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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 258 out of 5,069

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VAERS ID: 1394678 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Feeling cold, Immediate post-injection reaction, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Hypersensitivity (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: Daily vitamin, nexium 20 MG, and Claritin
Current Illness: No
Preexisting Conditions: No
Allergies: None known
Diagnostic Lab Data: None having done on 6/15/21 at cardiologist.
CDC Split Type:

Write-up: Upon immediate injection. I started to shudder, tremble and was freezing cold and my BP spiked to 177/104 at highest. Took a full 12 hours to normalize BP. HR was totally normal. But BP was still in 160?s after 2 hours.


VAERS ID: 1394765 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Decreased appetite, Headache, Hyperhidrosis, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Fever up tp 102? sweats and body aches headache and loss of appetite lasted 11 days after vaccination


VAERS ID: 1394866 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: PHARMACY LEFT PFIZER VIALS IN THE FREEZER FOR LONGER THAN 2 WEEKS AT THE TEMPERATURE (-25 AND -15 DEGREES C). WE GAVE DOSES OUT FROM THE VIALS,RENDERING THEM POSSIBLY LESS EFFECTIVE


VAERS ID: 1394905 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-07
Onset:2021-06-02
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / UN
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / UN

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal pain upper, Constipation, Dehydration, Disturbance in attention, Dysmenorrhoea, Dysphemia, Headache, Malaise, Mental fatigue, Nausea, Vision blurred, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad), Dehydration (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: Occassionally: Alprazolam
Current Illness: none
Preexisting Conditions: Diverticulosis
Allergies: sulfa drugs, rodents and cats
Diagnostic Lab Data:
CDC Split Type:

Write-up: Second Vaccine Location: Pharmacy. On 6/2/21 (day after 2nd dose) I vomited repeatedly throughout the day, a total of 4 times between 9am and 5pm and was unable to keep any water or Tylenol down at all. I had a strong headache the entire day, which also brought with mental fatigue and overwhelm - I couldn''t even manage to watch tv I was so ill, it was hard to concentrate, think or even focus my eyes. Around 5pm, feeling severely dehydrated and realizing the urgent cares would be closing soon I scheduled a telehealth dr. appt. with assistance. (I couldn''t sit up or focus long before being overcome with nausea, and it was very hard to think.)The telehealth dr. prescribed me anti nausea medicine - Ondansetron, orally disintegrating tablet, 4mg. Told me to attempt drinking 1tsp water every 10 min. after having the medicine. After taking this medicine and also a dissolving form of tylenol you could put on your tongue, and waiting another hour I was able to begin taking sips of water and sit up. I was able to drink more water over the next few hours and finally some cold plain cereal. I thought I was finally in the clear, however I was surprised that I continued to feel nauseous the next two days and continued to need to take the medicine prescribed (from 6/2 - 6/4). My stomach was so upset from nausea and also I had cramps from beginning my menstrual cycle, but I continued to have stomach aches for the following two days (6/2-6/5). I wondered if it was a side effect from the vaccine or the anti nausea medicine. I also experienced constipation 6/2-6/12, (up to the day of writing this) something I never have an issue with. While I could say it might be related to the medicine, I don''t understand why it would continue so long. It has improved somewhat gradually. What was most surprising to me after all of this is I then began to experience having a stutter when speaking, approximately once a day every day since returning to work through June 8th. (6/4 - 6/8). While this might seem minor, I have not ever experienced this in my life, so four times in four days is markedly unusual.


VAERS ID: 1394916 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-18
Onset:2021-06-02
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Rash, 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lexapro, plaquenil, iud
Current Illness: no
Preexisting Conditions: asthma, arthritis
Allergies: guinea pigs, grass seed
Diagnostic Lab Data: rheumatologist ran labs to determine if it was the plaquenil (ruled out)
CDC Split Type:

Write-up: hives and rash


VAERS ID: 1394942 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-30
Onset:2021-06-02
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Intermenstrual bleeding, Muscle spasms, Sleep disorder
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Dystonia (broad)

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

Write-up: Really bad cramping, like period but worse and through the lower back. Only a few days of spotting intermittently since - no full period but still pain. Enough to wake up in the middle of the night several nights


VAERS ID: 1394944 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Balance disorder, Fatigue, Feeling cold, Myalgia, Pain in extremity, Photophobia, Secretion discharge, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament 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: 2006 - age 62.5 years - Dtap shot (information not known) similar strong reaction to shot as to Modeerna
Other Medications: Antivert, Lovastatin, Cilostazol, Albuterol Solfate, Estradiol
Current Illness: None
Preexisting Conditions: Allergies, asthma, peripheral artery disease, mitral valve prolapse, fibromyalgia
Allergies: Naproxen, Trental, Zocor, flu shots, NSAIDS, paper tape bandag
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Symptoms began 12-13 hours after shot was given. 2-4 a.m., strong chill with whole body shaking and knife-like sharp pains in legs 5- 7 days heavy nasal mucus discharge painful muscles and joints; fatigue, unstable balance, sensitivity to light lasted 3-4 days 3rd day sore upper left arm with rash from injection site to elbow lasted 3-4 days Symptoms generally cleared up by June 16. Treatment: bed rest, fluids and 1000 mg Tylenol every 6 hrs over 4 days


VAERS ID: 1394959 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-26
Onset:2021-06-02
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO191 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Conjunctivitis, Herpes simplex, Hypersensitivity, Lymphadenopathy, Pain, Pain of skin, Paraesthesia, Paraesthesia oral
SMQs:, Severe cutaneous adverse reactions (broad), Angioedema (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Otc allergy citrizine
Current Illness: Hashimoto''s
Preexisting Conditions: Seasonal allergies,
Allergies: Codeine aspirin, nuts, pollens, dust
Diagnostic Lab Data:
CDC Split Type:

Write-up: Eye virus prob herpes. Multiple lesions around left eye. Conjunctivitis. Initially diagnosed as allergic issue. Then after Dr visit, localized pain, swollen lymph nodes, for herpes sores around orbital lobe, headaches, multiple tingling Locations around mouth and scalp.


VAERS ID: 1395252 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-19
Onset:2021-06-02
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea, Palpitations, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, heart racing, trouble breathing.


VAERS ID: 1395444 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-24
Onset:2021-06-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Blood test, Computerised tomogram, Renal disorder
SMQs:, Retroperitoneal fibrosis (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: Pravastatin, Norvasc 10mg, Janumet 100/1000
Current Illness:
Preexisting Conditions: High blood pressure and Type 2 diabetes
Allergies: Aspirin, citrazine, phenobarbital
Diagnostic Lab Data: CT scan 6/2/21, 6/4/21, 6/5/21 Blood tests daily from 6/2/21 to 6/5/21
CDC Split Type:

Write-up: On 6/2/21 I got a severe pain starting in my left side and wrapped around my back. Went to ER. Was told I had pooled blood around my left kidney. The doctors still haven''t figured out why.


VAERS ID: 1395737 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-05-13
Onset:2021-06-02
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0165 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adenovirus test, Borrelia test negative, C-reactive protein increased, COVID-19, Chest pain, Chills, Cytomegalovirus test negative, Dyspnoea, Echocardiogram normal, Electrocardiogram normal, Enterovirus test negative, Epstein-Barr virus test negative, Fatigue, Full blood count normal, Injection site pain, Metabolic function test normal, Myalgia, Parvovirus B19 test negative, Red blood cell sedimentation rate increased, Respiratory viral panel, SARS-CoV-2 antibody test positive, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Autism Epistaxis Ehlers Danlos hypermobility Von Willebrands disease type 1
Allergies: Sulfa
Diagnostic Lab Data: Troponin (6/4) 56, (6/6) 1097, 6/8 (98) EKG (6/4,5,6) wnl ECHOcardiogram (6/5), (6/7) wnl CBCd, CMP (6/4) wnl ESR (6/4) 30 CRP (6/4) 98, (6/6) 34 mg/L ID work up (6/7): 1. Respiratory viral panel negative 2. COVID Ab positive 3. Enterovirus, adenovirus, parvovirus B19 Qual PCR blood neg 4. Quant PCR EBV, CMV blood PCR neg 5. Lyme serologies neg
CDC Split Type:

Write-up: Got second dose of vaccine 6/2. Same day had chills, myalgia, fatigue and soreness at injection site. 6/3 developed substernal chest pain and dyspnea. Admitted to hospital for suspected myocarditis given elevated troponin and mildly elevated inflammatory markers 6/4. No treatments given. Symptoms resolved and troponins improved prior to discharge 6/8. He remains well today 6/14.


VAERS ID: 1396416 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-17
Onset:2021-06-02
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

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

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

Write-up: Sore and lethargic first 48 hours after initial shot. A severe headache began the evening of June 2. I woke up and vomited due to head pain later that evening/early morning.. Slight Fever at 99.5, sore and Lethargic for about 48 hours. The headache has continued since it began, including pain and soreness around neck, jaw, back of head and eyes. I spoke with a clinician prior to my second Pfizer shot on June 7th, and they said to treat the symptoms. For pain relief, I''ve tried acetaminophen (no help) and aspirin (helpful). The headache has persisted and continues to this day (June 14th. This is unusual, as I rarely have headaches, probably averaging less than one a year, and for no more than an hour or two.


