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From the 7/23/2021 release of VAERS data:

Found 506,830 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 256 out of 5,069

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VAERS ID: 1375643 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-05-25
Onset:2021-06-02
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Skin reaction, Vaccination complication
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Local skin vaccine reaction, delayed. 4 cm x 5 cm. Started day 8 after vaccination and worsened on day 10.


VAERS ID: 1375692 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Unknown  
Location: California  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210604979

Write-up: EXPIRED VACCINE ADMINISTERED; This spontaneous report received from a pharmacist concerned a 27 year old of unspecified sex. 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: 205A21A expiry: 30/JUN/2021) dose was not reported, administered on 02-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUN-2021, the subject experienced expired vaccine administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of expired vaccine administered was not reported. This report was non-serious. This case, from the same reporter is linked to 20210606143.


VAERS ID: 1375698 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210606143

Write-up: EXPIRED VACCINE ADMINISTERED; This spontaneous report received from a pharmacist concerned a 27 year old of unspecified sex. 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: 205A21A, expiry: 30-JUN-2021) dose was not reported, administered on 02-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUN-2021, the subject experienced expired vaccine administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of expired vaccine administered was not reported. This report was non-serious. This case, from the same reporter is linked to 20210604979.


VAERS ID: 1375701 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Indiana  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: No known allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210607394

Write-up: EXPIRED VACCINE USE; OUT OF SPECIFICATION PRODUCT USE; This spontaneous report received from a pharmacist concerned a 45 year old male. The patient''s pre-existing medical conditions included no known allergies. The patient received covid-19 vaccine (suspension for injection, intramuscular, batch number: 042A21A,expiry: 06-JUN-2021) dose was not reported, administered on 02-JUN-2021 15:41 for prophylactic vaccination. No concomitant medications were reported. On 02-JUN-2021, the subject experienced expired vaccine use. On 02-JUN-2021, the subject experienced out of specification product use. The action taken with covid-19 vaccine was not applicable. The outcome of the expired vaccine use and out of specification product use was not reported. This report was non-serious.


VAERS ID: 1375705 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Incorrect dose administered, Poor quality product administered, Wrong technique in product usage process
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210607539

Write-up: PATIENT GIVEN DILUTED JNJ VACCINE BY ACCIDENT; WRONG TECHNIQUE IN DRUG USAGE PROCESS; POOR QUALITY DRUG ADMINISTERED; This spontaneous report received from a pharmacist concerned a 32 year old male. 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, and batch number: 204A21A expiry: 23-JUN-2021) .3 ml, administered on 02-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUN-2021, the subject experienced subject given diluted JNJ vaccine by accident. On 02-JUN-2021, the subject experienced wrong technique in drug usage process. On 02-JUN-2021, the subject experienced poor quality drug administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the patient given diluted JNJ vaccine by accident, wrong technique in drug usage process and poor quality drug administered was not reported. This report was non-serious. This case, from the same reporter is linked to 20210608711 and 20210607725.


VAERS ID: 1375707 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling abnormal, Pain
SMQs:, Dementia (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: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: The patient did not have any history of drug abuse or illicit drug use. The patient had no premedical history.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210607795

Write-up: TIRED; BRAIN FOG; ACHES; CHILLS; This spontaneous report received from a pharmacist concerned a 38 year old male. The patient''s weight was 130 pounds, and height was 62 inches. The patient''s concurrent conditions included non alcoholic, and non smoker, and other pre-existing medical conditions included the patient did not have any history of drug abuse or illicit drug use. the patient had no premedical history. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 02-JUN-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 02-JUN-2021, the subject experienced brain fog. On 02-JUN-2021, the subject experienced aches. On 02-JUN-2021, the subject experienced chills. On 03-JUN-2021, the subject experienced tired. The action taken with covid-19 vaccine was not applicable. The patient was recovering from brain fog, chills, aches, and tired. This report was non-serious. This case, from the same reporter is linked to 20210456372.


VAERS ID: 1375787 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Musculoskeletal stiffness
SMQs:, Peripheral neuropathy (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)

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

Write-up: hi, I got Pfizer covid vaccine''s first shot on 6/2 at 10:20 am. At around 10:30 pm, the left side of my face and facial bones became a bit stiff. Though I recovered next morning (on 6/3) but I still have a very slight numbness in my left jaw. So I wanted to report this adverse effect.


VAERS ID: 1375828 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-27
Onset:2021-06-02
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: On 5/27/2021 a parent presented to pharmacy with an Immunization Consent form signed and dated requesting a Pfizer Covid vaccine for her son. The form listed his date of birth as 2/24/2009 which would make him 12 years old. On Wednesday 6/2/2021 a representative from the state immunization registry called regarding the date of birth. She stated that the date of birth was 2/21/2010. She informed me that the state would be looking into this and that I should contact the mother and inform her that we gave an immunization to her child who is underage. When I spoke to the mother she stated that patient''s dob was 2009. I told her that the immunization registry listed it as 2010 and that she should look into it. I then asked her again what the dob was and she admitted that it was 2/2010. I told her that the state would be contacting her and hung up. An hour later she called to apologize to me and said she wasn''t a bad mother. She then went on to say that she put 2010 on the form and I said he could get the shot. I corrected her and said the form has 2009 with her signature on it and that we would never give the immunization to an 11 year old. She stated it''s only 6 months no big deal. I wished her a good vacation and hung up.


VAERS ID: 1375830 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-24
Onset:2021-06-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pain, Injection site pruritus, Injection site rash, Injection site swelling, Injection site warmth, Muscle spasms, Muscle twitching, Myalgia, Neck pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Dyskinesia (broad), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi Vitamin, Vit D
Current Illness: none
Preexisting Conditions: none
Allergies: Sulfa
Diagnostic Lab Data: None to date
CDC Split Type:

Write-up: Pain at site of injection for 3 days. Muscle twitching and spasms in eye, arm, shoulder, leg starting on day 5 and continuing thru today day 11. Large raised itchy hot rash appeared on day 7 around the injection site. Extreme fatigue day 8. Constant muscle pain in legs just above knees. Pain that comes and goes in head, neck and right arm.


VAERS ID: 1375851 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site swelling, Vaccine positive rechallenge
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: had the same reaction with the first dose at a different location. He did not report that reaction on the VARs of the second dos
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient had swelling and bruising at injection site for 3 days after receiving the shot. Patient went to urgent care and was prescribed antibiotics


VAERS ID: 1375920 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO168 / 3 AR / IM

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

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

Write-up: Patient received a third dose of the vaccine. Patient was asked whether it was the first or second dose to which they replied 2nd dose. Upon attempting to enter into the LINKS database, it was discovered that this was in fact the patient''s 3rd dose.


VAERS ID: 1375928 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-18
Onset:2021-06-02
   Days after vaccination:76
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abortion spontaneous, Exposure during pregnancy, Foetal growth restriction, Maternal exposure before pregnancy, Ultrasound antenatal screen abnormal
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow), Termination of pregnancy and risk of abortion (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: Lexapro Prenatal vitamin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Miscarriage confirmed via ultrasound on 6/3/21.
CDC Split Type:

Write-up: First dose moderna: 3/18/21 Second dose moderna: 4/15/21 Conceived: 4/14/21 Miscarriage at 7.5 weeks pregnant. Baby stopped growing at size 6 weeks pregnant. Due date: January 17 2022 Pregnancy confirmed 5/24/21. gestation age: 8 weeks 1 day based on LMP. Baby only measured 6 weeks 0 days on this date.


VAERS ID: 1375982 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Condition aggravated, Oxygen saturation decreased, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Chewable Aspirin, Atorvastatin, Bisacodyl Suppository, Constulose, Famotidine, Fenofibrate, Fleet Bisacodyl Enema, DuoNeb, Levetiracetam Solution, Metoclopramide Solution, Metoprolol Tartrate, Niacin, Omega-3 Ethyl Esters, Phenobarbital, Sc
Current Illness: Patient was hospitalized between 1st and 2nd COVID doses for abdomen abscess
Preexisting Conditions: Seizures, Ventilator-Dependent Respiratory Failure, Hyperlipidemia, Dysphagia, Diabetic, Stroke
Allergies: None
Diagnostic Lab Data: Blood work and chest x-ray in ER
CDC Split Type:

Write-up: Patient was sent out to the hospital on Wednesday night (June 2) due to a decrease in oxygen saturation levels. He was admitted into the ER with a diagnosis for recurrent seizures. Patient has a history of seizures, but a facility worker mentioned that the seizures did not look like the ones he would have.


