28/21 Diagnosed covid positive:09/08/2021 Symptom onset:09/06/21 Exposure: Symptoms:cough, fatigue,muscle aches,sore throat,diarrhea,chills HA


VAERS ID: 1704398 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-26
Onset:2021-09-06
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Oropharyngeal pain, SARS-CoV-2 test positive
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (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:
CDC Split Type:

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose01/05/21 2nd dose01/26/21 Diagnosed covid positive:09/09/21 Symptom onset:09/06/21 Exposure: Symptoms:SORETHROAT


VAERS ID: 1704403 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-01-27
Onset:2021-09-06
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Myalgia, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose01/06/21 2nd dose01/27/21 Diagnosed covid positive:09/10/21 Symptom onset:09/06/21 Exposure:Home Symptoms:cough, muscle aches,runny nose


VAERS ID: 1704497 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-03
Onset:2021-09-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Coronary arterial stent insertion, Electrocardiogram, Myocardial infarction, Thrombosis, Ultrasound scan
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Other ischaemic heart disease (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levothryoxine 150mcg Lisinopril-HCTZ 20-25mg Testosterone 50mg Fish Oil 4000 Vitamin C Zinc
Current Illness: NA
Preexisting Conditions: High Blood Pressure under control for years Thyroid condition under control for years Low testosterone under control for years
Allergies: NA
Diagnostic Lab Data: EKG, Ultrasound, all on 9-6-21
CDC Split Type:

Write-up: Blood clot causing a heart attack and stent.


VAERS ID: 1705029 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-01
Onset:2021-09-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Arthralgia, Back pain, Balance disorder, Blood potassium, Chest pain, Coordination abnormal, Dizziness, Fatigue, Full blood count, Haematocrit, Hypoaesthesia, Immediate post-injection reaction, Impaired work ability, Insomnia, Loss of personal independence in daily activities, Musculoskeletal stiffness, Neuralgia, Pain, Pain in extremity, Paraesthesia, Red blood cell abnormality, Spinal pain, Urine analysis abnormal, Vertigo
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine
Current Illness: Tested positive ANA, unresolved autoimmune positive markers
Preexisting Conditions: Hypothyroid stable
Allergies: No
Diagnostic Lab Data: Cbc panel showing some out of range red blood cell, potassium, hct 9/11 Urine test showed blood in urine Back nerve pain analyzed at urgent care 9/16
CDC Split Type:

Write-up: Immediate lightheaded, dizzy and within 12 hours sore arm and fatigue. Within 24 hours severe back pain and severe fatigue interfering with daily activities, inability to work at job. Over the course of 5 days severe side and back pain radiating to lower back up through shoulder on left side wrapping to chest and stomach . After 10 days developed spinal pain, nerve and poking sensations, numbness and tingling in legs and ankles, stiff neck, loss of balance and coordination, dizziness, vertigo and insomnia. Visited ER and urgent care facilities.


VAERS ID: 1706452 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-31
Onset:2021-09-06
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Myalgia, Pain, Pain in extremity, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Systemic: Body Aches Generalized-Severe, Additional Details: UPPER LEFT ARM PAIN STARTED 9/6. NOT IT HURS LIKE A POOLED MUSCLE SPREADING ACROSS THE RIGHT BACK AND SWALLEN. PAIN SEVERITY IS SEVERE. ADVISED TO CONTACT HER PRIMARY CARE PHYSICIAN TOMORROW.