VAERS ID: 1396417 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 59676-0580-15 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Disorientation, Dizziness, Fatigue, Feeling abnormal, Headache, Impaired work ability, Nausea, Neck pain, Pyrexia, Rash, Skin discolouration
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Massive headache for 8 days. I believe it was encephalitis. Dizziness, fatigue, nausea, terrible neck pain, pain allover skull. Completely out of it. Disoriented, Fever, rash, missed work. Now I have a purple spot on my inside of left leg, found this morning 6/14/21 7:30 am.


VAERS ID: 1396540 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-05-13
Onset:2021-06-02
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022C21A / 2 LA / IM

Administered by: Other       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: Losartan-hctz 100-25
Current Illness: None
Preexisting Conditions: None
Allergies: Celiac Disease
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Rash in groin area, legs, chest and neck


VAERS ID: 1396633 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-06
Onset:2021-06-02
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 1 RA / IM

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

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

Write-up: Patient came into the pharmacy on 6/2/21 to get his 2nd dose of Pfizer vaccine. One of our technicians noticed he had vaccination cards for all 3 COVID-19 vaccines in his wallet (Moderna, Janssen, and Pfizer). We refused service on 6/2/21 due to patient showing multiple COVID-19 vaccinations and admitting that he had received all except his 2nd dose of Pfizer. He stated he needed them for travel since he traveled to various countries for work. It is not advised to receive all doses of the COVID 19 vaccines, so myself as the pharmacist on duty at the time, refused to give him the 2nd dose of Pfizer. We had already given him the 1st dose of Pfizer as he had written on the consent form he had not received any previous COVID 19 vaccines and when verbally asked on 5/6/21, he stated he hadn''t either. Upon checking system on 6/2/21, it showed he was going to various clinics and pharmacies to get the different vaccines.


VAERS ID: 1396655 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2020-12-20
Onset:2021-06-02
   Days after vaccination:164
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1685 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3246 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Coagulation test, Computerised tomogram abnormal, Thrombosis, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad)

Life Threatening? Yes
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: advair celexa adderall singulair
Current Illness: none
Preexisting Conditions: asthma
Allergies: none
Diagnostic Lab Data: clotting factor lab work/ct scan /venous and arterial ultrasound xarelto po
CDC Split Type:

Write-up: large blood clot in right leg/groin, xarelto po, consult hematologist and vascular surgeon, still waiting for treatment to resolve blood clot


VAERS ID: 1396742 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Intermenstrual bleeding, Menstruation irregular
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Fertility disorders (broad)

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

Write-up: She recieved the COVID19 vaccines that day and later in the day she started menses 3 weeks early, accompanied by continued abdominal/pelvic cramping and spotting which has continued


VAERS ID: 1396822 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-19
Onset:2021-06-02
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Intensive care, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

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

Write-up: Bilateral pulmonary embolisms, patient admitted to ICU.


VAERS ID: 1397015 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Chills, Dyspnoea, Fatigue, Injection site pain, Migraine, Myocarditis, Neuralgia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 50mg spironolactone once a day; 20mg Adderall XR once a day; 10mg loratadine once a day; 7mg naltrexone hcl once a day; 500mg valacyclovir twice a day; 0.1mg aripiprazole once a day; depo-provera shot once every 3 months
Current Illness: None
Preexisting Conditions: chronic fatigue syndrome, ehlers-danlos syndrome hypermobility type, acne, ADD
Allergies: Dust, pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Myocarditis-Severe fatigue and chest pain amd shortness of breath for 7 days beginning 3 hours after injection and occurred after any small physical exertion like taking out the trash or walking 2 blocks (lingering moderate fatigue and some chest soreness still remains today ), migraine for 3 days beginning 2 days after injection, left upper arm pain (sore) for 3 days beginning 12 hours after injection, sporadic mild running nerve pain for 7 days beginning 2 min after injection (no pain during injection itself), cold chills for 3 days beginning 24 hours after injection.


VAERS ID: 1397027 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal distension, Back pain, Condition aggravated
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (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: Acyclovir 400 MG 1 Time Per Day Armour Thyroid 120 MG Capsule (1 Per Day) Climara .1 Mg/Day (1 Estrogen Patch Weekly) Dilauded 2 Mg (5 Tablets Per Day) Lisinopril, 10 MG Tablet 1 Per Day Promethazine (Phenegren) 12.5 MG Tablet as Needed To
Current Illness: Recovering from back surgery.
Preexisting Conditions: Fibromyalgia, arthritis
Allergies: All Antihistamines Antibiotics - For Surgery Vancomycin Works Very Well Antibiotics - Most (Ciprofloxacin 500 MG is OK) Augmentan Clindamycin HCL Keflex Levaquin Anti-Depressants Beta & Channel Blockers Beta dine Celebrex Chlordiazepoxide-Clidinium Cap Codeine Cortisones Decongestants Epinephrine Hydrocodone / Contrast Dye Oxycodone Penicillin Prilosec Prvicid Reglan Salsalate Steroid Inhalers i.e. Provental Versed Vioxx Zelnorm
Diagnostic Lab Data:
CDC Split Type:

Write-up: Recovering from surgery, doing well after shot, back pain became signifantly worse (back to right after surgery). Assume reaction caused swelling in the tissues of my back.


VAERS ID: 1397719 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-10
Onset:2021-06-02
   Days after vaccination:53
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance test, Blood test, Blood thyroid stimulating hormone, Vertigo
SMQs:, Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Blood test (5.970 TSH level) on 06/14/2021, failed basic balance test on 06/10/2021
CDC Split Type:

Write-up: Vertigo aggravated by looking at screens, sudden onset vertigo


VAERS ID: 1399022 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / -

Administered by: Senior Living       Purchased by: ?
Symptoms: No adverse event
SMQs:

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

Write-up: No adverse affects and no side effects since vaccine given..


VAERS ID: 1399137 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-18
Onset:2021-06-02
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Autoimmune disorder, Nephropathy, Protein urine, Weight increased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Chronic kidney disease (broad), Proteinuria (narrow), Immune-mediated/autoimmune disorders (narrow)

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

Write-up: Pinkish rash on face, neck, chest, arms and hands. Lasted 3 days after first vaccine, after second dose - autoimmune kidney disease. Started feeling protein in urine, gained 30 lbs water weight


VAERS ID: 1399214 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO178 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Asthenia, Chest pain, Dizziness
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow), Vestibular disorders (broad)

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

Write-up: Dizziness, light headed, heart pain, chest pain low energy


VAERS ID: 1399290 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 LA / IM

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

Write-up: Disrupted menstrual cycle: Expected June 4th, started spotted on June 1st (possibly a side effect of first dose received May 4). June 1st and morning of 2nd: spotting. - June 2nd - bleeding stopped altogether immediately after 2nd dose received. - June 6th - bleeding started back up 4 days later. - June 7-8 -- extremely heavy bleeding (unusual). - June 9 -- light - June 10 -- nothing (also unusual as my periods usually taper off and last at least 7-8 days) - June 11 -- back up again with a light day (strange). - June 12 -- official end but post-period I did not have the usual ovulation discharge . This was a highly unusual and erratic cycle, that was inconsistent with my typically predictable periods.


VAERS ID: 1399406 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-18
Onset:2021-06-02
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Exposure during pregnancy, Herpes virus test, Herpes zoster, Paraesthesia, Rash
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

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

Write-up: When I got the first vaccine I was in my 36th week of pregnancy. I started to get a tingling sensation 06/3/2021 on my right pelvic area and extended up to my back. I developed a rash on 06/05/2021 and it felt like a burning sensation if I touched it. I went to the Urgent Care two days later because the rash was spreading. They took a swap and it was positive for Shingles. I had the Chicken Pox as a child and I had the Chicken Pox vaccine as well. I was given Acyclovir5Xdaily for 7 days. The rash dried up and it is starting to get better. Due Date: 06/28/2021 Pregnancy: First


VAERS ID: 1400256 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 2 LA / IM

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

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

Write-up: the first dose was given on 05/14/2021 and the second dose on 06/02/2021


VAERS ID: 1400366 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling hot, Flushing
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad)

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

Write-up: Pt. left after observation period of 15 minutes. Pt. returned back to vaccine clinic a few minutes later and stated his face felt a little flushed and his ears felt warm. Vitals taken and BP 177/97. Pt states he takes medication for high BP. Pt. waited additional 15 minutes and stated he felt okay to go home. Pt dc'' d home with precautions given.


VAERS ID: 1401658 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Delaware  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Influenza like illness, Injection site bruising, Sensory disturbance, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes; Rash
Preexisting Conditions: Comments: Patient had no known allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210612247

Write-up: SHE FELT LIKE GOT HIT BY A TRUCK; FLU LIKE SYMPTOMS; URTICARIA (RASH ALL OVER BODY EXCEPT NECK AND FACE AND SCALP); INJECTION SITE BRUISING; This spontaneous report received from a consumer concerned an 84 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included diabetes, and stress induced rash, and other pre-existing medical conditions included patient had no known allergies. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 206A21A expiry: 23-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 injection site bruising. On 03-JUN-2021, the subject experienced she felt like got hit by a truck. On 03-JUN-2021, the subject experienced flu like symptoms. On 03-JUN-2021, the subject experienced urticaria (rash all over body except neck and face and scalp). The action taken with covid-19 vaccine was not applicable. The patient was recovering from urticaria (rash all over body except neck and face and scalp), and injection site bruising, and the outcome of flu like symptoms and she felt like got hit by a truck was not reported. This report was non-serious.