VAERS ID: 1375992 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-17
Onset:2021-06-02
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0161 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Cold sweat, Decreased appetite, Vomiting
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: B complex 1 daily Benadryl 25 mg. 1 daily Diphenhydramine 25 mg. 1 daily Vitamin D3 50mcg (2000iu) 1 daily Naproxen Sodium 1 daily 220 mg B12 5000 mcg 2 daily
Current Illness: None, last illness 8/2017
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 5:40 am 6/2/2021 awakened to cold sweat. 8:00 am unable to keep morning coffee down. 11:00 eat 1/2 bagel with peanut butter, unable to keep it down. 2:00 and after further attempts at water, saltine cracker, unable to keep anything down 11:00 pm, attempt to drink sparkling water, unable to keep down. No appetite, inability to keep food down and cold sweats after vomiting each occurrence. June 3, once again able to tolerate food, energy low I assume from available energy from lack of food, progressive improvement through the day. Self managed care.


VAERS ID: 1376009 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Inflammation
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine (thyroid), Escotalipram (Lexapro), Omega 3 fish oil, Tumeric, multi-vitamin
Current Illness: NA
Preexisting Conditions: Had total knee replacement in February 2021 (4.5 months ago)
Allergies: Sensitivity to Demoral, Welbutrin, Cymbalta
Diagnostic Lab Data: None. My physician has not yet responded. The symptoms are diminishing but still present 2 days following the vaccination.
CDC Split Type:

Write-up: I had a total knee replacement in February 2021. I experienced significant inflammation in that same knee, calf, ankle and foot as a result of that surgical procedure. Then just 2 days ago, following my first Covid-19 vaccination, I had/am now having an inflammatory response in that same leg (knee, calf, ankle and foot). I reported it to my surgeon Dr.


VAERS ID: 1376330 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Adenovirus test, Alanine aminotransferase normal, Aspartate aminotransferase normal, Blood creatine normal, Blood sodium normal, Chest pain, Chills, Computerised tomogram thorax normal, Cytomegalovirus test, Dyspnoea, Echocardiogram normal, Electrocardiogram ST segment abnormal, Electrocardiogram abnormal, Enterovirus test, Eosinophil percentage, Epstein-Barr virus test, HIV test, Haematocrit normal, Headache, Herpes simplex test negative, Human herpes virus 6 serology, Intensive care, International normalised ratio decreased, Lymphocyte percentage, Magnetic resonance imaging heart, Malaise, Metabolic function test, Mycobacterium tuberculosis complex test, Myocarditis, Neutrophil percentage decreased, Parvovirus B19 test, Platelet count normal, Prothrombin time prolonged, Pyrexia, SARS-CoV-2 antibody test positive, SARS-CoV-2 test negative, Troponin increased, White blood cell count decreased
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Agranulocytosis (broad), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: None: no cough/cold/URI or other illnesses
Preexisting Conditions: None
Allergies: none
Diagnostic Lab Data: 6/4: Outside hospital WBC 4.2 HCT: 39.7 Plt: 164 N: 45.2 E:2.9 L: 38.8 CMP: Na 140 Cr: 0.71 AST: 28 ALT 16 Trop: 2980 INR: 1.1 PTT: 29.1 EKG: "reported ST changes" Chest CT: negative for PE 6/4: Troponin 4.90$g$g3.07$g1.41$g1.23$g1.24 ID labs: COVID PCR negative; COVID Ab positive (qual/semi); HSV negative Pending: HHV6/Enterovirus/Parvovirus/CMV/EBV/Adenovirus PCR, EBV panel; HIV; TB Quant Gold Cardiac MRI: 1. Normal left ventricular size and systolic function. 2. Normal right ventricular size and systolic function. 3. No significant valvular disease. 4. No abnormal late gadolinium enhancement. 5. No evidence for active or remote pericarditis. Lack of evidence for active myocarditis. ECHO 6/4: without dysfunction
CDC Split Type:

Write-up: 8 hours post vaccination, developed subjective fever, chills, headache, malaise 6/2: Around 32 hours post vaccination, developed acute chest pain, shortness of breath, difficulty breathing when laying flat. Required ibuprofen. 6/3: felt better, required ibuprofen. Presented to ED on 6/4 with continued symptoms (chest pain, shortness of breath), noted to have elevated troponins. Transferred to Hospital on 6/4 to ICU for monitoring. To the floor on 6/5. Clinically doing well just on NSAIDs with slowly decreasing troponins. Dx: probable acute myocarditis per cardiology based on clinical symptoms and troponin leak


VAERS ID: 1376344 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / UNK LA / IM

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

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

Write-up: Greater than 45 days since 1st dose


VAERS ID: 1376355 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood pressure decreased, Fatigue, Feeling abnormal, Heart rate increased, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: In observation post vaccine within 15 minutes c/o tired and "loopy" and when being evaluated continued to have a drop in BP with and Increase in HR= became unresponsive and 911 called. NO resp issues or hives


VAERS ID: 1376421 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Abortion spontaneous, Exposure during pregnancy
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (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:
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient called the pharmacy a few days after her 2nd Moderna vaccination and stated about a day after her shot she started experiencing abdominal cramps. Patient was pregnant so was very concerned and went to the hospital. Unsure how far along she was but she wanted us to know she had a miscarriage. We are unaware if this is linked to the vaccination but patient is stating that''s the only thing that has changed since her three previous pregnancies that had no issues whatsoever. Reporting this since she called the pharmacy so we were aware and since we are not aware if the hospital filed this report.


VAERS ID: 1376435 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-30
Onset:2021-06-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram normal, Chest pain, Dyspnoea, Echocardiogram normal, Electrocardiogram normal, Troponin increased
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Gabapentin - 2400 mg daily Trazodone - 50mg daily in the evening
Current Illness: None.
Preexisting Conditions: Thoracic Outlet Syndrome, formerly treated with physical and occupational therapy. Otherwise in good health and no prior heart issues.
Allergies: Allergic to penicillin and amoxicillin
Diagnostic Lab Data: Echocardiogram, EKG, angiogram- all came out normal/healthy.
CDC Split Type:

Write-up: Experienced chest pain and shortness of breath on Wednesday morning, after getting the second vaccine shot on Sunday. Went to the hospital where they reported elevated troponin levels and possible myocarditis. Troponins continued to rise over the next day and peaked at 7.2 before starting to go back down. Stayed at the hospital for two nights to be observed.


VAERS ID: 1376476 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye pain, Headache, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad)

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

Write-up: Swelling in legs, and severe headache, eye pains


VAERS ID: 1376483 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Pain, Somnolence
SMQs:, Peripheral neuropathy (broad), 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: Insulin
Current Illness:
Preexisting Conditions: Diabetes, history of stroke
Allergies: shrimp, fish, peanuts,some other nuts
Diagnostic Lab Data: I sent a note to my GP. Realistically, what does medicine actually DO about this? Noting item 21... I do not know if this is temporary or permanent. Neither does my doctor.
CDC Split Type:

Write-up: Wednesday, I fell asleep soon after I got home. I had a couple of hours of extremely deep sleep. (In retrospect, this makes perfect sense because neurological stress does that to me.) When I was waking up, I realized that I had the sensation of hot. I didn''t have a fever or a sunburn. Nonetheless, the nerves near the skin for much of my arms, legs, and part of my torso were saying, ''Hot''. They were all normal body temp when I checked with my hand. On Thursday, the sense of ''hot'' continued. The sensation was morphing from ''hot'' to the sore feeling one gets from a sunburn. The truth didn''t match the sensation. There is no skin damage. Touching it does not aggravate the soreness. As I type on Sunday, my inner thighs have a slightly lesser version of both ''hot'' and sore. This is also true of my arms, rest of my legs, and other parts of my body to a lesser extent. In light of health issues noted above... The sensations were the same between right and left. My glucose was normal a couple hours before the shot and when I checked soon after waking.


