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From the 10/15/2021 release of VAERS data:

Found 800,916 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 258 out of 8,010

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VAERS ID: 1731225 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cetirizine, APAP, Artificial Tears, Vit B Comp W-C/FA
Current Illness: No
Preexisting Conditions: Cirhosis
Allergies: Codiene
Diagnostic Lab Data: N/A
CDC Split Type: MOD21/145959

Write-up: 2nd Dose of Moderna Vaccine administered on 9/6/21 from Lot #011A21A expired 8/16/21. *Site leadership consult and received the below confirmation: * If the dose given in error is the first dose, a second dose should be administered 28 days later. If this dose is the second dose, the series is complete and no additional doses are needed.


VAERS ID: 1731256 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-18
Onset:2021-09-06
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP8730 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Atrial fibrillation, COVID-19, Hypoxia
SMQs:, Asthma/bronchospasm (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalization for COVID19, AFIB, hypoxia. Treated with dexamethasone 6 mg IV daily and Remdesivir.


VAERS ID: 1731281 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Miconazole, Lipitor, carbidopa/levodopa/terazosin, Testosterone oil, artificial tears, Ibuprofen, Prilosec, Tums.
Current Illness: No
Preexisting Conditions: Dyslipidemia, Lipids
Allergies: PCN, Propranolol, Metoprolol.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 2nd Dose of Moderna Vaccine administered on 9/6/21 from Lot #011A21A expired 8/16/21. *Site leadership consulted with the Moderna and received the below confirmation: * If the dose given in error is the first dose, a second dose should be administered 28 days later. If this dose is the second dose, the series is complete and no additional doses are needed.


VAERS ID: 1731294 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Docusate Sodium, Analgesic Balm, Naproxen.
Current Illness: No
Preexisting Conditions: UNSPECIFIED MDD W/PARANOIA; THC USE D/O
Allergies: Pork, Iodine
Diagnostic Lab Data: N/A
CDC Split Type: MOD21/145959

Write-up: 2nd Dose of Moderna Vaccine administered on 9/6/21 from Lot #011A21A expired 8/16/21. *Site leadership consulted with the Moderna and received the below confirmation: * If the dose given in error is the first dose, a second dose should be administered 28 days later. If this dose is the second dose, the series is complete and no additional doses are needed.


VAERS ID: 1731360 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-29
Onset:2021-09-06
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Dysmenorrhoea, Heavy menstrual bleeding, Menstruation irregular, Pain in extremity
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (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: None
Current Illness: NONE
Preexisting Conditions: Migraines
Allergies: None
Diagnostic Lab Data: None yet I have an appoint on 9/27
CDC Split Type:

Write-up: After the shot I had an abnormal period extremely painful, and very heavy. Secondly my knee joints, hands and feet have been hurting, I didn''t have issue like this before.


VAERS ID: 1731419 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-12
Onset:2021-09-06
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen, combivent respimat, alendronate, aspirin, atorvastatin, budesonide inhaler, cholecalciferol, diltiazem, fluticasone nasal spray, breo ellipta inhaler, furosemide, ipratropium-albuterol (neb), melatonin, montelukast, nystatin
Current Illness:
Preexisting Conditions: bronchiectasis, chronic idiopathic thrombocytopenia, chronic rhinitis, CREST syndrome, decubital ulcer, depression, GERD, hyperlipidemia, hypertension, interstitial lung disease, left shoulder pain, asthma, osteoarthrosis, osteoporosis, parotid mass, stroke, vitamin D deficiency.
Allergies: environmental (mold, dust), sertraline, onion.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received both doses of the Pfizer COVID-19 vaccine, on 1/22/2021 and 2/12/2021 respectively. Pt tested positive for COVID on 9/6/2021, presented to ED same day and was admitted for stroke-like symptoms. Over the course of her hospitalization, she developed symptoms of severe COVID, with pneumonia and acute hypoxic respiratory failure. She was discharged back to her ALF on 9/15/2021.