VAERS ID: 1401690 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Indiana  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Abstains from alcohol; Non-smoker; Seasonal allergy
Preexisting Conditions: Comments: patient had no drug abuse or illicit drug usage. Patient was pretty health and does not take any medication
Allergies:
Diagnostic Lab Data: Test Date: 20210602; Test Name: Heart rate; Result Unstructured Data: intermittent rapid heart beat; Comments: Typically patient have a low heart rate of about 60 beats
CDC Split Type: USJNJFOC20210627740

Write-up: INTERMITTENT RAPID HEARTBEAT AND NOTICE MORE HEART BEATS WHILE SITTING; This spontaneous report received from a patient concerned a 66 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included seasonal allergies, non-alcoholic, and non-smoker, and other pre-existing medical conditions included patient had no drug abuse or illicit drug usage. Patient was pretty health and does not take any medication. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 042A21A, expiry: UNKNOWN) dose was not reported, administered on 01-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-JUN-2021, the subject experienced intermittent rapid heartbeat and notice more heart beats while sitting. Laboratory data included: Heart rate (NR: not provided) intermittent rapid heart beat. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from intermittent rapid heartbeat and notice more heart beats while sitting. This report was non-serious.


VAERS ID: 1402007 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Wisconsin  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 antibody test, Therapy non-responder
SMQs:, Lack of efficacy/effect (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210602; Test Name: SARS-CoV-2 ELISA test; Result Unstructured Data: NEGATIVE
CDC Split Type: USJNJFOC20210626695

Write-up: SUSPECTED IMMUNOLOGICAL VACCINE FAILURE; This spontaneous report received from a health care professional concerned a 69-year-old male. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included no information on medical history. 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 14-MAY-2021 for prophylactic vaccination. The batch number was not reported. Per procedure, no follow up will be requested for this case. No concomitant medications were reported. On 02-JUN-2021, the patient had a negative antibody test (coded as suspected immunological vaccine failure). Laboratory data included: SARS-CoV-2 ELISA test (NR: not provided) as negative. The test was an IgG Elisa-Spike. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of suspected immunological vaccine failure was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0:20210626695 -Covid-19 vaccine ad26.cov2.s- suspected immunological vaccine failure. This event is considered not related. The event has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1402043 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-31
Onset:2021-06-02
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Headache, Myalgia, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test, Upper-airway cough syndrome
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: adapalene (DIFFERIN) 0.1 % gel amLODIPine (NORVASC) 10 mg tablet azithromycin (ZITHROMAX) 500 mg tablet clindamycin (CLEOCIN T) 1 % lotion fluocinolone and shower cap 0.01 % oil JUNEL FE 1/20, 28, 1 mg-20 mcg (21)/75 mg (7) per tablet lisin
Current Illness: None
Preexisting Conditions: Circulatory Renovascular hypertension Secondary hypertension Genitourinary Stage 2 chronic kidney disease Musculoskeletal Strain of thoracic paraspinal muscles excluding T1 and T2 levels, initial encounter Hematologic Anemia Immune Psoriasis Immunosuppression (CMS/HCC) Other Status post kidney transplant Tremor Proteinuria Moderate major depression, single episode (CMS/HCC) Generalized anxiety disorder
Allergies: Ibuprofen PenicillinsRash
Diagnostic Lab Data: POCT COVID-19 PCR
CDC Split Type:

Write-up: Cough Fever Sore throat headaches myalgias Postnasal drip


VAERS ID: 1402156 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-05-14
Onset:2021-06-02
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Depressed mood, Headache, Injection site reaction, Mental disorder, Micturition disorder, Pain, Pyrexia, Unevaluable event
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Depression (excl suicide and self injury) (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: She got her vaccine, she went crazy that night, she lost her mind. Her fever was so high that she thought that she would not wa
Other Medications: Lipitor, multivitamin, hair/skin/nail vitamin.
Current Illness: None.
Preexisting Conditions: High cholesterol.
Allergies: Latex, eggs, whole milk, strawberries, kiwi''s and some shellfish and nuts.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: She got her vaccine, she went crazy again that night, she lost her mind. Her fever was so high (not measured and home by herself), that she thought that she would not wake up. At one point she felt like she was in the bed, and she could see her own body and she could see herself sweating and that something else entered her body. She did not know what she was doing. Days after she was very stressed out. Two days later the fever went away and she was okay. Then on 6/2/21 she started urinating for a long time, and never used to happen to her and frequent. She became worried and she noticed that she was getting headaches that she had not gotten before. She has a throbbing feeling in her arm like something wants to burst out of her arm, and the feeling is on the inside not the outside. She claims that her arm is magnetic now, she was doing something and her phone stuck to her arm, and so she tried a knife, fork, and a spoon and everything sticks to the vaccine site, but not the other arm. She also put a light bulb up to her and it shocked her so she didn''t see if it would light up like she had seen on social media. She said she never saw a hole from the vaccine, never saw where the shot went just the reaction from it, but sometimes feels a little throbbing and pain in that area. She had a telemed appointment with her doctor this morning and she demonstrated the fact that the utensils were magnetic to her skin and she told her to call us and report the event. She is nervous about the throbbing pain and the sticking of the magnetic problem, and wanting to travel and wanting to know if this was going to be a problem, and will her life be the same again. She is now very depressed about the whole situation.


VAERS ID: 1402207 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-06
Onset:2021-06-02
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alcohol withdrawal syndrome, COVID-19, Hospitalisation, Hypertensive urgency, SARS-CoV-2 test positive
SMQs:, Psychosis and psychotic disorders (broad), Hypertension (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 650 mg 8 hr tablet ARIPiprazole (ABILIFY) 10 mg tablet ARIPiprazole (ABILIFY) 5 mg tablet aspirin 81 mg chewable tablet atorvastatin (LIPITOR) 80 mg tablet chlorthalidone (HYGROTON) 25 mg tablet docosahexanoic acid/e
Current Illness:
Preexisting Conditions: Hospital Coronary artery disease Bipolar disorder Depression Dyslipidemia Hypertension H/O heart artery stent COPD, mild Tobacco abuse Alcohol abuse Obstructive sleep apnea hypopnea, moderate Hyponatremia History of MI (myocardial infarction) Closed fracture of nasal bone Transaminitis Non-Hospital Benign essential hypertension Caries Condyloma acuminatum Insomnia Myopia Cigarette nicotine dependence without complication Obesity Chest pain Caffeine dependence Erectile dysfunction, unspecified erectile dysfunction type Daytime hypersomnia Lesion of left external ear Exposure to COVID-19 virus Nodule of anterior chest wall Hypertensive urgency Anterior mediastinal tumor
Allergies: Paroxetine HclMental Status Change
Diagnostic Lab Data:
CDC Split Type:

Write-up: was admitted for hypertensive urgency & alcohol withdrawal management. In regards to COVID, he was asymptomatic, did not require supplemental oxygen and did not require treatment. Precautions were kept in place throughout his stay and he was instructed to do a 10-day quarantine from the date of his positive test which was 6/2.


VAERS ID: 1402839 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-26
Onset:2021-06-02
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), 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: N/A
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Neck Stiffness


VAERS ID: 1402969 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dizziness, Injection site swelling, Migraine, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular 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: COVID-19 Moderna 1 vaccine, age 19, 4/27/21, vomiting, migraines, fever, chills, eye sight affected, dizziness
Other Medications: None
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Projectile vomiting High fever Migraine Chills Severely swollen limb on side of injection Dizziness


VAERS ID: 1403268 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: tingling in Left hip (random times)


VAERS ID: 1403375 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Rash maculo-papular
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Full body macular papular rash that began within 24 hours s/p dose #2 and lasted for ~ 7 days. Not reported to be pruritic, no urticaria.


VAERS ID: 1403469 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-05-19
Onset:2021-06-02
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Laboratory test, Thrombosis, Ultrasound scan
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: unknown
Preexisting Conditions: migraines, arthritis
Allergies: none
Diagnostic Lab Data: ER visit on 6/2/2021 labwork and ultrasound
CDC Split Type:

Write-up: Pt developed a blood clot.


VAERS ID: 1403698 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH #EW0185 / 1 AR / IM

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

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

Write-up: mom noted start of urticarial rash within a couple of hours of administration, rash pesists 10+ days


VAERS ID: 1403740 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-01
Onset:2021-06-02
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Postmenopausal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (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: General multivitamin QD
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA or other allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Post menopausal bleeding. 2+ years post menopausal without bleeding.


VAERS ID: 1404013 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Balance disorder, Clumsiness, Disturbance in attention, Dizziness, Feeling abnormal, Headache, Sinus pain
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: HPV, age 12, dizziness/passing out
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Headaches and pain in sinuses Dizziness persisting "Brain fog" trouble concentrating/memory clumsiness, balance problems possible vertigo


VAERS ID: 1404019 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Acoustic stimulation tests abnormal, Deafness, Eye irritation, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Corneal disorders (broad), Hearing impairment (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: Estradial .0375 patch, Progesterone 200 mg (10 days a month from the 15th thru the 25th of the month), Tagamet 200 mg as needed for GERD, Metoprolol tartrate 25 mg as needed for heart palpitations
Current Illness: None
Preexisting Conditions: Diagnosed with Cochlear Hydrops at age 38 in left ear
Allergies: Decadron, Protonix, Soma, Ibuprofen
Diagnostic Lab Data: Hearing tests conducted two days after the start of the hearing loss. Symptom of hearing loss started June 2nd. First hearing test conducted on June 4th. That hearing test showed a 30 decibel hearing loss.
CDC Split Type:

Write-up: About 12 hours after receiving my 2nd shot I had a normal immune response, low grade fever around 100 degrees, achy, burning eyes. By the next morning I felt better. That evening around 6 pm I couldn''t hear. I went to bed around 9pm and when I woke up the morning of June 3rd I could not hear normal speech. I called my ENT and went into his office on June 4th at 2pm. A hearing test was conducted and I had a 30 decibel hearing loss in my right ear. My ENT started steriod injections behind my ear drum. I went back in on June 7, 11 and the 14th for additional steriod injections. Currently, my hearing is better but still compromised. I am going in for a hearing test on Friday June 18th.