VAERS ID: 1376530 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Periorbital swelling, Rash macular, Tenderness, Vision blurred
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Patient''s extremities are red and splotchy. Patient has swelling under right eye that is sore to touch. Patient reported no issues with vision but has slight blur of vision at times that goes away when blinking. She is taking Benadryl to help with swelling and will follow up with physician if symptoms do not improve.


VAERS ID: 1376538 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-31
Onset:2021-06-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041CZ1A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Migraine, Nausea, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine 5 mg (Lisinopril 10 mg) (Sambucol)
Current Illness:
Preexisting Conditions: High blood pressure, Sinus
Allergies: Sulfa, Lactose to dairy
Diagnostic Lab Data: Taradol injection 6-2-2021 6:44 pm: Care Center
CDC Split Type:

Write-up: Severe migraine headache, blurred vision and dizziness and nauseous and passing out for 5 days so far


VAERS ID: 1376569 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Headache, Loss of consciousness, Nausea, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Nausea-Medium, Additional Details: Possible Vasovagal reaction, out for a very short time, then had nausea, a bit confused, shakiness, headache


VAERS ID: 1376579 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Nausea, Pyrexia, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: NAUSEA, FEVER/CHILLS, SHAKES/TREMORS. PT HAS NOT TRIED ANY RX OR OTC TREATMENTS


VAERS ID: 1376615 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Lip swelling, Nasal discomfort, Pyrexia, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: Vitamin D, Vitamin C, testosterone enanthate, HCG 500 IU
Current Illness: None
Preexisting Conditions:
Allergies: Have had allergic reactions to NSAIDs.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: After receiving the J&J Covid vaccine I was awake all night with fever and chills, which I understand is completely normal. However the next day my upper lip and lower nose swole up in an allergic reaction. I took Benadryl and went to sleep and by the time I work up it had subsided. Two days after that incident I woke up (this morning) and my left cheek was swollen from another allergic reaction. During this time I had not eaten or taken anything out of the ordinary.


VAERS ID: 1376654 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamins, Vitamin D, Propolis
Current Illness:
Preexisting Conditions:
Allergies: Kiwi, Pollen, Dust mites
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, fever, muscle aches, which lasted for about 24 hours


VAERS ID: 1376679 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Contusion, Feeling hot, Malaise, Muscular weakness, Oral contusion, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Arthritis (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: Food allergies
Allergies: All Poultry/Foul, All Tree nuts
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 6/2, complained of feeling hot and sick, no fever. Joint aches and leg weakness 6/3 had a strange bruise like spot on the back of his neck. Continues leg aches and weakness 6/4 had a strange bruise like spot near corner of mouth. Neck was better though. Never pain at the bruise like spot sites Spot on face is fading, but still present on the face as of today. All other symptoms resolved besides the spot on his face


VAERS ID: 1376827 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-24
Onset:2021-06-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast pain, Chest pain, Headache, Hypoaesthesia, Limb discomfort, Pain, Paraesthesia, Peripheral swelling, Skin discolouration, Swelling face, Visual impairment
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Lipodystrophy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Developed swollen legs tight and discolored.. had a massage to relieve pressure on Friday.. started noticing Thirsday and at present have very bad vision changes that isn''t normal. I also have on and off cheat pains this morning with numbness in my left arm and tingling fingers. Pain move from my right under breast area to left side before subsiding. But vision problem persists with swollen face and headache.


VAERS ID: 1376856 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 1 LA / IM

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

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

Write-up: PATIENT was given Modern vaccine and is 17 yrs old. No reactions.


VAERS ID: 1376930 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-12
Onset:2021-06-02
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Myocarditis, Pancytopenia, Pericarditis, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Myelodysplastic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Few hours after vaccine developed fevers for 2 days which resolved. Then 6/2/21 developed fevers, rash, chest pain, admitted to hospital 6/4/21 with fevers, rash, pancytopenia, pericarditis, myocarditis


VAERS ID: 1377031 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Chills, Diarrhoea, Dizziness, Fatigue, Flushing, Headache, Hyperhidrosis, Lethargy, Nausea, Pain, Pyrexia, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Systemic: Abdominal Pain-Medium, Systemic: Body Aches Generalized-Medium, Systemic: Chills-Severe, Systemic: Diarrhea-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Fever-Medium, Systemic: Flushed / Sweating-Severe, Systemic: Headache-Medium, Systemic: Nausea-Severe, Systemic: Shakiness-Medium


VAERS ID: 1377055 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 LA / 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: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type: NA

Write-up: 2ND VACCINE GIVEN TOO EARLY- 15 DAYS BETWEEN 1ST DOSE AND 2ND DOSE. NO EFFECTS NOTED WITH THE PATIENT.


VAERS ID: 1377088 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Injection site pain, Movement disorder, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Tdap 03/03/2020 0.5 mL Left Deltoid U6378AA Sanofi Pasteur 07/04/2021 Same Symptoms as previously described, along with Muscle s
Other Medications: Amlodipine, Calcium, Magnesium, Zinc, Melatonin
Current Illness: None
Preexisting Conditions: High Blood Pressure
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: It started with soreness in the top of the left shoulder and injection site, which was to be expected. Then muscle pain and strain that starts in the inner arm traveling down the muscle to the left wrist. Left arm cannot extend to full range with out a "pulling, or ripping " feeling. The left arm is painful to the touch, and the pain gets worse when manipulated. No redness or obvious swelling. Just lasting pain through the entire left arm muscles. There is no soreness on the injection site, and no longer any soreness on the shoulder. Took Tylenol PM for three straight nights but the pain and strain is persistent and only provided a very mild temporary relief. Also tried using a cold compress that only gave minimal relief. Symptoms are still on going.


VAERS ID: 1377094 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-24
Onset:2021-06-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: multivitamin, brain bright supplement, Omega creel, doxycycline 20mg, Lexapro 20mg, Lunesta 2mg, gabapentin 900mg 3 x daily, nortriptyline 50mg, venlafaxine 37.5 mg,
Current Illness:
Preexisting Conditions: MS
Allergies: nka
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt woke up on 6/2/2021 and noticed she had a warm red spot on her left arm around the injection site. The next day it was the size of a half dollar. It continued to spread down and out on the arm and was still red and warm. She went to the walk in clinic on 6/6/2021. Her vitals were normal. She was prescribed Cephalexin 500mg antibiotic and told to FU w her doctor if it didnt get better. Pt will contact her MS specialist to let them know about the infection.


VAERS ID: 1377104 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-05-24
Onset:2021-06-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Joint stiffness
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Joint pain and stiffness in knees, wrists and fingers.


VAERS ID: 1377313 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-05-23
Onset:2021-06-02
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW9178 / 1 - / IM

Administered by: School       Purchased by: ?
Symptoms: Abdominal pain, Appendicectomy, Appendicitis, Computerised tomogram abnormal, Full blood count abnormal, Pyrexia
SMQs:, Acute pancreatitis (broad), Haematopoietic leukopenia (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: penicillin
Diagnostic Lab Data: 6/2/2021 CBC showed elevated white count. 6/3/2021 CT with oral contrast confirmed appendicitis. 6/3/2021 appendectomy
CDC Split Type:

Write-up: 6/2/2021 abdominal pain with fever, diagnosis appendicitis. 6/3/2021 appendectomy


VAERS ID: 1377316 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen, albuterol inhaler, atorvastatin, biscabodyl suppository, carvidiol, Ferrous Sulfate Elixer, Gabapentin, Hydralazine, Levemir, Levothyroxine, Lisinopril, Lorazepam, Novolog, Omeprazole, Polyethelene glyco powder, sildenafil, s
Current Illness: none
Preexisting Conditions: end stage renal disease, type 2 diabetes, 2nd hyperparathyroidism, dyphasgia, muscle wasting atrophy, elipepsy, pulmonary hypertention,
Allergies: no known drug/food allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: pt has no adverse events pt recieved two diffirent manufacturers of the Covid-19 vaccines, both are MRna vaccines the Pzifer vaccine (2 doses at Dialysis) and the Moderna Vaccine (2 doses at the nursing home where she ''s staying.