VAERS ID: 1707220 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-07
Onset:2021-09-06
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Back pain, Cough, Drug ineffective, Headache, SARS-CoV-2 test, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Retroperitoneal fibrosis (broad), Arthritis (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210906; Test Name: SARS-CoV-2 test; Test Result: Positive ; Result Unstructured Data: Result : Patient tested positive for Covid 19 via rapid test
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: back and joints pain; cough; headache; back and joints pain; lack of efficacy; Positive for Covid; This spontaneous case was reported by a consumer and describes the occurrence of BACK PAIN (back and joints pain), COUGH (cough), DRUG INEFFECTIVE (lack of efficacy), SARS-COV-2 TEST POSITIVE (Positive for Covid) and HEADACHE (headache) in a 52-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 030A21A and 019B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 07-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 06-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 06-Sep-2021, the patient experienced DRUG INEFFECTIVE (lack of efficacy) and SARS-COV-2 TEST POSITIVE (Positive for Covid). On an unknown date, the patient experienced BACK PAIN (back and joints pain), COUGH (cough), HEADACHE (headache) and ARTHRALGIA (back and joints pain). The patient was treated with PARACETAMOL (TYLENOL) at an unspecified dose and frequency. At the time of the report, BACK PAIN (back and joints pain), COUGH (cough), DRUG INEFFECTIVE (lack of efficacy), SARS-COV-2 TEST POSITIVE (Positive for Covid), HEADACHE (headache) and ARTHRALGIA (back and joints pain) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 06-Sep-2021, SARS-CoV-2 test: positive (Positive) Result : Patient tested positive for Covid 19 via rapid test. No Concomitant medications were reported.; Sender''s Comments: Covid infection following vaccination has a causality assessment of "not applicable" by convention. Other events captured are likely symptoms of the Covid infection but a causal relationship cannot be excluded.


VAERS ID: 1707256 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-05
Onset:2021-09-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 1 - / OT

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

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

Write-up: felling itching/got itching again, eyes, nostril, throat, and bottom of the right foot; rush in some spot on the left arm,; This spontaneous case was reported by a consumer and describes the occurrence of PRURITUS (felling itching/got itching again, eyes, nostril, throat, and bottom of the right foot) and RASH (rush in some spot on the left arm,) in a 57-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 062e21a) for COVID-19 vaccination. Concurrent medical conditions included Blood pressure. Concomitant products included METOPROLOL for Blood pressure, PREDNISONE, COLESEVELAM, LISINOPRIL, ESOMEPRAZOLE and VERAPAMIL for an unknown indication. On 05-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 06-Sep-2021, the patient experienced PRURITUS (felling itching/got itching again, eyes, nostril, throat, and bottom of the right foot). 06-Sep-2021, the patient experienced RASH (rush in some spot on the left arm,). The patient was treated with DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL A) for Itching, at an unspecified dose and frequency. At the time of the report, PRURITUS (felling itching/got itching again, eyes, nostril, throat, and bottom of the right foot) and RASH (rush in some spot on the left arm,) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown.


VAERS ID: 1707263 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-06
Onset:2021-09-06
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Intentional product use issue
SMQs:, Drug abuse and dependence (broad), Depression (excl suicide and self injury) (broad)

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

Write-up: Did not get second dose in the time period stipulated for the second dose; This spontaneous case was reported by a consumer and describes the occurrence of INTENTIONAL PRODUCT USE ISSUE (Did not get second dose in the time period stipulated for the second dose) in a 41-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 050c21a) for COVID-19 vaccination. No Medical History information was reported. On 06-Jun-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 06-Sep-2021, the patient experienced INTENTIONAL PRODUCT USE ISSUE (Did not get second dose in the time period stipulated for the second dose). On 06-Sep-2021, INTENTIONAL PRODUCT USE ISSUE (Did not get second dose in the time period stipulated for the second dose) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant product use was not provided. Treatment information was not provided.


VAERS ID: 1707377 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-01
Onset:2021-09-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Fatigue, Feeling abnormal, Mobility decreased
SMQs:, Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (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: Type 1 diabetes mellitus
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: I was a totally different person; Could not move; Weak; Very tired; This spontaneous case was reported by a consumer and describes the occurrence of FEELING ABNORMAL (I was a totally different person), MOBILITY DECREASED (Could not move), ASTHENIA (Weak) and FATIGUE (Very tired) in an 82-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Type 1 diabetes mellitus. On 01-Sep-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 06-Sep-2021, the patient experienced FEELING ABNORMAL (I was a totally different person), MOBILITY DECREASED (Could not move), ASTHENIA (Weak) and FATIGUE (Very tired). At the time of the report, FEELING ABNORMAL (I was a totally different person), MOBILITY DECREASED (Could not move), ASTHENIA (Weak) and FATIGUE (Very tired) outcome was unknown. Concomitant medication of the patient was not reported. The patient did not took any medications or treatment. Most recent FOLLOW-UP information incorporated above includes: On 07-Sep-2021: Follow-up information received on 07-Sep-2021; included no new information.