VAERS ID: 1404020 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Muscle spasms, Pain, Paralysis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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: I was unable to breathe. Airway closed up and was unable to take deep breaths. I went to urgent care and the refused to see me as I the triage nurse said had a fever of 102degrees Fahrenheit. I had severe bodily cramps and paralysis. I sti
Current Illness: None
Preexisting Conditions: No
Allergies: Aleve
Diagnostic Lab Data: Temp and oxygen taken
CDC Split Type:

Write-up: Difficulty breathing. Paralysis body aches and cramping. Fever. I was unable to breathe. Airway closed up and was unable to take deep breaths. I went to urgent care and the refused to see me as I the triage nurse said had a fever of 102 degrees Fahrenheit. I had severe bodily cramps and paralysis. I still have difficulty breathing and it''s the 16th. The first dose also presented me w/ the inability to breathe however went away after about 7 days. This second dose seems to have given me ongoing lung issues.


VAERS ID: 1404264 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-02-05
Onset:2021-06-02
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA R16M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A211A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Hyperaesthesia, Injection site pain, Photosensitivity reaction, Sunburn
SMQs:, Systemic lupus erythematosus (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (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: COPD diagnosis 8 years ago. Have had treatment for skin cancers (both benign and malignant) during the past 25 years.
Allergies: mild allergy to milk and eggs
Diagnostic Lab Data: None - I do not have a primary care provider and next available appointment with a primary care physician (online) is over 30 days away.
CDC Split Type:

Write-up: After first injection on 02/05/2021, the only event was a 24 hour soreness at injection site. No adverse effects after second injection on 3/5/2021. During the first few days of June 2021, I noticed that my skin became hyper-sensitive to sunlight and it was like I got sunburned in as little as 30 minutes to sun exposure. I''m a red-haired person (grey now) and have always sunburned easily but prior to the vaccine I could tolerate 3-4 hour sun exposure with little or no effect. Now I''m a noticeable redness to my skin after exposure of 30 minutes or less and my skin (face mostly) feels sunburned. This skin sensitivity has not abated since I became aware of it.


VAERS ID: 1404279 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-04-29
Onset:2021-06-02
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: turmeric, CQ10
Current Illness: none
Preexisting Conditions: none
Allergies: sulfa
Diagnostic Lab Data: Postive shlinges test
CDC Split Type:

Write-up: fWithin the first 24 hours I had a low grade fever, headache, and chills. About 35 days later I noticed serve pain in my leg and a skin rash which was diagnosed as shlinges.


VAERS ID: 1404786 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-31
Onset:2021-06-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eyelid disorder, Hordeolum, Swelling of eyelid
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Swelling and drooping of right eyelid. Painful to touch. Turned into a stye after several days. Believe it could be a reaction to a dermal filler.


VAERS ID: 1404792 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Postmenopausal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: I got my period after not having it for over 2 years. It was very heavy and lasted almost two weeks.


VAERS ID: 1404805 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-05-28
Onset:2021-06-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022821A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram thorax, Electrocardiogram, Laboratory test, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Pericarditis


VAERS ID: 1404808 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-03-29
Onset:2021-06-02
   Days after vaccination:65
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN ? / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Bell's palsy, Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: Levothyroxine
Current Illness: None
Preexisting Conditions: Slight Hypothyroidism
Allergies: None
Diagnostic Lab Data: Emergency room visit June 2nd, 2021 for Bell''s Palsy
CDC Split Type:

Write-up: 2 weeks after the shot I had a scary night where I had severe chest pain. I sat up for a few hours hoping I wasn''t having a heart attack and taking water and tums. I have never had chest pain before or since. I was very concerned and wondered if it was the vaccine. I didn''t have anything unusual to eat or drink. I was happy when it finally resolved that same night. I also experienced Bell''s Palsy 2 months after the vaccine. (~June 1st) I have never experienced Bell''s Palsy. I am not sure if either of these events were related to the vaccine, but I have no intention of getting a yearly covid or flu vaccine now that I have Bell''s Palsy. It is terrible, and I''m not taking ANY chance of getting this again even if that means I get the flu and covid yearly. I placed my trust in science, and not I am not sure I made the right choice. Although I hope my facial movement and ability to use my lips and face come back, I realize that some never recover.


VAERS ID: 1405291 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-05-08
Onset:2021-06-02
   Days after vaccination:25
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Chest pain, Dizziness, Dysstasia, Headache, Hypoaesthesia, Loss of consciousness, Nausea, Paraesthesia, Pyrexia, Vaccination site pain
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia 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), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BUSPAR; LAMOTRIGINE
Current Illness: Anxiety
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210603; Test Name: Body temperature; Test Result: Borderline ; Result Unstructured Data: Fever-99 degrees Fahrenheit
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Temperature was 99 degrees Fahrenheit; Almost passed out; Whole right side of my body went numb; Left leg tingly/Whole right side of my body tingly; Dizzy; Hard to stand; Chest pain; Arm pain at the injection site; Nausea; Slight Headache; This spontaneous case was reported by a consumer and describes the occurrence of LOSS OF CONSCIOUSNESS (Almost passed out) in a 33-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Anxiety. Concomitant products included BUSPIRONE HYDROCHLORIDE (BUSPAR) and LAMOTRIGINE for Anxiety. On 08-May-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 02-Jun-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 02-Jun-2021, the patient experienced LOSS OF CONSCIOUSNESS (Almost passed out) (seriousness criterion medically significant), HYPOAESTHESIA (Whole right side of my body went numb), PARAESTHESIA (Left leg tingly/Whole right side of my body tingly), DIZZINESS (Dizzy), DYSSTASIA (Hard to stand), CHEST PAIN (Chest pain), VACCINATION SITE PAIN (Arm pain at the injection site), NAUSEA (Nausea) and HEADACHE (Slight Headache). On 03-Jun-2021, the patient experienced PYREXIA (Temperature was 99 degrees Fahrenheit). At the time of the report, LOSS OF CONSCIOUSNESS (Almost passed out), HYPOAESTHESIA (Whole right side of my body went numb), PARAESTHESIA (Left leg tingly/Whole right side of my body tingly), DIZZINESS (Dizzy), DYSSTASIA (Hard to stand), CHEST PAIN (Chest pain), VACCINATION SITE PAIN (Arm pain at the injection site), NAUSEA (Nausea), HEADACHE (Slight Headache) and PYREXIA (Temperature was 99 degrees Fahrenheit) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 03-Jun-2021, Body temperature: 99 (Borderline) Fever-99 degrees Fahrenheit. Patient reported that she had not taken anything for her symptoms. Company comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1405841 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Ohio  
Vaccinated:0000-00-00
Onset:2021-06-02
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Dizziness, Hypersensitivity, Hypoacusis, Near death experience, Pulmonary function test
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy (shot made my allergies like ten times worse)
Allergies:
Diagnostic Lab Data: Test Name: test in my lung; Result Unstructured Data: Test Result:everything is fine
CDC Split Type: USPFIZER INC2021643055

Write-up: I have severe allergies now because from the shot I almost died; shot made my allergies like ten times worse; I have severe allergies now because from the shot I almost died; shot made my allergies like ten times worse; I can''t hear you my allergies are horrible today; Light-headed; Cough; This is a spontaneous report from a contactable consumer (patient). A 53-year-old female patient received bnt162b2 (BNT162B2), dose 1 via an unspecified route of administration at 1 O''clock on an unspecified date (Batch/Lot number was not reported) as single dose for covid-19 immunisation. Medical history included allergies from an unknown date. The patient reported I''m on five different pills, I don''t have them right now I didn''t take up from the pharmacy yet. The patient stated, "I had to go to emergency room last night and I had a reaction to the vaccine and I have severe allergies now because from the shot I almost died. I can''t hear you my allergies are horrible today. I started now with a cough, I have severe allergies and this all I had to go to hospital. I''m still like light-headed and I''m coughing too much and I never done it until I got the COVID shot. The events started couple of days after the injection. The patient further stated, "I have severe allergies and they thought I have a blood clot in my lung and I still have nothing wrong with that, my lungs and heart are fine. It''s this shot the shot made my allergies like ten times worse. Now I''m in like on five different pills now." The patient reported no treatment received for the events, only thing they did is they done a test in my lung and everything is fine, my heart is fine so I''m doing pretty good. The event Cough started on 02Jun2021; other events started on unspecified date. The patient was hospitalized for the severe allergies now because from the shot she almost died. The outcome of event Cough and Light-headed was not recovered, outcome of other events was unknown. Information on the lot/batch number has been requested.