VAERS ID: 1377357 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Erythema of eyelid, Eye infection, Eyelids pruritus, Periorbital swelling, Swelling of eyelid, Visual acuity tests
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Ocular infections (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Taken Daily: Alive 50+ Ultimate Daily Vitamin, Krill oil 1250mg, B-100 Complex, Allegra-24hr, D3 5000 I.U., E-180mg, Align 24/7, Citracal + D3, Simvastatin 5mg, Quinol-meg COQ10, Paxil 20mg, Singular 10mg, Wixela 250/50, Flonase spray
Current Illness:
Preexisting Conditions: Year round allergies, Moderate Asthma, Cholecystectomy, Hysterectomy
Allergies: Codeine, Biaxin, Sulfa drugs
Diagnostic Lab Data: Vision test (from wall)
CDC Split Type:

Write-up: Left eye infection(itchy, red, puffy, swollen) above on eyelid and underneath eye/Allergic Reaction/Covid-19 Vaccine Diagnosis: Adverse effect of other viral vaccines Prescribed: H. Cortisone 1oz - 1% cream, apply lightly and use cold compress 3x daily


VAERS ID: 1377653 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fall, General physical condition abnormal, Thirst
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: 1:08pm client c/o feeling dizzy and thirsty. Patient was offered water. 1:15pm Patient found on floor. Patient was monitored and EMS called. 162/110, HR 88. EMS arrived, patient refused transportation, was accompanied home by husband. Patient was advised to call 911 or contact medical doctor if still experiencing symptoms. Understanding verbalized. 13:40 Patient left site, accompanied by husband.


VAERS ID: 1377718 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-02-02
Onset:2021-06-02
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / N/A UN / UN

Administered by: Public       Purchased by: ?
Symptoms: Aphasia, Bell's palsy, Blood pressure increased, Corneal reflex decreased, Ear pain, Facial paralysis, Hypoaesthesia, Hypoaesthesia oral, Hypogeusia, Hyposmia, Magnetic resonance imaging head normal, Pain in jaw, Scan with contrast normal, White blood cell count increased
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Corneal disorders (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hearing impairment (broad), Osteonecrosis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations:
Other Medications: Losartan, Metformin, Carvedilol, Aciphex, Cymbalta, Wellbutrin,
Current Illness: None
Preexisting Conditions: Diabetes, Obesity, HTN
Allergies: PCN, Naproxen, Peanuts, Tree nuts, Latex
Diagnostic Lab Data: ER visit with MRI w/wo contrast to r/o stroke. Results: Normal. Labs WNL, White count 12.2. No temp. Elevated BP 210/120 upon arrival down to 165/88 at end of ER visit. DX: Bell''s palsy. Given script for 60 mg prednisone once a day for 7 days and 1gm of Valtrex three times a day for 7 days. Follow up with Primary care.
CDC Split Type:

Write-up: Began to have an earache and lower jaw ache around 10:30 AM on 06/02 while at work. Symptom''s of decreased ability to blink, smell, taste, talk, and pronounced facial droop by 3:30 pm. 1/2 face including tongue numb with full right side of face completely paralyzed by 6 pm.


VAERS ID: 1377732 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Headache, Knee operation, Pain, Sleep disorder
SMQs:, Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: When I was a young girl, 6 or 7, my grandfather contracted TB. Everyone that was local in the family had to take some kind of s
Other Medications: synthroid, pepcid, xyzal, lipitor, aspirin, multivitamin and magnesium on a daily basis. I took 10 ml of benadryl about 30 minutes prior.
Current Illness: Hypothyroidism, Type II diet and exercise controlled diabetic.
Preexisting Conditions: same as above
Allergies: penicillin, sulfa, lozol, amaprox, cardura, glucophage, micronas, thiazide, lopressor, tetracyline, ultrasound gel with menthol, ct dye (I had an anaphylactic reaction to ct dye and some type of shot I had to take when I was little because my grandfather had TB)
Diagnostic Lab Data: Did not seek medical help.
CDC Split Type:

Write-up: Around 7:00-8:00 that evening, approximately four hours after recieving the vaccine, I started having shooting pain in my head. It was mild at first, then harder and more frequent as the evening went on. It did that until late the next morning and was completely gone by around noon. This wasn''t a ''headache'' or migraine. It was shooting pain like none I had ever had in my head. I had a knee revision years ago and it also affected the knee through the night with that same type of pain. I wasn''t as concerned about the knee, but, the head was concerning. I didn''t report it because I didn''t know I had to register to check in.


VAERS ID: 1377736 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-03-31
Onset:2021-06-02
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allopurinol, amitiza, aspirin, cefadroxil, fluticasone, insulin detemir, insulin regular, levothyroxine, linzess, midrodrine, multivitamin, omerazole, pravastatin, rena-vite, sevelamer
Current Illness:
Preexisting Conditions: "weak heart", vertigo, OSA, reduced mobility, postoperative nausea and vomiting, peripheral edema, nystagmus, neuropathy, lymphedema, left knee pain, "illiterate", hyperlipidemia, HTN, hx total knee arthroplasty, hep B, GERD, DM2, occasional smoker, CHF, Back pain, angina pectoris, anemia, renal cell carcinoma of right kidney, ESRD needing dialysis
Allergies: None known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received both doses of COVID Pfizer vaccine., on 3/10/21 and 3/31/21. Pt tested positive for COVID prior to a routine unrelated procedure on 6/2/21, but was asymptomatic.


VAERS ID: 1377829 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic shock, Blood test, Burning sensation, Peripheral swelling, Pruritus, Rash, Swelling, Swelling face, Urticaria, White blood cell count increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: viibryd and alprazolam
Current Illness: None
Preexisting Conditions: None
Allergies: penicillin
Diagnostic Lab Data: blood work showing increased white blood cell counts (6/5-6/7)
CDC Split Type:

Write-up: anaphylactic shock (fully body hives/extreme swelling of faces, neck, and limbs/ full body rash/painful itching/ feeling like a very intense burn) has lasted for 5 days causing hospitalization (has not gone away yet)


VAERS ID: 1377847 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 005C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Paraesthesia, Paraesthesia oral
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

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

Write-up: Pt began experiencing tingling on left face and tongue without breathing difficulty 1 hour after vaccine administration. Went to ED and was given acute facial numbness diagnosis, provider stated that it "could represent a transient facial palsy after administration of the vaccine, however it is not unilateral."


VAERS ID: 1377882 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-05-19
Onset:2021-06-02
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / SC

Administered by: Other       Purchased by: ?
Symptoms: Aspartate aminotransferase decreased, Blood alkaline phosphatase increased, Blood creatinine decreased, Dehydration, Diarrhoea, Lymphocyte count decreased, Neutrophil count increased, Syncope, Unresponsive to stimuli, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Liver related investigations, signs and symptoms (broad), Haematopoietic leukopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Biliary system related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow)

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: Sertraline HCL 25 mg x2 daily, Methylphenidate ER 20 mg once daily, 2 multivitamin gummies daily for teens.
Current Illness: None
Preexisting Conditions: ADHD inattentive type, new this year is depression and anxiety. Other than that she is healthy teenager.
Allergies: None
Diagnostic Lab Data: Creatinine low 0.51 mg/dl, Alk Phos high 116 IU/L, AST low 13 IU/L, WBC high 12.6 K/mcL, Neutros Abs high 11.19 K/mcL, Lymphocytes Absolute low 0.79 x10, EKG normal.
CDC Split Type:

Write-up: Daughter stated she had diarrhea for 3 weeks while we were at the hospital on 6/2 for IV fluids and severe dehydration. Her poop was mushy, and not diarrhea, however for her it was much softer than normal. She collapsed at home and was unresponsive, 911 was called, ER doctor determined she was severely dehydrated and administered 2 bags of IV fluids to stabilize her blood pressure.