VAERS ID: 1731481 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-01-20
Onset:2021-09-06
   Days after vaccination:229
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multiple medications.
Current Illness: Recovering from sepsis, kidney stone stint placed, hospitalized from mid July until sept 4th
Preexisting Conditions: Body Dementia, Parkinson?s
Allergies: Halidol
Diagnostic Lab Data: Antigen test provided. Positive.
CDC Split Type:

Write-up: Tested positive to COVID 9/6. Cough, congestion, and low grade fever noted few days prior.


VAERS ID: 1731895 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-04
Onset:2021-09-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Night sweats
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: N/a
Current Illness: N/a
Preexisting Conditions: N/a
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sever night sweats for 2 weeks following the shot


VAERS ID: 1731999 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-30
Onset:2021-09-06
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bacterial infection, Eye swelling, Pruritus, Swelling of eyelid
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: I didn''t have a reaction at first until a couple days later, about 5 days. I had my right eye swollen around the top eyelid and it was itchy. It didn''t affect my vision; my primary doctor prescribed some antibiotics and steroid and allergy medication. My doctor said I possibly had a bacterial infection before and the vaccine aggravated it.


VAERS ID: 1732000 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-03-15
Onset:2021-09-06
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802070 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccinated patient hospitalized with COVID-19


VAERS ID: 1732090 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-03-02
Onset:2021-09-06
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, Type II DM
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After being fully vaccinated against COVID-19, patient was hospitalized after contracting the virus.


VAERS ID: 1732182 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-03
Onset:2021-09-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC31E1 / 1 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hashimoto''s thyroiditis
Allergies: Foods: Chicken, Eggs, Wheat/Gluten, Soy Medications; Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Woke up early at around 7am feeling itchy, but there was no visible reaction such as rash or a hives or a rash. About 30 minutes later I was having issues taking deep breaths which led to difficulty breathing entirely. Got dressed in about 5 minutes and alerted my father that I needed to go to the hospital because of the breathing difficulty. We arrived at the hospital close to 8am where I was taken back within 2 minutes. Standard bloodwork was ran and I was given a prescription for diphenhydrAMINE 25mg CAP, FAMOTIDINE 40mg TAB, predniSONE 20mg TAB, and an Epipen; as they thought I was having an allergic reaction. Was discharged the same day at roughly 10:40 am


VAERS ID: 1732198 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-03-22
Onset:2021-09-06
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Headache, Nasal congestion, Pyrexia, SARS-CoV-2 test negative, SARS-CoV-2 test positive, Sneezing
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine; Aspirin; Lisinopril; Hydocothizide;, Vitamin D3; Vitamin C; Fish Oil; Red yeast; Calcium; Probiotic
Current Illness: No
Preexisting Conditions: Mild Hypertension, Thyroid Hypothyroidism, Obese
Allergies: Hydrocodone
Diagnostic Lab Data: PCR test for the second COVID which took 24 hrs.
CDC Split Type: vsafe

Write-up: Started 09/6/2021 PM excessive sneezing, nasal congestion, chills, fever and head ache that progressively worsen 09/08/2021 tela health visit with doctor then had a drive up test for COVID negative, family members and friend was testing positive and spoke with her physician for a re- test recommended, 5 days later 09/15/2021 COVID tested positive.


VAERS ID: 1732418 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: prednisolone, latanoprost, timolol maleate ophthalmic solution, prednisolone acet, brimonidine, dorzolamide, cetirizine, famotidine, ibuprofen.
Current Illness: No
Preexisting Conditions: Glaucoma, Asthma
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type: MOD21/145959

Write-up: 2nd Dose of Moderna Vaccine administered on 9/6/21 from Lot #011A21A expired 8/16/21. *Site leadership consulted with the Moderna Medical Safety Department and received the below confirmation: * If the dose given in error is the first dose, a second dose should be administered 28 days later. If this dose is the second dose, the series is complete and no additional doses are needed.