VAERS ID: 1405850 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-23
Onset:2021-06-02
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021648926

Write-up: running a fever yesterday; This is a spontaneous report from a contactable consumer (reporting on herself). A 64-years-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Batch/Lot Number and Expiration date was not reported), via an unspecified route of administration on 23May2021 as 2nd dose, single dose for COVID-19 immunization. The patient medical history and concomitant medications were not reported. Previously patient took first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) on 02May2021 for COVID-19 immunization. It was reported that a patient received first dose of Pfizer''s COVID vaccine on 02May2021 and the second dose on 23May2021. She was running a fever yesterday (on 02Jun2021) and it is gone today (on 03Jun2021). Asking does she need to quarantine because she was out of town and does she need to test for COVID if she had the fever yesterday (on 02Jun2021). Patient asking if the vaccine was good for 6 months. What are the 6 months top line analysis results of the Pfizer-BioNTech COVID-19 Vaccine. The outcome of the event was recovered on 03Jun2021. Information about lot/batch number has been requested.


VAERS ID: 1405877 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, Chest discomfort, Decreased appetite, Dizziness, Fatigue, Headache, Malaise, Musculoskeletal discomfort, Nausea, Paraesthesia, Paranasal sinus discomfort
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Sulfonamide allergy (Verbatim: Sulfa-Drugs)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021659638

Write-up: Pins and needle sensations that moved to the rest of body; Sinus pressure; Tingling that started in the feet; Loss of appetite; Headache; Nausea; Dizziness; Fatigue; Pressure in back and abdomen; Pressure in back and abdomen; Chest tightness; Malaise; This is a spontaneous report from a contactable consumer (patient) reported that: A 29-year-old non-pregnant female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: EW0185; formulation: solution for injection; Expiration date: unknown), via unspecified route of administration in left arm on 01Jun2021 at 15:00 (at the age of 29-years-old) as second dose, single dose for COVID immunisation in Health Clinic/Administration facility. The patient medical history included Sulfa-Drugs with allergies. The concomitant medications were not reported. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. Patient known allergies included Sulfa-Drug. Device timestamp was reported as 05Jun2021. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient did not received other medications within two weeks of vaccination. The patient previously received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: ER8736; formulation: solution for injection; Expiration date: unknown), via unspecified route of administration in left arm on 11May2021 at 14:00 (at the age of 29-years-old) as first dose, single dose for COVID immunisation. On 02Jun2021 at 11:00, the patient experienced Pins and needle sensations that moved to the rest of body including feet, legs, pelvis, buttocks, back, abdomen, chest, arms, neck, cheeks, back and front of head as well as occasional sensation in right eye, Sinus pressure, Tingling that started in the feet, Loss of appetite, Headache, Nausea, Dizziness, Fatigue, Pressure in back and abdomen, Pressure in back and abdomen, Chest tightness, Malaise. The adverse events resulted in doctor or other healthcare professional office/clinic visit. The adverse events resulted in Emergency room/department or urgent care. The patient did not received treatment for the events. The outcome of the event was not recovered.


VAERS ID: 1405961 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-15
Onset:2021-06-02
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Lymphadenopathy, Pruritus, Rash, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021672022

Write-up: rashes; hives; itching; headache; swollen lymph nodes; This is a spontaneous report from a contactable consumer (patient). A female patient of an unspecified age received second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on 15Apr2021 as single dose for COVID-19 immunization. The patient medical history and concomitant medications were not reported. The patient previously received first dose of BNT162B2 for COVID-19 immunization. On 02Jun2021, patient experienced rashes, hives, itching, headache and swollen lymph nodes. The outcome of events was unknown. Information about batch/Lot number has been requested.


VAERS ID: 1406190 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-05-17
Onset:2021-06-02
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure abnormal, Blood pressure measurement, Costochondritis, Mass, Musculoskeletal chest pain, Musculoskeletal stiffness, Pain, Product dose omission issue
SMQs:, Neuroleptic malignant syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hypertension (broad), Arthritis (broad), Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anxiety; Aortic aneurysm (Diagnosed about 3 years ago.); Cancer (Father had prostate cancer that went into his throat.); Depression; Heart block (Diagnosed about 3 years ago.)
Allergies:
Diagnostic Lab Data: Test Name: blood pressure; Result Unstructured Data: Test Result:abnormal
CDC Split Type: USPFIZER INC2021702883

Write-up: has problems with his blood pressure; didn''t get the second shot; His lower back tightens up sometimes.; a growth at the base of his rib cage; causing pain; Soreness in his ribcage; costochondritis; This is a spontaneous report from a contactable consumer or other non hcp. A 67-year-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Lot Number: EN6198), via an unspecified route of administration in the right arm on 17May2021 at 15:30 (at the age 67-year-old) as 1st dose, single dose for COVID-19 immunisation. Medical history included atrioventricular block, diagnosed about 3 years ago; aortic aneurysm, diagnosed about 3 years ago; anxiety and depression. The patient''s family history included father had prostate cancer that went into his throat. Historical vaccine included flu vaccine about 4 years ago and experienced has not had anything except a sore arm after vaccines. One time the patient had weakness in his left arm for months. The pharmacist said it was because of how they administered it. The patient''s concomitant medications were not reported. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient stated he was called about the COVID 19 vaccine. He had his first vaccine on 17May2021, and second shot was supposed to be on 07Jun2021. He went to his doctor "tomorrow" at 20:40 regarding a growth at the base of his rib cage. He called and spoke to someone at Pfizer earlier "today", 14Jun2021 and forgot to tell the agent that he was taking Tylenol and Advil. He completely forgot. He does not have a report number from the call "this morning". When probed the information from the COVID 19 vaccine card, he reports it was hard to read the pharmacist''s handwriting but the date for the first vaccine was 17May2021, he remembered it was a Monday and he was supposed to have his second vaccine 3 weeks from 17May2021. He reported he did not have the growth on his rib cage prior to the COVID 19 vaccine. He had soreness in-between his ribs and went to the doctor. The doctor said he had costochondritis, two weeks after the vaccine and felt all along that area in his ribs. This was 3 weeks and 3 days after he had the first COVID 19 vaccine. He woke up and felt big lump right underneath where his ribcage ends, the size of his hand, and it was causing pain. That Wednesday the patient was fine and then Thursday it was there. He does not know if the lump was pressing on nerves or whatever. His doctor told him to take Tylenol. The patient''s physician assistant said it was a sub-Q lump of fat, it was very pronounced. The caller sees his doctor "tomorrow". When he first got up in the morning for the first 5 or 10 minutes, he has pain that nearly brings him to tears and the Advil and the Tylenol was not curing that. He has been fortunate that the pain disappears after about 10 minutes. He has been taking Tylenol at 1000mg twice a day, once in the morning and once in the evening. He stopped taking the Advil because he has problems with his blood pressure. His doctor does not want him to take Advil. He was not reported any new events. He was taking the Tylenol also taking a muscle relaxer, Skelaxin. He takes Skelaxin for his lower back. His lower back tightens up sometimes. He was not blaming that on the vaccine because he had this problem in the past. The Patient was very questionable to get the COVID 19 vaccine, but his doctor said he does not want the caller to be the last person who ends up in a grave. So, he decided to get the COVID 19 vaccine. The Tylenol was Acetaminophen at 500mg (Lot# OKE2997, Expiry Sep2022). He bought it from the supermarket "PRIVACY". Advil at 200mg, Lot# X84375, Expiry Jul2021. He would take 2 tablets in the morning and 2 tablets at bedtime so he could sleep. He has one tablet left but he was not taking this anymore. He will ask the doctor tomorrow at this appointment if he was going to order an ultrasound. He was not in pain at the time of the first call to Pfizer. The events resulted in visit to physician''s office. The outcome of event "a growth at the base of his rib cage" was not resolved; pain was resolved and rest all other was unknown.


VAERS ID: 1406855 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-25
Onset:2021-06-02
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, SARS-CoV-2 test negative, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyprex, Elavil, Neurontin, Tadalafil, Celebrex
Current Illness:
Preexisting Conditions: Scerosing Mesenteritis, Mitral Valve Prolapse, Schizoaffective Disorder
Allergies: Gluten/dairy (but not a true allergy)
Diagnostic Lab Data: Yesterday I was retested for COVID and it came back negative.
CDC Split Type:

Write-up: My breathing has chronically been a little wheezy with some coughing.


VAERS ID: 1407709 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-05-15
Onset:2021-06-02
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171, / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / SYR

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

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

Write-up: Patient developed Unilateral (Left)numbness and tingle 3 weeks post 2nd vaccination. Symptoms have not improved. Patient says his left side is very sensitive to hot and cold now. Its his entire left side from left side of face to his foot. Describes it like a line down center of body. No prior episodes of anything like this in teh past. Says it was sudden onset . went to bed fine and woke up with it.


VAERS ID: 1407781 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Glossodynia, Lip pain, Pruritus, Psychomotor hyperactivity, Upper respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None (had been taking Vitamin C, D3, Zinc) in the days prior. Some homeopathic drops for allergies, but none on that day.
Current Illness: Was having an issue with sternal wires (open heart surgery, 1/4/2018. Found out there is nickel in the titanium wires. Had a procedure to remove some of them on 6/6/2021
Preexisting Conditions:
Allergies: Corn starch, many antibiotics, Warfarin, Metoprolol, Eliquis, smoke, nickel, coconut oil, dimethicone (in lotions), mineral oil, wool. I had seen an allergist (May 20, 2021) and was tested for the 2 things most likely to cause a reaction (Polysorbate - in the Johnson and Johnson and PEG - in the Moderna). Negative reaction to bot
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Congestion in throat, stinging tongue and lip, general itching, hyperactivity


VAERS ID: 1407922 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 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: There was a mix up with expired vaccine and recently reconstituted vaccine. The patient may have received a vaccine that was outside the recommended syringe storage time of 6 hours. After consultation with Pfizer, the CDC and our vaccine experts it was determined that microbial contamination was primary concern and revaccination was not necessary. We made daily attempts to reach out to patient and notify but they do not answer phone or return calls. We are going to discuss at next dose. Unknown if patient had any increase incidence of fever or site reaction.