VAERS ID: 1377896 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-03-27
Onset:2021-06-02
   Days after vaccination:67
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Amylase, Aspartate aminotransferase increased, Blood albumin increased, Blood alkaline phosphatase increased, Blood calcium normal, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood potassium normal, Blood sodium normal, Blood urea normal, Blood urine absent, Brain natriuretic peptide, Carbon dioxide normal, Cerebrovascular accident, Chest X-ray normal, Computerised tomogram head abnormal, Electrocardiogram normal, Haematocrit increased, Haemoglobin increased, Headache, Hemiparesis, Hypoaesthesia, International normalised ratio normal, Lipase, Mean cell volume normal, Nitrite urine absent, Platelet count normal, Protein urine absent, Prothrombin time normal, Red blood cell count normal, Specific gravity urine normal, Troponin, Troponin I, Ultrasound Doppler normal, Urine ketone body absent, Urine leukocyte esterase, Visual impairment, White blood cell count increased, White blood cells urine negative, pH urine normal
SMQs:, Liver related investigations, signs and symptoms (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Biliary system related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: nka
Diagnostic Lab Data: CBC Recent Labs Lab 06/02/21 1601 03/01/21 0800 WBC 10.3 4.7 HGB 16.4* 15.3* HCT 49.2* 45.3* PLT 222 193 MCV 93.5 92.4 RBC 5.26* 4.90 CHEMISTRY Recent Labs Lab 06/02/21 1601 04/26/21 0917 03/01/21 0800 03/01/21 0800 GLU 165* -- -- 113* BUN 16 -- -- 14 CREATININE 0.6 -- -- 0.7 NA 141 -- -- 138 K 4.2 -- -- 3.6 CL 105 -- -- 103 CO2 25 -- -- 30 CALCIUM 9.8 -- -- 9.1 LABALBU 4.4 -- -- 3.6 ALT 33 31 < $g 27 AST 17 17 < $g 15 ALKPHOS 121* -- -- 113 LABBILI 0.3 -- -- 0.4 < $g = values in this interval not displayed. GI No results for input(s): AMYLASE, LIPASE in the last 70080 hours. COAGS Recent Labs Lab 06/02/21 1601 10/21/19 0914 PROTIME 11.5 12.6 INR 0.9 1.0 CARDIAC No results for input(s): TROPONINI, TROPONIN2, TROPONIN3, TROPONIN4, BNP in the last 70080 hours. URINE Recent Labs Lab 06/02/21 1601 LEUKOCYTESUR NEGATIVE NITRITE NEGATIVE BLOODU NEGATIVE WBCU 0 to 5 SPECGRAV 1.015 KETONESU NEGATIVE PROTEINUA NEGATIVE PHUR 5.5 Imaging Review EKG Result Date: 6/2/2021 EKG Report Date: 6/2/2021 Time: 15:00:05 Previous EKG available for comparison: No The EKG showed a normal sinus rhythm with a ventricular rate of 84 bpm. PR interval normal at 140 ms. QRS duration normal at 94 ms. QT and QTC intervals are within normal range. R axis is normal at 77 degrees. There is no evidence of acute ST or T-wave changes. There is no voltage criteria for left ventricular hypertrophy. MD 6/2/2021 5:22 PM XR CHEST PA AND LATERAL 2 VIEW Result Date: 6/2/2021 EXAM DESCRIPTION: XR CHEST PA AND LATERAL 2 VIEW CLINICAL HISTORY: 69 years Female, right sided numbness COMPARISON: 10/22/2018 TECHNIQUE: PA and lateral views FINDINGS: There is no focal consolidation, pleural effusion or pneumothorax. The cardiac silhouette and pulmonary vascularity are within normal limits. Degenerative changes are seen in the thoracic spine. IMPRESSION: No acute cardiopulmonary pathology. Electronically signed by: MD 6/2/2021 4:09 PM. US CAROTID DUPLEX DOPPLER Result Date: 6/2/2021 EXAM DESCRIPTION: US CAROTID DUPLEX DOPPLER CLINICAL HISTORY: 69 years Female, right sided numbness COMPARISON: 2/1/2021 TECHNIQUE: Carotid duplex scan was performed using gray scale imaging and Doppler interrogation.NASCET criteria was utilized. FINDINGS: The peak systolic velocities in bilateral common carotid, internal and external carotid arteries are within normal limits. Peak systolic velocity for the ICA is 99.3cm/s on the right and 83.5cm/s on the left. Mild arthrosclerotic plaques are seen at the carotid bifurcations bilaterally. The vertebral arteries are patent with antegrade flow bilaterally. There has not been significant interval change. IMPRESSION: No hemodynamically significant stenosis. Electronically signed by: MD 6/2/2021 4:15 PM CT HEAD WO CONTRAST Addendum Date: 6/2/2021 ADDENDUM #1 Findings were discussed with Dr. (Name) on 6/2/2021 3:50 PM Electronically signed by: MD 6/2/2021 3:54 PM Result Date: 6/2/2021 EXAMINATION: UNENHANCED CT OF THE HEAD CLINICAL HISTORY: 69 years Female,stroke like symptoms, right sided numbness COMPARISON: There is no prior similar study available for correlation. TECHNIQUE: Axial imaging and 2-D reformatting performed without IV contrast. This exam was performed according to our departmental dose-optimization program, which includes automated exposure control, adjustment of the mA and/or kV according to patient size and/or use of iterative reconstruction technique. TOTAL DLP: 1150.84 mGy-cm FINDINGS: The mastoid air cells, middle ears and paranasal sinuses are clear. There is a 2 cm focal area of low-attenuation in the left centrum semiovale secondary to subacute infarct, mass. There is no acute hemorrhage, ventriculomegaly, midline shift. There is no tonsillar ectopia. IMPRESSION: 2 cm focal area of low-attenuation in the left centrum semiovale secondary to subacute infarct or mass. Correlate with clinical findings. MRI recommended for further evaluation. Electronically signed by: MD 6/2/2021 3:24 PM
CDC Split Type:

Write-up: 69 y.o. female that presented to my office with a 5 day history of weakness on her right side. In particular, she states her right arm, right face, and right torso was numb when she woke up on Saturday morning, May 29th. She initially thought she just had some radicular symptoms going down her right arm as she has had before. However, she does admit that the facial numbness did concern her. She had a headache that morning, but no headache after that. She states that some of the sensation has come back a little bit in the right arm and hand. However, she still can not hold anything without up falling out of her hand because she can not feel it. She denies any weakness in the right side of her body. She denies any facial droop. She does think her vision may have gotten a little bit worse, but this is difficult to tell because she does usually have poor vision. Because of her symptoms in the office, I thought it was best that I admit her for observation in order to rule out acute stroke. I sent her for a stat head CT which did come back showing a subacute left-sided CVA. Further workup is underway. Active Hospital Problems Diagnosis Date Noted ? Right sided numbness 06/02/2021 ? Acute cerebrovascular accident (CVA) (HCC) 06/02/2021 ? Essential hypertension 01/27/2021 ? Dyslipidemia 05/22/2017


VAERS ID: 1377969 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-04-23
Onset:2021-06-02
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Deafness unilateral, Sudden hearing loss
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Carboplatin, Taxol, Decadron, Ativan, Zofran, Compazine, DIM, Evening Primrose Oil, Probiotic
Current Illness: Stag 3 Ovarian Cancer - mid chemotherapy treatment when vaccinated
Preexisting Conditions:
Allergies: Sulfa Antibiotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sudden hearing loss, left ear, onset 6/2/2021. On 60 MG prednisone taper, starting 6/6/2021


VAERS ID: 1378047 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fear, Headache, Injection site pain, Nausea
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Chills, fever, severe headache, nasea. Took ibuprofen, cold compress to head, blanket for chills. Chills and nausea lasted for 6 or 7 hours, Fever lasted for 48 hours. Headache lasted for 60 hours. Very sore arm at injection site which lasted for about 72 hours.


VAERS ID: 1378069 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007C21A / 2 - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Arthralgia, Chills, Decreased appetite, Diarrhoea, Fatigue, Influenza like illness, Injection site pain, Injection site swelling, Lymphadenopathy, Myalgia, Pyrexia, Rash, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Asthma
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: pain at injection site with swelling after about one hour. About six hours later followed by flu like symptoms including high fever 102 with chills, fatigue, sleep disturbance, swollen armpit lymph nodes, intestinal discomfort, rash on shoulder and arm, and what I would describe as severe arthritic pain in pretty much all joints of body large and small. Fever subsided in about 24 hours but rash, fatigue, swollen glands and muscle and joint pain lasted at least five days. Diahrrea on days three and four. Little appetite entire time.