VAERS ID: 1732426 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Buspar, Prozac, Zyprexa, Dicyclomine, APAP, Excedrin, Famotidine, Meloxicam, Pantoprazole
Current Illness: No
Preexisting Conditions: MH3;BAD MANIC-MILD;GAD;PTSD
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type: MOD21/145959

Write-up: 2nd Dose of Moderna Vaccine administered on 9/6/21 from Lot #011A21A expired 8/16/21. *Site leadership consulted with the Moderna Medical Safety Department and received the below confirmation: * If the dose given in error is the first dose, a second dose should be administered 28 days later. If this dose is the second dose, the series is complete and no additional doses are needed.


VAERS ID: 1732432 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Excedrin, Oxcarbazepine, Tums, Cetirizine, Ibuprofen, Pantoprazole.
Current Illness: No
Preexisting Conditions: Seizure
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type: MOD21/145959

Write-up: 2nd Dose of Moderna Vaccine administered on 9/6/21 from Lot #011A21A expired 8/16/21. *Site leadership consulted with the Moderna Medical Safety Department and received the below confirmation: * If the dose given in error is the first dose, a second dose should be administered 28 days later. If this dose is the second dose, the series is complete and no additional doses are needed.


VAERS ID: 1732560 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: No
Preexisting Conditions: N/A
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type: MOD21/145959

Write-up: 2nd Dose of Moderna Vaccine administered on 9/6/21 from Lot #011A21A expired 8/16/21. *Site leadership consulted with the Moderna Medical Safety Department and received the below confirmation: * If the dose given in error is the first dose, a second dose should be administered 28 days later. If this dose is the second dose, the series is complete and no additional doses are needed.


VAERS ID: 1732565 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Calcium Polycarbophil
Current Illness: No
Preexisting Conditions: Hepatitis C
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type: MOD21/145959

Write-up: 2nd Dose of Moderna Vaccine administered on 9/6/21 from Lot #011A21A expired 8/16/21. *Site leadership consulted with the Moderna Medical Safety Department and received the below confirmation: * If the dose given in error is the first dose, a second dose should be administered 28 days later. If this dose is the second dose, the series is complete and no additional doses are needed.


VAERS ID: 1732592 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: APAP
Current Illness: No
Preexisting Conditions: Hepatitis C, Colostomy
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type: MOD21/145959

Write-up: 2nd Dose of Moderna Vaccine administered on 9/6/21 from Lot #011A21A expired 8/16/21. *Site leadership consulted with the Moderna Medical Safety Department and received the below confirmation: * If the dose given in error is the first dose, a second dose should be administered 28 days later. If this dose is the second dose, the series is complete and no additional doses are needed.


VAERS ID: 1732602 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 RA / IM

Administered by: Other       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: No
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type: MOD21/145959

Write-up: 2nd Dose of Moderna Vaccine administered on 9/6/21 from Lot #011A21A expired 8/16/21. *Site leadership consulted with the Moderna Medical Safety Department and received the below confirmation: * If the dose given in error is the first dose, a second dose should be administered 28 days later. If this dose is the second dose, the series is complete and no additional doses are needed.


VAERS ID: 1732611 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: APAP, Analgesic Balm
Current Illness: No
Preexisting Conditions: N/A
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type: MOD21/145959

Write-up: 2nd Dose of Moderna Vaccine administered on 9/6/21 from Lot #011A21A expired 8/16/21. *Site leadership consulted with the Moderna Medical Safety Department and received the below confirmation: * If the dose given in error is the first dose, a second dose should be administered 28 days later. If this dose is the second dose, the series is complete and no additional doses are needed.