VAERS ID: 1408002 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-05-24
Onset:2021-06-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anticoagulant therapy, Deep vein thrombosis, Pain in extremity, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? Yes
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: Daily multi-vitamin
Current Illness: None
Preexisting Conditions: None
Allergies: No known
Diagnostic Lab Data: 06/07/2021: Ultrasound performed in the ER. Diagnosis was Deep Vein Thrombosis (DVT) of distal vein of right lower extremity.
CDC Split Type:

Write-up: Pain in the back of patient''s right calf started after a flight on 6/2/2021. We ended up in the ER on 6/7/2021. There he was diagnosed per ultrasound with DVT or having a blood clot in a vein in his right calf. He was prescribed Eliquis and counseled to follow up with his physician at home. Patient met with our family physician on 6/9/2021, the day we arrived home to follow-up. After receiving the medical records Dr. advised us to file this report. We understand that blood clots can happen on flights, but Dr. felt that this event was such an anomally for patient that it merited further reporting. Patient is a completely healthy 16 year old male who is an extremely active athlete who participates in basketball, track, cross-country and other physical activities daily. For him to develop a blood clot after a 4 hour flight is an exceptional, unexpected event. Dr. long term plan is to keep patient on Eliquis for 6 months, then take him off of the medicine and then run more blood tests after 2 weeks to fully investigate the incident.


VAERS ID: 1408253 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO 186 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Chest X-ray, Chest pain, Chest scan, Chills, Dyspnoea, Fatigue, Immediate post-injection reaction, Lymph node pain, Myalgia, Pyrexia, Scan with contrast, Tachycardia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Sleeve resection of right lung 2019 due to carcinoid tumor.
Allergies: None
Diagnostic Lab Data: X-ray and CT scan with contrast Note: he had taken one Flexeril on June 7, 2021 for back and chest pain prior to seeking medical attention at Hospital.
CDC Split Type:

Write-up: Patient experienced fatigue and muscle aches immediately following the vaccination. His symptoms became progressively worse as time passed and by the next day he was experiencing chills, fever, tachycardia, shortness of breath, and excruciating chest and upper back pain. He described the pain in his chest as "stabbing" and also had a small and painful protrusion from his chest wall that was determined to be a lymph node.


VAERS ID: 1409649 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Cold sweat, Dysphagia, Mydriasis, Pallor, Presyncope
SMQs:, Anaphylactic reaction (narrow), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021641495

Write-up: anaphylactic reaction; about to black out/lost consciousness; cold sweats; had a hard time /trouble swallowing; turning pale; his pupils were dilated; This is a spontaneous report from a contactable Pharmacist via Medical Information. This Pharmacist reported for two patients, this is the first of two reports regards to a male patient. A 34-year-old male patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via intramuscular, administered in left arm on 02Jun2021 between 10:00 and 11:00 am, maybe around 10:30ish (Batch/Lot Number: EW0178; Expiration Date: Aug2021, NDC number: 59267100002) as 1ST DOSE 0.3ML, SINGLE for covid-19 immunisation at pharmacy. The patient medical history and concomitant medications were not reported. No prior vaccinations (within 4 weeks). No additional vaccines administered on same date of the Pfizer suspect. A pharmacist from pharmacy had 2 patients who received the vaccine and both had a reaction after the dose, within one hour after receiving the dose, and EMS was called. The pharmacist confirmed the first patient had the reaction within 1 hour of receiving the dose. She clarified this person was having cold sweats, about to black out, had a hard time and trouble swallowing and was turning pale, his pupils were dilated. Pharmacist explained they make them sit there for 15 minutes after receiving the vaccine so this reaction happened maybe 3 minutes after he got the shot. The EMS came and he was brought to the hospital. The patient did come back afterwards and he said the doctor didn''t know 100 percent what happened, but it might been a slight allergic reaction, not to the point where he lost consciousness, but they did release him. She clarified they checked his vitals and everything and released him. When pharmacist was probed for the event, the pharmacist thought it was an anaphylactic reaction. The events require a visit to Emergency Room, patient was brought by EMS. Not had a visit to Physician Office. Unknown if patient received treatment, the pharmacist wasn''t be told that much information. The outcome of events was unknown. Causality: In this case, pharmacist did not think so. She thinks maybe it was anxiety but she wouldn''t know.; Sender''s Comments: Based on plausible temporal relationship, a possible causal association between the events and the suspect drug BNT162B2 cannot be excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.,Linked Report(s) : US-PFIZER INC-2021646208 same reporter, product, different patient and similar events.


VAERS ID: 1409664 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 LA / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021646208

Write-up: anaphylactic reaction; This is a spontaneous report from a contactable pharmacist. This Pharmacist reported for two patients. This is the second of two reports regards to a female patient. A 29-year-old female patient received first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE) intramuscular, administered in Deltoid Left on 02Jun2021 (Batch/Lot Number: EW0178; Expiration Date: Aug2021) at the age of 29-year-old, as 1st dose, single for covid-19 immunisation. The patient medical history was not reported. The patient''s concomitant medications was reported as taking other medication (unspecified). The patient experienced anaphylactic reaction on 02Jun2021. They took her to the hospital. It was reported the vaccine shot was between 11:30 and 12:00 in the morning. The patient experienced anaphylactic reaction literally like may be within 5 minutes after taking the shot. So its again 11:30 or 12:00. The outcome of event was unknown. Information on Lot/Batch number is available; Further information has been requested.; Sender''s Comments: Based on the plausible temporal relationship and known drug safety profile, a possible causal relationship between the event Anaphylactic reaction and suspect drug BNT162B2 cannot be excluded.,Linked Report(s) : US-PFIZER INC-2021641495 same reporter, product, different patient and similar events.


VAERS ID: 1409729 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-02-19
Onset:2021-06-02
   Days after vaccination:103
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 RA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Muscle strain, Musculoskeletal stiffness, Myalgia, Pain in extremity, Vaccination site discomfort, Vaccination site pain
SMQs:, Rhabdomyolysis/myopathy (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), 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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021682886

Write-up: she was working in the garden and she hurt her arm. She pulled a muscle in it. It was her right arm where she had gotten the shot; I got both shot on right arm because I used right arm and I wanna workout the stiffness of the shot right arm.; sore arm/sored and painful arm on the same site where the vaccine was administered; injection site magnetic; sore muscles; sore arm/sored and painful arm on the same site where the vaccine was administered; This is a spontaneous report from a contactable consumer. This 61-year-old female consumer (patient) reported for herself that she received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Lot Number: EM9810, and Expiration date: 30Jun2021), via an unspecified route of administration, administered in right arm on 19Feb2021 (at the age of 61-year-old) as 2nd dose, single dose for COVID-19 immunization. The patient medical history and concomitant medications were not reported. Previously the patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Lot Number: EL9262, and Expiration date: 31May2021), via an unspecified route of administration, administered in right arm on 29Jan2021 as 1st dose, single dose for COVID-19 immunization. The patient was wondering if anyone had complained about their injection site being magnetic. Her girlfriend said that she heard that it was magnetic. Caller could stick a magnet on her arm, and it sticks there. It was weird that her arm was magnetic since the shot and it was not magnetic before. The patient was concerned as the magnet sticks on the same arm where she got the shot. On 02Jun2021, the patient had her injection site magnetic, sore arm/sored and painful arm on the same site where the vaccine was administered, and sore muscles. The patient reported that she got both shot on right arm because she used right arm and she wanted to work out the stiffness of the shot right arm. She got shot just she worked, she got both shot on right arm 3 weeks apart and her right arm got sored and right arm had been magnetic you can stick a magnet on her right arm. A week and half ago (on an unspecified date), she was working in the garden and she hurt her arm. She pulled a muscle in it. It was her right arm where she had gotten the shot. Her arm was so bad that she was not able to use it properly. She went to the doctors and they wanted to make sure her rotator cuff was connected so she could lift her arm up. Her arm was still sore, and they put it in a sling. It had not been recovered. She could lift it up, but it was sore than normal. The patient wondered if they put metal (that could possibly contribute to its magnetic properties) in the shot and it goes on my arm, that''s why it was not recovering. She also wanted to know if this (a probable magnet presence in the vaccine) was the reason why her arm was sore. She was wondering since her arm was not feeling well, she wondered if they connect since her arm had been sore for so long. The patient had been informed that there was no metal on the shot. The patient got both shot on right arm because she used right arm and she wanted to workout the stiffness of the shot right arm. The patient was given with muscle relaxant (as treatment) and she took muscle relaxant but as per patient it was waste of time, it did nothing. The patient stated, "I put give on one minute I better look for cream waste of time. I thought to release that waste of time nothing work, its only things feel good, live things let it rest." Upon addressing Medical Inquiry, she also reported that one of her girlfriends had experience the same side effect where a magnet was sticking on the same arm where they got the vaccine. Unspecified muscle relaxant was given as therapeutic measure as a result of sore arm/sored and painful arm on the same site where the vaccine was administered and sore muscles. The outcome of the events injection site magnetic, sore arm/sored and painful arm on the same site where the vaccine was administered, and sore muscles was reported as not resolved. The outcome of the event "she was working in the garden and she hurt her arm. She pulled a muscle in it. It was her right arm where she had gotten the shot" and "I got both shot on right arm because I used right arm and I wanna workout the stiffness of the shot right arm" was unknown.