VAERS ID: 1707390 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 - / -

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

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

Write-up: Expired vaccine administered beyond 12 hours expiration for punctured vial; Expired vaccine administered beyond 12 hours expiration for punctured vial; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered beyond 12 hours expiration for punctured vial) and PRODUCT STORAGE ERROR (Expired vaccine administered beyond 12 hours expiration for punctured vial) in a 67-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 058E21A) for COVID-19 vaccination. No Medical History information was reported. On 06-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 06-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered beyond 12 hours expiration for punctured vial) and PRODUCT STORAGE ERROR (Expired vaccine administered beyond 12 hours expiration for punctured vial). On 06-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered beyond 12 hours expiration for punctured vial) and PRODUCT STORAGE ERROR (Expired vaccine administered beyond 12 hours expiration for punctured vial) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown Route), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. Treatment information was not provided. Pharmacist is called to report that 8 patients received expired doses of Moderna COVID-19 vaccine beyond 12 hour expiration for punctured vials. Date the vial was initially stored in the refrigerator was 31AUG2021. Date first punctured was on 05SEP2021 11AM Kept in Refrigerator. Date of administration of vaccine was on 06SEP2021 4:30PM Room Temperature on 06SEP2021 then discarded the vial. Total amount of time the vial was exposed to room temperature range 46? to 77? F. From 06SEP2021 9:00AM and discarded vial after 4:30PM. This case was linked to MOD-2021-311383 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 07-Sep-2021: Follow up information included Updated Fax Contact details.


VAERS ID: 1707418 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 - / OT

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

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

Write-up: Expired vaccine administered beyond 12 hours expiration for punctured vial; This spontaneous case was reported by a consumer and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered beyond 12 hours expiration for punctured vial) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 058E21A) for COVID-19 vaccination. No Medical History information was reported. On 06-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 06-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered beyond 12 hours expiration for punctured vial). At the time of the report, EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered beyond 12 hours expiration for punctured vial) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown Route) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown Route), the reporter did not provide any causality assessments. Relevant concomitant medications were not provided. Treatment information was not provided.


VAERS ID: 1707440 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 - / OT

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

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

Write-up: Expired vaccine administered beyond 12 hours expiration for punctured vial; This spontaneous case was reported by a health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered beyond 12 hours expiration for punctured vial) in a 56-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 058E21A) for COVID-19 vaccination. No Medical History information was reported. On 06-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 06-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered beyond 12 hours expiration for punctured vial). On 06-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered beyond 12 hours expiration for punctured vial) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant medication details were not reported by the reporter. Treatment details was not reported by the reporter. Other information related to product is vial was initially stored in the refrigerator on 31-AUG-2021. Product first punctured on 05-SEP-2021 11AM Kept in Refrigerator. Total amount of time the vial was exposed to room temperature range (46? to 77? F): "From 06SEP2021 9:00AM and discarded vial after 4:30PM.


VAERS ID: 1707541 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-05
Onset:2021-09-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066D21A / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Chills, Decreased appetite, Discomfort, Feeling hot, Myalgia, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Back pain; Decreased appetite; chills; fever; Myalgia; General discomfort; Feeling hot; Pain; This spontaneous case was reported by a consumer and describes the occurrence of DISCOMFORT (General discomfort), FEELING HOT (Feeling hot), PAIN (Pain), BACK PAIN (Back pain) and DECREASED APPETITE (Decreased appetite) in a 58-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 066D21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 05-Sep-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 06-Sep-2021, the patient experienced DISCOMFORT (General discomfort), FEELING HOT (Feeling hot), PAIN (Pain), DECREASED APPETITE (Decreased appetite), CHILLS (chills), PYREXIA (fever) and MYALGIA (Myalgia). On 07-Sep-2021, the patient experienced BACK PAIN (Back pain). On 07-Sep-2021, CHILLS (chills) and PYREXIA (fever) had resolved. On 08-Sep-2021, MYALGIA (Myalgia) had resolved. At the time of the report, DISCOMFORT (General discomfort), FEELING HOT (Feeling hot), PAIN (Pain), BACK PAIN (Back pain) and DECREASED APPETITE (Decreased appetite) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication was reported. No treatment medication use was reported. This case was linked to MOD-2021-313117 (Patient Link).