VAERS ID: 1734208 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-08-26
Onset:2021-09-06
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Illness, Pain in extremity, SARS-CoV-2 test
SMQs:, 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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OZEMPIC
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: none
Allergies:
Diagnostic Lab Data: Test Date: 20210826; Test Name: Covid 19 test; Test Result: Negative ; Test Date: 20210909; Test Name: Covid 19 test; Test Result: Positive ; Test Date: 20210917; Test Name: Covid 19 test (Nasal Swab); Test Result: Negative
CDC Split Type: USPFIZER INC202101233837

Write-up: made her arm sore; symptoms of covid -19/tested positive for covid-19; I believe the Pfizer vaccine got me and my 12 year old daughter sick.; This is a spontaneous report from a contactable consumer reported for herself and her daughter, this case is for herself. A 41-year-old non-pregnant female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 1 via an unspecified route of administration on 26Aug2021 14:30 (Batch/Lot number was not reported) as DOSE 1, SINGLE for covid-19 immunisation at age of 41 years old. Medical history was none. Concomitant medication included semaglutide (OZEMPIC) taken for an unspecified indication, start and stop date were not reported. The patient reported that that prior to her first covid Pfizer shot on 26Aug2021, she had a negative covid test. Prior to vaccination, the patient was not diagnosed with COVID-19. The shot made her arm sore on 06Sep2021 at 12: 00, and on 06Sep2021 she started to get symptoms of covid -19. She tested positive for covid-19 on 09Sep2021. She believed the Pfizer vaccine got her and her 12 years old daughter sick. The events were serious per life threatening and required physician office visit. No treatment received for the events. The patient underwent lab tests and procedures which included Covid 19 test (Nasal Swab): negative on 17Sep2021. The outcome of the events was resolving. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.


VAERS ID: 1734643 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-05
Onset:2021-09-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arrhythmia, Chest pain, Electrocardiogram abnormal
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (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: Vitamin D 1000IU daily
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EKG 9/Sept/2021 Cardiologist appointment pending but has been referred by paediatrician
CDC Split Type:

Write-up: Sudden onset sharp Pressure chest pain for 3 hours starting at 21:00 lasting until midnight on 6/Sept/2021. She fell asleep at midnight after a regular dose of Advil and Tylenol given at 21:15. Her paediatrician was notified and EKG performed same week on 9/Sept/2021 which confirmed arrhythmia. Paediatrician has sent out referral to cardiologist. Cardiologist appointment still pending at this time. Chest pain has subsided but arrhythmia still present.


VAERS ID: 1735143 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-05
Onset:2021-09-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 2 LA / IM

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

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

Write-up: Pt reported arm pain that comes and goes 5/10 , twenty days post injection


VAERS ID: 1735707 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-05
Onset:2021-09-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC2184 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Influenza like illness
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient feels extremely tired, with a lot fatigue and overall just feels flu like even 21 days after first dose


VAERS ID: 1735885 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-02
Onset:2021-09-06
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Work       Purchased by: ?
Symptoms: Abdominal discomfort, Chest pain, Dizziness, Fatigue, Headache, Hyperhidrosis, Hypersensitivity, Memory impairment, Nausea, Palpitations
SMQs:, Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Chest pain Heat racing Headache Nausea Dizziness Abdominal discomfort Allergies Sweating Tired Forgetful


VAERS ID: 1735946 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-04
Onset:2021-09-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Menstruation irregular
SMQs:, Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aldactone, Norgest/E Triphasic - Ortho Tri Cyclen Tab Pak
Current Illness: none
Preexisting Conditions: none
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Bleeding in between periods since the first injection


VAERS ID: 1735964 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-04-02
Onset:2021-09-06
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / SYR

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

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

Write-up: Shingles, neck being left ear and left shoulder, 2+ weeks


VAERS ID: 1736474 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-05
Onset:2021-09-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Chest Tightness / Heaviness / Pain-Mild, Additional Details: Patient had some chest pain & dyspnea the day after the shot. It was sporadic throughout the whole day & came in waves. She had COVID a year ago & experienced moderate chest pain & dyspnea back then. Recent chest pain wasn''t as bad as the COVID pain. All symptoms resolved the following day. Chest pain lasted 1 day.