VAERS ID: 1378132 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-08
Onset:2021-06-02
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Deafness neurosensory, Deafness unilateral, Ear, nose and throat examination
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: ENT administered tuning fork test June 3, 2021. Audiology test conducted June 4, 2021 confirmed 60-80db loss in left ear across all frequencies. Treated with high does prednisone steroid (60mg/day) starting June 3.. Hearing returned gradually over the following 4 days.
CDC Split Type:

Write-up: Sudden Sensorineural Hearing Loss (SSHL) in left ear June 2, 2021. Preceded by intermittent brief hearing loss in same ear, for a few minutes at a time, for up to one week prior to June 2.


VAERS ID: 1378151 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-05-30
Onset:2021-06-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Dizziness, Impaired driving ability, Loss of personal independence in daily activities, Motion sickness, Vertigo, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow)

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

Write-up: Day 3 I received severe vertigo which cause vomiting due to the motion and was completely down for two days. Now it is day 6 and I still have dizzy so bad that I can?t drive!


VAERS ID: 1378212 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: pt complained of feeling hot, sweaty and lightheaded approximately 10 minutes after vaccine administration. pt was moved to a cool area and given the opportunity to lie down after drinking a few sips of water. pt very quickly calmed down and stated that he was feeling better, though he was kept for a 30 minute observation. at the end of the period, he was reassessed and found to be ok. pt was released to the care of his mother.


VAERS ID: 1378231 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8737 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Anxiety, Dizziness, Hyperhidrosis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: pt complained of feeling sweaty and lightheaded approximately 10 minutes after receiving the vaccination. pt was given water and taken to a cool area to sit. pt stated that she was feeling somewhat anxious (which she has a history of). upon sitting for a few minutes, pt stated that she feeling better. pt was kept for 30 min observation and then left on her own accord.


VAERS ID: 1378236 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

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

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

Write-up: The day after my shot I noticed some hives, but I thought they were bug bites at first. But everyday I?m getting more and more bumps, and when I looked at a picture of hives, these bumps look very similar. The first ones look like big mosquito bites or spider bites. But the next day I got small bumps that looked more like hives. The big bumps are on my right arm, but not next to where I got my shot. The hives are on my right ankle, and now are popping up on my right arm. They are every itchy, and a bit disconcerting because they are growing in size and spreading more each day.


VAERS ID: 1378250 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-05-03
Onset:2021-06-02
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Cough, Eye disorder, Neurological symptom
SMQs:, Anaphylactic reaction (broad), Corneal disorders (broad), Retinal disorders (broad), Hearing impairment (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:
Preexisting Conditions: coronary artery disease-ongoing but function just fine-just hereditary
Allergies: hydralazine & statins
Diagnostic Lab Data: went to my urgent care on 6/4 and they diagnosed the bells palsey, gave me prednazone and an antibiotics
CDC Split Type:

Write-up: bells palsey - severe issue in left eye and left side; minor chest cough I didn''t have before


VAERS ID: 1378265 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Chills, Fatigue, Headache, Injection site pain, Injection site swelling, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain and swelling at the injection location. Extreme tiredness, headache, muscle pain/soreness, chills and intermittent (minimal) nausea. Felt like my body was working harder than normal, with slight tightness in my chest.


VAERS ID: 1378315 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

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

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

Write-up: Syncope. Felt very light headed, then said he was ''dreaming'' but lost consciousness for a few seconds. Gave water, and orange juice when pt said he hadn''t eaten. We moved him to the floor, where he laid down for a few minutes. He continued to sip water and OJ, and within a few minutes regained color and strength. Gradually felt better and back to baseline in about 15-20 minutes


VAERS ID: 1378345 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Injection site pain, Injection site warmth, Rash, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Large red area, covering arm (side to side) 3 inches by 6inches, below the injection site. The red area was hot to the touch. Feels sore/ bruised. Began fading after 4 days. Used topical Triamcinolone 0.5% ointment, and took allergy medication. 3 days after injection, began getting blister type rash on lower opposite arm from vaccination site. Today 07 June, 6 days after vaccine, large red area almost gone, no longer tender, but more blister type bumps appearing on lower right arm, and a few are now beginning to show on lower left arm (injection arm).


VAERS ID: 1378364 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Washington  
Vaccinated:1980-06-15
Onset:2021-06-02
   Days after vaccination:14962
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

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

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

Write-up: mom states that pt had to go to the er due to serious adverse reaction, high fever, feeling badly


VAERS ID: 1378447 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 547334 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: went to the emergency and I preserved CEPHALEXIN 500MG CAPSULES
Current Illness: NO
Preexisting Conditions: NO
Allergies: NO
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: the first one a huge big black brush, the second one gave me a huge pink rush.


VAERS ID: 1378484 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Neurological examination normal, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Not reported
Current Illness: Patient had an esophagogastroduodenoscopy on 6/1/2021, one day prior to vaccination. He had open heart surgery on 3/22/2021, and had a pacemaker implanted on 3/29/2021.
Preexisting Conditions: AV BLOCK, COMPLETE PRESENCE OF IMPLANTABLE CARDIAC PACEMAKER CAD W HX OF CABG ATRIAL FLUTTER, PAROXYSMAL HX OF ASCENDING AORTA REPAIR SCREENING FOR COLORECTAL CANCER, HIGH RISK OBESITY, BMI 35-39.9, ADULT ADULT OBSTRUCTIVE SLEEP APNEA FHX OF COLORECTAL CANCER ANEMIA INSOMNIA HX OF AORTIC ROOT REPLACEMENT UPPER GI HEMORRHAGE HX OF PEPTIC ULCER
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient felt fine during observation period after receiving Janssen. On his drive home he experienced blurred vision in his right eye that lasted for about 3 minutes. He returned to vaccine site. Doctor on site was called and patient was transferred to the doctor''s office for further evaluation. No symptoms of anaphylaxis. Neurological exam normal. No other symptoms of stroke. Vital signs stable. Patient feels fine. Due to patient''s cardiac history, doctor was concerned about a possible transient ischemic attack. Therefore, he was transferred to the emergency department for further evaluation. Patient declined additional tests in the ED. Patient admitted to the ED, pt with normal exam. Sx only lasted 2-3 minutes. Consulted with neurologist. Does not sound like stroke. Also not suggestive of known J & J vaccine reaction. Suggest ophth eval.


VAERS ID: 1378542 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Fall, Fear of injection, Head injury, Hyperhidrosis, Pallor, Syncope, Tremor, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: 14:08 While washing hands I heard commotion in the other section of the observation area. Noticed pt. on the floor, next to his chair. He was having "shaky" movements, unresponsive, diaphoretic and very pale. Also noticed he was hitting head twice on wall. After protecting his head, he regained consciousness in approx. 15 sec. Staff had been called and 911 was activated. My oximeter read pulse of 40 to 45 and saturation between 96 to 98%. Pt. claimed it wasn''t his first time after "needles" passing out. Said he had a good breakfast and lunch. He declined having his parents called.


VAERS ID: 1378763 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site hypoaesthesia, Injection site paraesthesia
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:
CDC Split Type:

Write-up: After patient had waited the 15 minutes-upon post vaccine check in patient stated that her are felt funny. I asked her to explain and she said kind of numb and tingly. Told patient to watch make sure no swelling/redness/or spots at injection site or around that area and also to watch and make sure are doesn''t get hot. If so or symptoms worsen patient need to go to ER immediately. I told patient if he symptoms were concerning enough she needed to go to er and patient stated that she did not feel they were that bad at this time.


VAERS ID: 1379005 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-23
Onset:2021-06-02
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: Very heavy bleeding on period. Abnormal amounts of blood. Typically, my period lasts no longer than 5 days, however, I''m on day 6 and I''m still bleeding very heavily.