VAERS ID: 1707544 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-09
Onset:2021-09-06
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0H8B21A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Decreased appetite, Dry throat, Dyspnoea, Headache, Hypoaesthesia, Hypokinesia, Limb discomfort, Nausea, Neck pain, Vaccination site pain
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Dehydration (broad), Sexual dysfunction (broad)

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

Write-up: movement reduced; vaccination site pain; Nauseous with smells of food.; Didn''t really have an appetite/ She couldn''t eat anything yesterday; Throat was dry; Couldn''t breathe through my nose; Pain in my neck; Stomach was hurting too; Headache/ head is still hurting; Couldn''t really move much; Legs would go numb; This spontaneous case was reported by a consumer and describes the occurrence of LIMB DISCOMFORT (Couldn''t really move much), HYPOAESTHESIA (Legs would go numb), DECREASED APPETITE (Didn''t really have an appetite/ She couldn''t eat anything yesterday), DRY THROAT (Throat was dry) and DYSPNOEA (Couldn''t breathe through my nose) in a 21-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 03NF21A and 0H8B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 09-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 06-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 06-Sep-2021, the patient experienced LIMB DISCOMFORT (Couldn''t really move much), HYPOAESTHESIA (Legs would go numb), DRY THROAT (Throat was dry), DYSPNOEA (Couldn''t breathe through my nose), NECK PAIN (Pain in my neck), ABDOMINAL PAIN UPPER (Stomach was hurting too) and HEADACHE (Headache/ head is still hurting). On 07-Sep-2021, the patient experienced DECREASED APPETITE (Didn''t really have an appetite/ She couldn''t eat anything yesterday) and NAUSEA (Nauseous with smells of food.). On an unknown date, the patient experienced HYPOKINESIA (movement reduced) and VACCINATION SITE PAIN (vaccination site pain). The patient was treated with PARACETAMOL (TYLENOL) at an unspecified dose and frequency and IBUPROFEN (oral) at a dose of 400 mg. At the time of the report, LIMB DISCOMFORT (Couldn''t really move much), HYPOAESTHESIA (Legs would go numb), DECREASED APPETITE (Didn''t really have an appetite/ She couldn''t eat anything yesterday), DRY THROAT (Throat was dry), DYSPNOEA (Couldn''t breathe through my nose), NECK PAIN (Pain in my neck), ABDOMINAL PAIN UPPER (Stomach was hurting too), HYPOKINESIA (movement reduced), HEADACHE (Headache/ head is still hurting), NAUSEA (Nauseous with smells of food.) and VACCINATION SITE PAIN (vaccination site pain) outcome was unknown. Concomitant drug details not provided. On the night of 06Sep2021, she had a sore arm. She couldn''t really move much because her legs would go numb. It lasted for 10 minutes. It would go away but then come back. She had headache. It felt like her brain was swelling. Her throat was dry, but it wasn''t sore. She couldn''t breathe through her nose, but it wasn''t runny. She couldn''t breathe no matter how much she tried to clean it. She had pain in her neck. If she lifted her head up, she would get another headache. Her stomach was hurting too. She felt nauseous with smells of food. She couldn''t eat anything yesterday 07Sep2021; she didn''t really have an appetite. Right now 08Sep2021 her head is still hurting a little bit and also the shot area Company Comment: Based on the current available information which includes a t temporal association between the use of the product and the start date of the reported event, a causal relationship with the event cannot be excluded. Nausea, headache and myalgia are consistent with the product established safety profile.; Sender''s Comments: Based on the current available information which includes a t temporal association between the use of the product and the start date of the reported events, a causal relationship with the events cannot be excluded. Nausea, headache and myalgia are consistent with the product established safety profile.


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