VAERS ID: 1736752 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: California  
Vaccinated:2021-06-01
Onset:2021-09-06
   Days after vaccination:97
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Computerised tomogram abdomen, Computerised tomogram head, Computerised tomogram spine, Condition aggravated, Dyspnoea, Dysuria, Fall, Laboratory test, Magnetic resonance imaging head, Magnetic resonance imaging neck, Magnetic resonance imaging spinal, Muscular weakness, Nausea, Urinary tract infection
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: DM, obesity, osteoarthritis, intermittent asthma, GERD
Allergies: depakote, codeine, erythromycin base, lamotrigine, pcn
Diagnostic Lab Data: MRI lumbar spine, MRI Cervical Spin, MRI brain, Chest frontal, CT abd/pelvis, labs, CT cervical Spine, CT Head.
CDC Split Type:

Write-up: Patient reports normal state of health yesterday however this morning when she woke up noted bilateral leg weakness leading to multiple fall at home. Reports chronic back pain but appears to have worsened today in the lumbar region. Reports some shortness of breath and nausea today. Also endorses dysuria, patient recently started on Bactrim for UTI currently on day 8 of 14 antibiotic.


VAERS ID: 1736817 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-15
Onset:2021-09-06
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin (LIPITOR) tablet 20 mg 20 mg Oral Q HS ? cefTRIAXone (ROCEPHIN) 1 g in sodium chloride 0.9 % 100 mL IVPB 1 g Intravenous Q 24 H ? dexamethasone (DECADRON) injection 10 mg 10 mg Intravenous DAILY ? heparin injection 5,000 Un
Current Illness: Arthropathy, unspecified, site unspecified ? Bleeding tendency ? DVT (deep venous thrombosis) ? Esophageal reflux ? Transfusion history ? Unspecified deficiency anemia ? Unspecified essential hypertension
Preexisting Conditions: Arthropathy, unspecified, site unspecified ? Bleeding tendency ? DVT (deep venous thrombosis) ? Esophageal reflux ? Transfusion history ? Unspecified deficiency anemia ? Unspecified essential hypertension
Allergies: Cortisone Rash/Itching flu like symptom ? Corn Oil Nausea and/or vomiting ? Demerol Unable to specify
Diagnostic Lab Data: SARS-CoV-2 (COVID-19) by NAA, Micro Not Detected Detected Abnormal Narrative The SARS-CoV-2 (COVID-19) by NAA test is for in vitro diagnostic use under the FDA Emergency Use Authorization (EUA) for laboratories certified to perform high complexity testing. This test has not been FDA cleared or approved. Methodology: Nucleic Acid Amplification (NAA)/Polymerase Chain Reaction (PCR). Specimen Collected: 09/07/21 4:49 PM Last Resulted: 09/07/21 5:38 PM
CDC Split Type:

Write-up: Patient is a79y.o. year old female who presented to the ED 9/7 with 5d hx sore throat and hypoxia. Diagnosed with COVID and was to receive monoclonal Ab, but was hypoxic and came to ED. S/p Pfizer vaccine 1/25, 2/15 O2 sat 95% 3L NC No n/v/d


VAERS ID: 1737006 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-27
Onset:2021-09-06
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 AND ER87 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Malaise
SMQs:

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

Write-up: onset symptoms 9/6/21. Several Emergency dept visits on 9/6, 9/8, 9/15, 9/22 and admitted 9/25 Hospitalized


VAERS ID: 1737124 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-22
Onset:2021-09-06
   Days after vaccination:137
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Diarrhoea, Oropharyngeal pain, Polymerase chain reaction positive, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: PCR collected 9-9-2021, resulted on 9-10-2021 as positive
CDC Split Type:

Write-up: Sore throat, cough, diarrhea, congestion


VAERS ID: 1737360 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-01-25
Onset:2021-09-06
   Days after vaccination:224
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Colitis ulcerative, Colonoscopy abnormal, Condition aggravated, Diarrhoea, Extra dose administered, Gastroenteritis viral, Gastrointestinal disorder, SARS-CoV-2 test positive
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal ulceration (narrow), Gastrointestinal nonspecific inflammation (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow), Medication errors (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), 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: Entyvio 300mg injection Q4 wk Apriso 0.375g 4 caps daily Prilosec 40 mg cap daily Prednisone 40 mg/day
Current Illness: Ulcerative colitis
Preexisting Conditions: Ulcerative colitis
Allergies: None
Diagnostic Lab Data: 9/6 Covid + PCR
CDC Split Type:

Write-up: Patient admitted with abdominal pain and increase in diarrhea. Pt with hx of ulcerative colitis previously on Entyvio and most recently on Humira. Pt s/p booster dosing of Covid vaccine on 8/15 - found to be COVID+ during routine admission testing. Pt did have GI symptoms c/w COVID gastroenteritis as well as a UC flare found on colonoscopy. Pt without respiratory symptoms during admission. Unknown if pt would have sought care or recognized infection given ongoing UC flare


VAERS ID: 1737634 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-03-22
Onset:2021-09-06
   Days after vaccination:168
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 RA / SYR

Administered by: School       Purchased by: ?
Symptoms: COVID-19, Cough, Ear discomfort, Fatigue, Headache, Pain, Pyrexia, SARS-CoV-2 test positive, Sinusitis, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Phentermine
Current Illness: None
Preexisting Conditions: Overweight Pre-diabetic Asthma Sleep Apnea
Allergies: None
Diagnostic Lab Data: I tested positive for Covid-19 on September 12, 2021.
CDC Split Type: vsafe

Write-up: Breakthrough case: I developed symptoms on 09/06/2021. The symptoms went away on 09/08/2021. Then the symptoms came back on 09/11/2021. My symptoms included: Fever Sinus infection Echo sensation in ear Cough Headache Fatigue Body soreness I was prescribed Prednisone. The majority of my symptoms have went away, but I am still dealing with the cough.


VAERS ID: 1738048 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-30
Onset:2021-09-06
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Pain, Rash, Rash papular, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient developed raised, circles on hands, elbows, knees and feet that resembled bug bites; 7 days after vaccination. They throbbed, burned and itched profusely. She tried OTC hydrocortisone and Benadryl creams with no relief. Visited urgent care and given a steroid injection. Resolved within one week.


VAERS ID: 1740910 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-03
Onset:2021-09-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Computerised tomogram, Dyspnoea, Echocardiogram
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins C and D
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data: Blood test and Chest X-ray performed on 09/11/2021. urgent care facility. Echocardiogram performed on 09/17/2021. Heart CT scan performed on 09/21/2021
CDC Split Type:

Write-up: Shortness of breath . Saw Dr. facility.


VAERS ID: 1741540 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-28
Onset:2021-09-06
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Loss of consciousness, dizzy spells, nausea, brain fog


VAERS ID: 1744354 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-13
Onset:2021-09-06
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Headache, Myalgia, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Rapid test resulted positive on 9-8-2021
CDC Split Type:

Write-up: Fever, muscle aches, cough, headache, fatigue, congestion


VAERS ID: 1744362 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-30
Onset:2021-09-06
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Rapid test positive on 9-9-2021
CDC Split Type:

Write-up: cough and congestion


VAERS ID: 1745040 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-09-04
Onset:2021-09-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

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

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

Write-up: Pain in back of head at base of skull for 10 days. Had to take motrin and tylenol to relieve the pain. Ended after 10 days.


VAERS ID: 1745423 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-05
Onset:2021-09-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Blood test, Mobility decreased, Muscle tightness, Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Angioedema (broad), Dystonia (broad), Parkinson-like events (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan 100mg and Hydrochlorothiazide 25mg (combined together for dosage of once daily)
Current Illness: None
Preexisting Conditions: None
Allergies: Aspirin
Diagnostic Lab Data: Various Test Ran
CDC Split Type:

Write-up: Achy pain in arm, tightness in bicep, pain underneath arm, under arm swollen with a knot, unable to stretch arm


VAERS ID: 1745442 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-03
Onset:2021-09-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Back pain, Breast pain, Breast swelling, Discomfort, Headache, Immunisation, Injection site pain, Lymphadenopathy, Oedema peripheral, Peripheral swelling, Product administered at inappropriate site, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Drug abuse and dependence (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Lipodystrophy (broad), Arthritis (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Headache, fever, discomfort and pain under armpit, swelling in arm, armpit , breast , and back (left side), pain w/ swelling areas, pain at injection site, swollen lymph nodes, pain in shoulder. Injection site seemed higher than "normal."