VAERS ID: 1379018 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-21
Onset:2021-06-02
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Blood lactic acid, C-reactive protein increased, Chest pain, Chills, Dyspnoea, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Fibrin D dimer, Intensive care, International normalised ratio increased, Lymphadenopathy, Oropharyngeal pain, Pericarditis, Prothrombin time prolonged, Pyrexia, Rash, Rash erythematous, SARS-CoV-2 test negative, Tachycardia, Tachypnoea, Troponin
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Arthritis (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Dehydration (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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: 6/4/2021 (all lab results) Lactate: 3.8; 2nd time-4,6 PT: 13.2 INR:1.2 Troponin: 0.30 CRp: 20 D-Dimer: 3,618 Sars COV2-PCR: negative EKG: sinus tachycardia, ST elevation suggests acute pericarditis
CDC Split Type:

Write-up: Pt was in usual state of health until 6/2/21 and experienced fevers, chills, sore throat, shortness of breath, chest pain, erythematous rash on trunk and limbs, arthralgia inthe ankle. Presented to ED on 6/4-febrile, tachycardic and mildly tachypneic. Pt is still currently admitted in Unit. left axillary adenopathy


VAERS ID: 1379065 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ozempic, Synjardy, Glipizide, Lisinopril, probiotic, daily vitamin, OTC allergy medication
Current Illness: None
Preexisting Conditions: Diabetes
Allergies: Sulfa drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills for 2-3 hours, followed by a headache and aching muscles.


VAERS ID: 1379290 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 2 LA / IM

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

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

Write-up: Pt called stating that starting about 6 hours after her second dose of Moderna vaccine, she began feeling ill with fever, chills, nausea, and aches. As of the time she contacted our pharmacy, 5 days later, she states her symptoms are gradually improving but she felt too sick to even make the phone call on days 2-3 following the vaccine. Advised pt to take OTC pain/fever relievers as needed and contact physician if symptoms worsen within 24 hrs.


VAERS ID: 1379301 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816027 / 1 LA / 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? 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: Patient said that she has experienced pain in her arm since receiving the shot.


VAERS ID: 1379698 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 2 LA / IM

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

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

Write-up: The patient stated that he needed his second vaccine and at first said the thought he first received the Pfizer injextion. I spoke to him and told him we have all 3 vaccines but the only 2 vaccines that required 2 shots was the Pfizer and then Moderna. I told him he needed to get the same vaccine for both and he then stated Moderna. I asked him if her was sure and he said yes. He didn''t have his card upon the initial visit. We vaccinated him with Moderna and when he returned with his card it indicated he received the Pfizer for the first vaccine. We observed his for the 15 minutes without any adverse reactions.


VAERS ID: 1379734 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: PT REACTED TO 1ST DOSE OF COVID VACCINE W SOB AND DIFFICULTY BREATHING. PT ALSO WENT TO ED FOR TREATMENT WITH 1ST SHOT. PT SAW AN ALLERGIST WHO PRESCRIBED PREDNISONE BEFORE 2ND DOSE + DIPHENHYDRAMINE, WHICH SHE TOOK BOTH. PT GOT 2ND DOSE ON 6/2 AND STILL HAD DIFFICULTY BREATHING AND WENT TO THE ED. PT GOT PREDNISONE 50MG, DIPHENHYDRAMINE 25MG PO, AND PEPCID 20MG. PT DID OK AND WAS DISCHARGED TO HOME.


VAERS ID: 1380633 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain upper, Blood test, Chills, Malaise, Pain in extremity, Pallor, Presyncope
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Nose bleed (two incident in past 5 years prior to this report.); Comments: Patient had no other health condition
Allergies:
Diagnostic Lab Data: Test Name: Blood test; Result Unstructured Data: low platelet count
CDC Split Type: USJNJFOC20210603429

Write-up: ALMOST PASSED OUT; SKIN LOOKED WHITE AND PALE; MILD PAIN IN STOMACH; LEG HURTS; CHILLS (FEELING COLD AND SHIVERING); FEELING UNWELL; This spontaneous report received from a parent concerned a 19 year old male. The patient''s height, and weight were not reported. The patient''s past medical history included nose bleed, and other pre-existing medical conditions included patient had no other health condition. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) dose was not reported, administered on 01-JUN-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 02-JUN-2021, the subject experienced almost passed out. On 02-JUN-2021, the subject experienced skin looked and pale. On 02-JUN-2021, the subject experienced mild pain in stomach. On 02-JUN-2021, the subject experienced leg hurts. On 02-JUN-2021, the subject experienced chills (feeling cold and shivering). On 02-JUN-2021, the subject experienced feeling unwell. Laboratory data (dates unspecified) included: Blood test (NR: not provided) low platelet count. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from almost passed out, had not recovered from skin looked white and pale, leg hurts, and chills (feeling cold and shivering), and the outcome of mild pain in stomach and feeling unwell was not reported. This report was non-serious.; Sender''s Comments: V0: Medical Assessment Comment not required as per standard procedure as case assessed as non serious.


VAERS ID: 1380639 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Heart rate, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210602; Test Name: Heart rate; Result Unstructured Data: 99
CDC Split Type: USJNJFOC20210604954

Write-up: FAST HEART RATE; SHORTNESS OF BREATH; This spontaneous report received from a parent concerned a 20 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 02-JUN-2021 09:15 am for prophylactic vaccination. Batch number was not reported and has been requested. No concomitant medications were reported. On 02-JUN-2021, the subject experienced fast heart rate. On 02-JUN-2021, the subject experienced shortness of breath. Laboratory data included: Heart rate (NR: not provided) 99. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from fast heart rate, and shortness of breath. This report was non-serious.


VAERS ID: 1380650 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: USJNJFOC20210607421

Write-up: SORE THROAT; JOINT PAIN; CHILLS; FEVER; This spontaneous report received from a patient concerned a 48 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 204A21A, expiry: UNKNOWN) dose was not reported, administered on 30-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUN-2021, the subject experienced sore throat. On 02-JUN-2021, the subject experienced joint pain. On 02-JUN-2021, the subject experienced chills. On 02-JUN-2021, the subject experienced fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the sore throat, fever, joint pain and chills was not reported. This report was non-serious.


VAERS ID: 1380666 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Incorrect dose administered, Poor quality product administered, Wrong technique in product usage process
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient was not pregnant at the time of vaccination.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210607725

Write-up: PATIENT GIVEN DILUTED JNJ COVID VACCINE; WRONG TECHNIQUE IN DRUG USAGE PROCESS; POOR QUALITY VACCINE ADMINISTERED; This spontaneous report received concerned a 42 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included the patient was not pregnant at the time of vaccination. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, and batch number: 204A21A expiry: 23-JUN-2021) .3 ml, administered on 02-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUN-2021, the subject experienced subject given diluted JNJ covid vaccine. On 02-JUN-2021, the subject experienced wrong technique in drug usage process. On 02-JUN-2021, the subject experienced poor quality vaccine administered. The action taken with covid-19 vaccine was not applicable. The outcome of the poor quality vaccine administered, wrong technique in drug usage process and patient given diluted JNJ covid vaccine was not reported. This report was non-serious. This case, from the same reporter is linked to 20210607539 and 20210608711.


VAERS ID: 1380677 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210608687

Write-up: CONSUMER GIVEN EXPIRED VACCINE; This spontaneous report received from a pharmacist concerned a patient of unspecified age and sex. 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: 1805022, and expiry: 25-MAY-2021) dose was not reported, administered on 02-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUN-2021, the subject experienced consumer given expired vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of consumer given expired vaccine was not reported. This report was non-serious.


VAERS ID: 1380694 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Body temperature, Chills, Cold sweat, Hypoaesthesia, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: 20210602; Test Name: Body temperature; Result Unstructured Data: 103 F
CDC Split Type: USJNJFOC20210612112

Write-up: FEELING NUMB ON RIGHT SIDE INCLUDING ARM AND LEG; WEAKNESS ON RIGHT SIDE INCLUDING ARM AND LEG; NAUSEA; COLD SWEATS; FEVER; CHILLS; This spontaneous report received from a patient concerned a 44 year old male. 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: 207A21A expiry: UNKNOWN) dose was not reported, administered on 02-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUN-2021, the subject experienced cold sweats. On 02-JUN-2021, the subject experienced chills. On 02-JUN-2021, the subject experienced fever. Laboratory data included: Body temperature (NR: not provided) 103 F. On 03-JUN-2021, the subject experienced nausea. On 04-JUN-2021, the subject experienced feeling numb on right side including arm and leg. On 04-JUN-2021, the subject experienced weakness on right side including arm and leg. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from cold sweats, chills, and fever on 04-JUN-2021, had not recovered from nausea, and weakness on right side including arm and leg, and the outcome of feeling numb on right side including arm and leg was not reported. This report was non-serious.