VAERS ID: 1409745 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-02
Onset:2021-06-02
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0176 / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Herpes virus infection, Inflammation, Pruritus, Rash vesicular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021690520

Write-up: Herpes Virus associated vesicular rash on top of left foot, with intense, radiating itchiness, inflammation; Herpes Virus associated vesicular rash on top of left foot, with intense, radiating itchiness, inflammation; Herpes Virus associated vesicular rash on top of left foot, with intense, radiating itchiness, inflammation; Herpes Virus associated vesicular rash on top of left foot, with intense, radiating itchiness, inflammation; redness; This is a spontaneous report from a contactable consumer. A 48-year-old female patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, solution for injection, Lot number: EW0187), via an unspecified route of administration in the right arm on 02May2021 as a single dose for COVID-19 vaccination. On an unknown date 03:45 PM the patient received second dose of BNT162B2 (Lot number: EW0176), via an unspecified route of administration in the right arm on 02May2021 as a single dose for COVID-19 vaccination. Medical history included hypothyroidism. Concomitant medications were not provided. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine nor any other medications within 2 weeks of vaccination. The patient was not diagnosed with COVID-19 prior to or since the vaccination. The patient experienced Herpes Virus associated vesicular rash on top of left foot, with intense, radiating itchiness, inflammation. On 02Jun2021 08:30 PM, intensely itchy area on top of left foot, which she thought was a bug bite. Topical Benadryl (Diphenhydramine) was applied. On 03Jun2021, two small scabs emerged (approx. 5-8mm wide) that looked like abrasion/scab from excessive scratching. 03Jun2021 - 04Jun2021 itchiness subsided. On 05Jun2021, there was visible redness, inflammation and small vesicle formation around two scabbed areas in conjunction with intense radiating itchiness extending beyond areas of visible inflammation. 05Jun2021 - 06Jun2021 inflammation, intense radiating itchiness and formation of new and larger vesicles ultimately forming a 3'' rash across top of foot. On 08Jun2021 the patient consulted with primary care physician (PCP): Weeping vesicles and new vesicles formation noted. Antibiotics and topical cream prescribed, and culture performed. On 11Jun2021: second opinion with dermatologist and testing of affected area positive for Herpes virus. Antiviral medication was prescribed. Treatment for the adverse events included Cephalexin, Mupirocin and Valacyclovir. Outcome of the events was not recovered. No follow-up attempts are needed. No further information is expected.


VAERS ID: 1409956 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Drooling, Lethargy
SMQs:, Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

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

Write-up: LETHARGY, DROOLING


VAERS ID: 1410158 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-05-29
Onset:2021-06-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / IM

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

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: Patient has cancer and had a reaction after his chemotherapy treatment a few days after receiving his second COVID vaccine.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient got his vaccine on 5/29/21 and then received his normal chemotherapy treatment a few days after receiving the vaccine. He had red blotches all over his body and his left leg swelled. He didn''t have any problems with his first vaccine. He was and is currently taking a prednisone taper. He''s still experiencing these blotches and it doesn''t seem to be getting better so he wanted to make sure the pharmacy was aware.


VAERS ID: 1410194 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (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? 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: For the duration of a couple weeks after the second Pfizer shot, I sporadically would experience moderate heart palpitations, chest pains, and chest feeling heavy. These symptoms would occur randomly throughout the day (typically when not doing any physical activity - i.e. driving in car or sitting on couch) and would last for several minutes. It never got severe enough to the point where I went to see a doctor. It has been 17 days since the second shot and I feel better and haven''t experienced the pains in a couple days.


VAERS ID: 1410681 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Body temperature increased, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (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: Isibloom OCP, fluoxetine
Current Illness: Issues with abdominal pain and diarrhea for a couple months seen on 5/13/21.
Preexisting Conditions: IBS, endometriosis, anxiety/depression, seasonal allergies
Allergies: shellfish, amoxicillin, cefprozil, environmental allergies
Diagnostic Lab Data: none.
CDC Split Type:

Write-up: June 2nd had second Covid vaccine. Afterward had Vomiting, low grade fever, temp 99.6 when checked in the day but thinks was warmer at night, nausea, arm pain.


VAERS ID: 1410873 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-28
Onset:2021-06-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blister, Rash
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Started with a rash on my face 5 days post vaccine that continued to spread to arms, stomach, back & thighs blistered in some areas


VAERS ID: 1411094 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Oedema peripheral, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: None
CDC Split Type:

Write-up: Hives and edema on bilateral hands/arms


VAERS ID: 1412441 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Head injury, Nausea, Pyrexia, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: VITAMIN D 2000; VITAMIN C & ROSEHIP
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC2021655848

Write-up: Fainted; Bumped my head on the tiles in the bathroom; Nauseous; Fever; Chills; Vomiting; This is a spontaneous report from a contactable consumer (patient). A 43-year-old non-pregnant female patient received bnt162b2 (BNT162B2), dose 2 via an unspecified route of administration, administered in Arm Left on 02Jun2021 10:00 (Lot Number: EW0186) as single dose for covid-19 immunisation at the age of 43-year-old. The patient was healthy, no illnesses before vaccination. Concomitant medications included calcium carbonate, colecalciferol (VITAMIN D 2000), ascorbic acid, rosa canina fruit (VITAMIN C & ROSEHIP). The patient didn''t receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient was not diagnosed with COVID-19 prior to vaccination and hasn''t been tested for COVID-19 since the vaccination. The patient previously received the dose 1 administered in Arm Left on 12May2021 11:15 (Lot Number: EW0183) at the age of 43-year-old. On 02Jun2021 22:00, the patient felt nauseous, had fever, chills and vomiting. On 03Jun2021 07:00, the patient fainted and bumped the head on the tiles in the bathroom. The events resulted in visit of Emergency room/department or urgent care. Treatment received for the events. The outcome of the events was recovering. The patient reported, my symptoms began 12 hours after the second dose. I felt nauseous throughout the night and I had fever, chills and vomiting. 21 hours after vaccination I fainted and I bumped my head on the tiles in the bathroom. My husband called 911. Emergency check received from first responders. Follow up attempts are needed. Further information has been requested


VAERS ID: 1413075 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-24
Onset:2021-06-02
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: School       Purchased by: ?
Symptoms: Pityriasis rosea
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: none
Current Illness: none known
Preexisting Conditions: none
Allergies: none known
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diagnosed with a case of Pityriasis rosea by general practitioner, symptoms started roughly 10 days after receiving Jansen vaccine. No possible cause could be identified.


VAERS ID: 1413139 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Arthralgia, Blood test normal, C-reactive protein normal, Chest X-ray normal, Chest discomfort, Chest pain, Chills, Dyspnoea, Electrocardiogram normal, Fibrin D dimer normal, Full blood count normal, Hypoaesthesia, Magnetic resonance imaging normal, Malaise, Metabolic function test normal, Migraine, Myalgia, Pyrexia, SARS-CoV-2 antibody test negative, Scan with contrast normal, Tachycardia, Troponin I normal
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: MRI with and without contrast (done at ER) Chest X-ray (done at ER) Blood labs 2 EKG?s CBC BMP CRP D dimer Troponin 1 All clear. Told it was from the vaccine. serum antibody test testing for any previous infection of covid and it was negative.
CDC Split Type:

Write-up: 1st day fine June 1 2021 Day 2 muscle aches joint pain malaise fever chills Day 3 nighttime/ morning of day 4 anaphylaxis Day 4 morning epi pen at urgent care/ tachycardia Day 5 tachycardia Day 6 tachycardia Day 7 tachycardia and migraine followed by numb right side arm / leg/ face Corticosteroids taken Day 9 visit ER FOR NUMBNESS to rule out stroke Corticosteroids end June 12 (tachycardia and shortness of breath continue since the symptoms first noticed) Night of 13th day anaphylaxis Urgent care june 14: prescribed beta blockers epi pens and corticosteroids Effects continuing today: Tachycardia (baseline prior to shot was 60 resting heart rate and now is in the 100+, going up 10 stairs causes it to hit 160, small movement triggers it- beta blockers help sometimes) Numbness on right side: face arm leg foot etc Chest pain, chest tightness, shortness of breath


VAERS ID: 1413265 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-26
Onset:2021-06-02
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO179 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Pain
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: Rash after a week. Burning but not itching. Right after shot dizzy, headaches. I''m allergic to gadolinium and bug bites. Was sick after 2nd shot on 6.16.21 for 2 days- headaches, fatigue, chills, sore


VAERS ID: 1413497 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-05-28
Onset:2021-06-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / 2 LA / SYR

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

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

Write-up: Rash on back side of hands and knuckles


VAERS ID: 1413580 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-11
Onset:2021-06-02
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-06-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Burning sensation, Headache, Herpes zoster, Hypoaesthesia, Nerve injury, Pain, Polymenorrhoea, Rash, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Opportunistic infections (broad)

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

Write-up: Shingles on the left side of the body, same side as vaccine injection. Numbness, systemic rash following C8 and T1 dermatome. pain and burning, require emergency care and medications. Rash lasting for over three weeks and nerve damage and numbness in the carpal tunnel of left hand requiring further medical appointments and further medical attention. Apart from this most serious side effect, also experienced fainting and headaches as well as a discontinuance of my menstrual cycle during the initial injection. Subsequently a much shorter cycle the second one after injection of said vaccine.