VAERS ID: 1745518 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-15
Onset:2021-09-06
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Pneumonia, SARS-CoV-2 test positive
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID test 9/6/21
CDC Split Type:

Write-up: Patient hospitalized 9/6/21 for pneumonia and tested positive for COVID same day.


VAERS ID: 1745705 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-01
Onset:2021-09-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Haemoglobin decreased, Haemorrhage, Oesophagogastroduodenoscopy normal, Thrombocytopenia, Transfusion
SMQs:, Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Hypertension (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Abacavir, Tivicay, Lamivudine-iron
Current Illness: Kidney Failure (dialysis ) HIV
Preexisting Conditions: Kidney disease ,HIV
Allergies: Shellfish ,tylenol
Diagnostic Lab Data: More blood transfusions performed in the next week with more blood loss
CDC Split Type:

Write-up: Thrombocytopenia, was the result of getting this vaccine. Symptoms began during routine dialysis treatment with spikes in blood pressure and steady drop in hemoglobin values over a two week period. I was notified by my dialysis clinic that I was loosing blood some where. I went to the emergency room at Hospital on 9-16-2021 and was given three blood transfusions. An esophagogastroduodenoscopy was performed with no significant signs of bleeding and was told by Dr. at Hospital (Dignity )to schedule a colonoscopy as an outpatient


VAERS ID: 1745773 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-09-01
Onset:2021-09-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 04ZA21A / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Burning sensation, Electric shock sensation, Pain
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (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: Alprazolam
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: My first vaccine was no problem. I barley felt anything. When I got my 2nd injection, I immediately felt a burning sensation in my left shoulder. It felt like fire! My shoulder was very sore for a few days and I wasn?t surprised because that?s normal after a shot or vaccine. I took it easy for about a week but there was still pain but not a soar feeling anymore. There is a sharp electric pain that I feel when doing certain movements with my shoulder. Turning the steering wheel driving causes pain. It has been almost a month since I?ve gotten the injection. I am getting very concerned about this. I plan on seeing a doctor as soon as my insurance kicks in for my new job.


VAERS ID: 1747537 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-09-02
Onset:2021-09-06
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Hypoacusis, Tinnitus
SMQs:, Hearing impairment (narrow)

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

Write-up: Ringing in left ear with decreased hearing. Feels like pulsating in ear intermittently. Other times it?s just ringing or whirling sensation. Have not seen provider yet for symptoms/adverse reaction.


VAERS ID: 1747886 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Missouri  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 - / OT

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

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

Write-up: Expired vaccine used; This spontaneous case was reported by an other health care professional and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired vaccine used) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 011A21A) for COVID-19 vaccination. No Medical History information was reported. On 06-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 06-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired vaccine used). At the time of the report, EXPIRED PRODUCT ADMINISTERED (Expired vaccine used) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medication information was not provided by the reporter. Treatment information was not provided by the reporter.


VAERS ID: 1749349 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-02
Onset:2021-09-06
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Alopecia, Dry skin, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dry, itchy scalp and large amounts of hair loss beginning 4 days after 1st dose of Moderna COVID vaccine.


VAERS ID: 1749619 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-27
Onset:2021-09-06
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Blood test, Bronchitis, Chest X-ray abnormal, Chest discomfort, Chills, Diarrhoea, Discomfort, Electrocardiogram, Exposure to SARS-CoV-2, Headache, Oropharyngeal pain, Patient isolation, Pneumonia, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test, Sinus disorder
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: pfizer2nd dose, swollen lymph node, flu like symptoms
Other Medications: Pro air inhaler; Symbicort; hydrochlorizide; gabapentin; tizanidine; generic Celebrex; fortify pro and prebiotic; vitamin D3; one a day multivitamin; omega 367 gummy; vitamin C; hair and skin gummy with biotin; magnesium plus calcium and tu
Current Illness:
Preexisting Conditions: Asthma; high blood pressure
Allergies: Erythromycin; amoxicillin; penicillin; cats; dogs; trees
Diagnostic Lab Data: Chest X-rays, EKG, blood work
CDC Split Type: vsafe