VAERS ID: 1381351 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Incorrect dose administered, Off label use, Wrong technique in product usage process
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210608711

Write-up: WRONG TECHNIQUE IN DRUG USAGE PROCESS; INAPPROPRIATE DOSE OF VACCINE ADMINISTERED; OFF LABEL USE; This spontaneous report received from a pharmacist concerned a 61 year old male. 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: 204a21a, expiry: 23-JUN-2021) .3 ml, administered on 02-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUN-2021, the subject experienced wrong technique in drug usage process. On 02-JUN-2021, the subject experienced inappropriate dose of vaccine administered. On 02-JUN-2021, the subject experienced off label use. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the wrong technique in drug usage process, inappropriate dose of vaccine administered and off label use was not reported. This report was non-serious. This case, from the same reporter is linked to 20210607539 and 20210607725.


VAERS ID: 1381352 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Eye pain, Influenza like illness
SMQs:, Glaucoma (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: Abstains from alcohol; Non-smoker
Preexisting Conditions: Comments: The patient had no known allergies and no history of drug abuse or illicit drug use.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210611631

Write-up: This spontaneous report received from a patient concerned a 47 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included non smoker, and non-alcohol user, and other pre-existing medical conditions included the patient had no known allergies and no history of drug abuse or illicit drug use. The patient received COVID-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808986, expiry: UNKNOWN) dose was not reported, administered on 02-JUNE-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUNE-2021, the subject experienced pain in eyes. On 02-JUNE-2021, the subject experienced flu like symptoms. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from pain in eyes, and flu like symptoms. This report was non-serious.


VAERS ID: 1381386 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021645195

Write-up: Woke up feeling a bit nauseous/ Experiencing nausea "on and off"; This is a spontaneous report received from a contactable consumer. A 14-years-old female patient received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Lot number was not reported) via an unspecified route of administration on 01Jun2021 15:30 as single dose for COVID-19 immunization. The patient medical history and concomitant medications were not reported. The patient woke up feeling a bit nauseous. experiencing nausea "on and off" throughout the morning on 02Jun2021. Event took place after use of product. The outcome of the event was unknown. No follow-up attempts are needed; information about lot/batch number cannot be obtained.


VAERS ID: 1381683 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety
SMQs:, 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: No
Current Illness: No
Preexisting Conditions: Glaucoma in both eyes
Allergies: No
Diagnostic Lab Data: N/A
CDC Split Type: 03052

Write-up: Anxiety


VAERS ID: 1381786 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect product formulation 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: vaccine that was drawn up in syringe past the 6 hour window was inadvertently mixed with newly drawn up vaccine. Patient may have rec''d expired vaccine or non-expired vaccine. We contacted Pfizer, CDC and our Facility vaccine experts and the conclusion made was that microbiological contamination was the primary concern and patient was advised to watch for signs of infection at site or fever and report to us if any other symptoms occur. We were advised revaccination is not required.


VAERS ID: 1381790 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-05-25
Onset:2021-06-02
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

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

Write-up: 8 days after the shot, I got a large, red, very hot, itchy rash that still has not gone away after two weeks. Symptoms still include spreading of rash (not nearly as red though), it''s still hot to the touch and itchy.


VAERS ID: 1381821 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

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

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

Write-up: Vaccine product that was past the 6 hours in the syringe in the fridge was inadvertently mixed up with newly reconstituted and drawn up syringe. Patient may have received product that was $g 6 hours in the syringe after reconstitution. We contacted Pfizer, the CDC, and our Pharmacy vaccine experts. It was determined that microbial contamination was primary concern and no need to revaccinate. Patient was advised to watch for signs of infection, i.e. fever, redness or swelling at site and general illness. This patient reported no symptoms at time of consultation and was advised to follow up if any new symptoms occur.


VAERS ID: 1381875 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-05-21
Onset:2021-06-02
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1085025 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Cough, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad)

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

Write-up: Could be coincidence, Bad Cough and congestion 8-10 days after vaccine lasting 5 days, just now getting better


VAERS ID: 1381887 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-03-19
Onset:2021-06-02
   Days after vaccination:75
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

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

Write-up: Fully Vaccinated with Covid19 Moderna EUA -3/19/21-4/17/21-


VAERS ID: 1381910 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

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

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

Write-up: There was a mix up with expiring product coming out of fridge and new product drawn up. Patient may have received vaccine that was in syringe in fridge longer than the recommended 6 hours. We contact Pfizer, CDC and our vaccine experts. Microbial contamination was primary concern and there was no recommendation for revaccination. Patient was advised of error and to monitor for signs of infection, i.e. redness at injection site and fever. The patient had no reaction at time of contact and was told to follow up if anything changes.


VAERS ID: 1381920 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 3 LA / IM

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

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

Write-up: Pt was given a third covid19 vaccination in the Pfizer series.


VAERS ID: 1381921 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

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

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

Write-up: There was a mix up of expired product coming out of fridge and newly drawn product. Patient may have received product that was in syringe past the 6 hour recommended timeframe. We contacted Pfizer, CDC and our Facility vaccine experts and it was determined the primary concern seems to be microbial contamination and revaccination was not necessary. Patient was advised of the error and to monitor for signs of infection, i.e. redness at site of injection and fever. Patient reported some nausea, the usual arm pain, and fever around 100 degrees after vaccine. At time of consultation all symptoms had resolved.


VAERS ID: 1381947 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, Injection site erythema, Nausea, Pain, Pyrexia, Visual impairment
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Systemic: Body Aches Generalized-Medium, Systemic: Fever-Medium, Systemic: Nausea-Medium, Systemic: Visual Changes/Disturbances-Medium, Systemic: Weakness-Medium


VAERS ID: 1381973 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-31
Onset:2021-06-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Postmenopausal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Systemic: vaginal bleeding/ discharge in post menopause-Mild


VAERS ID: 1382017 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205AZIA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Hyperhidrosis, Myalgia, Pain in extremity, Pyrexia, Ultrasound scan normal, X-ray limb
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabupentin, Bystolic, Rosuvastatin
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Ultra Sound and xray of right let. 6/3
CDC Split Type:

Write-up: Severe chills and fever and sweating started at 7pm and continued until around 6am. Severe pain in right calf muscle started at 3am on 6/3 and lasted for 24 hours. At the direction of my dr, i was seen in the ER at hospital. The hospital checked for blood clot but ultra sound showed no clots.


VAERS ID: 1382298 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Dysgeusia, Fatigue, Headache, Migraine, Nausea, Pain, Pyrexia, Thirst, Vision blurred
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Started off with extreme fatigue the morning after the vaccine, then throbbing intense migraine started around 11 am that lasted until the next morning after which a dull headache lasting till Friday, 102.3 fever, EXTREMELY painful body aches, metallic taste in mouth, thirst that could not be quenched, dizziness, blurred vision, confusing, nausea.


VAERS ID: 1382304 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

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

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

Write-up: vaccine was administered outside of storage recommendations. Notified pt to return for re-vaccination


VAERS ID: 1382308 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Omeprazole OTC 20mg, Iron OTC 65mg
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: fever/chills and whole body muscle soreness for about 2 days, gone by third day.


VAERS ID: 1382309 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone, Full blood count, Glycosylated haemoglobin, Lymphadenopathy, Metabolic function test, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (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: Tylenol, Ibuprofen
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: Medical evaluation 06-03-2021; CMP, CBC, THS and A1C
CDC Split Type:

Write-up: Lymphadenopathy and localized lower neck swelling


VAERS ID: 1382310 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / IM

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

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

Write-up: vaccine was administered outside of storage recommendations. Notified pt to return for re-vaccination


VAERS ID: 1382312 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Dysgeusia, Fatigue, Headache, Migraine, Nausea, Pain, Pyrexia, Thirst, Vision blurred
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Started off with extreme fatigue the morning after the vaccine, then throbbing intense migraine started around 11 am that lasted until the next morning after which a dull headache lasting till Friday, 102.3 fever, EXTREMELY painful body aches, metallic taste in mouth, thirst that could not be quenched, dizziness, blurred vision, confusing, nausea.


VAERS ID: 1382318 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

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

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

Write-up: vaccine was administered outside of storage recommendations. Notified pt to return for re-vaccination


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