VAERS ID: 1414187 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-05-27
Onset:2021-06-02
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Burning sensation, Fatigue, Hypoaesthesia, Muscle spasms, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: topomaz methotrextate folic acid sumatriptan
Current Illness: CIDP UCTD
Preexisting Conditions: CIDP
Allergies: penicillin propranolol buspurone
Diagnostic Lab Data: none, had IV steriod treatment for 3 days to treat
CDC Split Type:

Write-up: Right side numbness, tingling, weakness, felt like icy hot all of right side of my body, fatigue. Slight burning, numbness tingling left foot. Muscle spasms under both rib cages/diaphram.


VAERS ID: 1414414 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-02-01
Onset:2021-06-02
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9266 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Nasal congestion, Oropharyngeal pain, Rhinorrhoea, SARS-CoV-2 test positive, Secretion discharge, Throat irritation
SMQs:, Anaphylactic reaction (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 mg tablet amLODIPine (NORVASC) 2.5 mg tablet atorvastatin (LIPITOR) 40 mg tablet brimonidine (ALPHAGAN) 0.2 % ophthalmic solution cholecalciferol, vitamin D3, (VITAMIN D3 ORAL) cyanocobalamin, vitamin B-12, (VITA
Current Illness:
Preexisting Conditions: Nervous Glaucoma Neuropathy, lumbosacral plexus Meibomian gland dysfunction (MGD) of both eyes Respiratory Allergic rhinitis Circulatory Hypertension Digestive Diverticulosis Fatty liver GERD without esophagitis Genitourinary CKD (chronic kidney disease) stage 2, GFR 60-89 ml/min Musculoskeletal Lipoma of left thigh Lipoma of right thigh Hirsutism Endocrine/Metabolic Familial hyperlipidemia Hypothyroidism Controlled type 2 diabetes mellitus, without long-term current use of insulin (CMS/HCC) Multinodular goiter Other Anxiety Depression Lactose intolerance Leukoplakia Overweight(278.02) History of repair of retinal tear by laser photocoagulation
Allergies: CinnamonSwelling PromethazineHallucinations CodeineAnxiety, Nausea and Vomiting Milk Containing ProductsNausea Only
Diagnostic Lab Data: 06/03/21 0036 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 06/02/21 1256 | Final result | Specimen: Swab from Nares COVID-19 SARS-CoV-2 Overall Result DetectedCritical 06/03/21 0036 COVID-19 PCR Collected: 06/02/21 1256 | Final result | Specimen: Swab from Nares
CDC Split Type:

Write-up: Topic: Acute Illness $g$g Jun 2, 2021 9:18 AM: Pt states she has a sinus infection. Pt sxs include, sore throat, burning in throat, coughing, head congestion, nose drainage, yellow mucus. Pt states provider has prescribed her medication in the past that has helped alleviate her sinus symptoms.


VAERS ID: 1414642 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-01
Onset:2021-06-02
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Pneumonia, Pneumonia streptococcal
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad)

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

Write-up: Acute respiratory failure; pneumonia; Strep pneumonia


VAERS ID: 1414648 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-01
Onset:2021-06-02
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow)

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

Write-up: Acute respiratory failure


VAERS ID: 1414652 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-01
Onset:2021-06-02
   Days after vaccination:93
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Atrial fibrillation
SMQs:, Anaphylactic reaction (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow)

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

Write-up: Acute respiratory failure; atrial fibrillation


VAERS ID: 1414662 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-01
Onset:2021-06-02
   Days after vaccination:93
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Atrioventricular block, Bradycardia, Respiratory failure
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypokalaemia (broad)

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

Write-up: Respiratory failure; bradycardia with heart block


VAERS ID: 1414975 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Diarrhoea, Fatigue, Headache, Pain in extremity
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), 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: none
Current Illness:
Preexisting Conditions: mainly diabetes
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: On the next day, 06/02/2021 and lasting 4 days, I experienced the following: painful left shoulder/arm, headache, extremely tired, uncontrollable diarrhea. Note: Daughter living in another city also had trouble over 4 days with the second shot. My Mother had Guillen-Barre Syndrome over 40 years ago and was incapacitated for a year.


VAERS ID: 1415005 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1415226 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-05-03
Onset:2021-06-02
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8736 / 1 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal pain, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood alkaline phosphatase increased, Blood lactic acid, C-reactive protein, Chest X-ray abnormal, Computerised tomogram abdomen, Drug screen, Electrocardiogram QT prolonged, Electrocardiogram abnormal, Laboratory test, Lung infiltration, Lung opacity, Lymphadenopathy, Motor dysfunction, Muscular weakness, Neutrophil percentage increased, Pneumonia, Procalcitonin, Protein total decreased, Pyrexia, Sepsis, Sinus tachycardia, Supraventricular extrasystoles, Tachycardia, Urine analysis normal, White blood cell count normal
SMQs:, Torsade de pointes/QT prolongation (narrow), Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Torsade de pointes, shock-associated conditions (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Drug abuse and dependence (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Biliary system related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lyrica, Estroven Complete Menopause, Cymbalta, Suboxone, Wellbutrin
Current Illness: Uncertain
Preexisting Conditions: Pt. vague with history when seen in ED, reports having "7 surgeries in 7 months" but not able to recall reason for surgeries.
Allergies: NKA, unaware if allergic to foods or other products
Diagnostic Lab Data: EKG - Sinus Tach, with PAC, borderline prolonged QT interval; CXR - bibasilar pneumonia - a single portable AP semierect view of the chest was obtained showing patchy hazy/ground glass infiltrates in the lung bases representing multifocal pneumonia; CT of ABD and pelvis - infiltrates in the lower lobe, lingula and right middle lobe, significant stool indicating constipation, common bile duct 1.4 cm in diameter may relate to prior cholecystectomy, prominent right external iliac and right inguinal lymph nodes - possibly reactive. WBC - 7.2, Neutrophil % - 85.2%, MDW - 22.5, Lactic acid 1.3, AST 55, ALT 50, Alkaline Phosphate 228, CRP 2.20, Total Protein 5.8, Procalcitonin 8.59. UA was WNL/negative. Rapid drug screen per urine was obtained.
CDC Split Type:

Write-up: Pt. presents to ER on 06/02/2021 stating "has not felt right for a long time". Pt. is not sure how long of time that she has not felt right. Pt. reports this am going to the refrigerator and was not able to grasp a pop. Pt. reports having right hand weakness that started this am. Pt. reports not being able to grasp her phone either due to the right hand weakness. Pt. was found to have an initial temp of 100.4 which spiked to 103.1, HR tachy at 126, BP 108/71, O2 sat on RA 98% and respirations 18. Pt. received and IV lock, fluids, CXR, EKG and CT of ABD and pelvis for c/o abd pain/discomfort and Lab were obtained. Pt. received Rocephin 1 gm IV and Zosyn 3.375 gm IV times 1 dose of each in ED. Pt. was transferred to Hospital in another area for diagnosis of sepsis and fever of unknown origin for higher level of care.


VAERS ID: 1415279 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1415280 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-05-05
Onset:2021-06-02
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

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

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

Write-up: Medication error. 1st dose was Moderna. 2nd dose should have been Moderna, but was given Pfizer.


VAERS ID: 1415340 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-05-21
Onset:2021-06-02
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Bell's palsy, Facial paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AllerClear (Loratadine)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: went to urgent care for diagnosis on June 2nd, date of onset of symptoms
CDC Split Type:

Write-up: Bell''s Palsy - right side facial paralysis, on day 20, still no improvements


VAERS ID: 1415515 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036B21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Pain, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (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:
Other Medications: Not taken at time of vaccine but taken morning and evening on the day of vaccine. One a day vitamin over 50+ age Gabapentin Hydrocodone Mucinix DM Vitamin D3 Vitamin B12 Extra strength Tylenol
Current Illness: None
Preexisting Conditions: Symptoms of Neuropathy but not 100% diagnosed
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain in right foot. Pain between ankle all the way up to knee. Waking up in night with tingling and sharp pain.


VAERS ID: 1416347 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-01
Onset:2021-06-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, blurred vision, fatigue, freezing chills with no fever. Symptoms lasted about 36 hours


VAERS ID: 1416747 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1416828 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-19
Onset:2021-06-02
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Fish Oil, Thera-m (multivitamin-iron-calcium), Psyllium, Rizatriptan 5mg
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE.
Diagnostic Lab Data: Went to follow up with cardiologist on 06/22/2021.
CDC Split Type:

Write-up: Patient has been having chest pain, shortness of breathe after 2 weeks of getting vaccine and was diagnosed with pericarditis on 06/22/2021.


VAERS ID: 1416975 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-05-28
Onset:2021-06-02
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / SYR

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

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: Alligen, Vitamin D, B-12 shots (April).
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin, Antihistamines, epinephrine, novocaine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Rash on arm that went over complete body next day. Extreme itching which could not be calmed. Exhaustion. Swelling in hands and feet. Treatments: 6 day steroid, hydrocortisone cream 2.5%, acetaminophen, Xanax, Benedryl spray,


VAERS ID: 1417276 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Mom lied about the child''s age during a mass vaccination clinic.


VAERS ID: 1417585 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1417748 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1417789 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 AR / 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: Error: Improper Storage (temperature)


VAERS ID: 1417969 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Unknown  
Location: New York  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 2 AR / 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: Error: Improper Storage (temperature)


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