Write-up: I was exposed by two unvaccinated adults who live in my house. I woke up felt like I had a sinus infection, massive headache pressure and congested. It was ragweed season so just thinking Sinus infection. I started feeling worse took a rapid test and went to ER got a PCR test. I started having fever and chills. I had rattily feeling in my chest. I stomachache and diarrhea and sore throat at times. I was supposed to be out of isolation but the health department recommended I stay home until I feel better. I have been to Urgent care twice, I have been taking Mucinex DM, Tessalon pearls cough suppressant pill. My lungs showed I had pneumonia in my left lung and bronchitis, The first chest x-ray showed I had ground glass opacity in my lungs. The Dr. prescribed antibiotics and prednisone. My oxygen dipped into 80s so I went to ER they checked for blood clot, EKG, XRAYS. and other test sent me home my oxygen went up to 93. I''m still sick with fevers and in isolation.


VAERS ID: 1749694 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-03
Onset:2021-09-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test abnormal, Blood test normal, Dehydration, Diarrhoea, Dizziness, Headache, Herpes zoster, Laboratory test, Pain in extremity
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Dehydration (narrow), 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: metroplol 100mg Metformin 500mg levothroxin 75mcg lisinopril 10mg
Current Illness: none
Preexisting Conditions: high bp pcos thyroid issues
Allergies: bactrim
Diagnostic Lab Data: labs 9/6 and 9/16
CDC Split Type:

Write-up: Diarrhea, headache and arm pain started the day after and lasted for 3 days. Became dehydrated and almost passed out multiple times, Went to Medical Center ER and was seen on 9/6/21. Bloodwork was crazy. Followed up with my PCP on 9/16 and bloodwork was back to normal. Now I have shingles on my forehead. Symptoms for shingles started approx 9/19.


VAERS ID: 1749773 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-02
Onset:2021-09-06
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Dysgeusia, Laboratory test, Oropharyngeal pain, Sensation of foreign body
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Arthritis (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: No
Current Illness: No
Preexisting Conditions: Covid long hauler
Allergies: Amoxicillin, Azithromycin, Levaquin, Albuterol
Diagnostic Lab Data: Labwork
CDC Split Type: vsafe

Write-up: Within minutes of getting the vaccine I exp a metallic taste in my mouth which lasted about a week. It seems like it was reactivated when I drink something. I noticed lump in my throat on 09/06/2021 thought I had a sore throat at first, had a lot of joint pain. I went to see the doctor on 9/10/2021 thyroid levels was checked and labs that looks at my inflammatory markers. Since then over time the lump has slowly resolved.


VAERS ID: 1751877 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / UNK LA / OT

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

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

Write-up: Dose given past the 12 hour post puncture time; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 22-Sep-2021 and was forwarded to Moderna on 22-Sep-2021. This spontaneous case was reported by a nurse and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Dose given past the 12 hour post puncture time) in a 22-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 008C21A) for COVID-19 vaccination. No Medical History information was reported. On 06-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 06-Sep-2021, the patient experienced EXPIRED PRODUCT ADMINISTERED (Dose given past the 12 hour post puncture time). On 06-Sep-2021, EXPIRED PRODUCT ADMINISTERED (Dose given past the 12 hour post puncture time) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. The reporter stated that dose was given past the 12hour post puncture time. No concomitant medications were reported. No treatment information was reported. This case was linked to MOD-2021-327879 (Patient Link).


VAERS ID: 1751948 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-08
Onset:2021-09-06
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 - / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Crying, Dysarthria, Headache, Influenza like illness, Lacrimation increased, Loss of consciousness, Nausea, Pain
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad), Lacrimal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: could barely talk to the point of people understanding; to the point she was crying; she could not function. When she tried to walk, she almost passed out/someone had to grab her; Had flu like symptoms the day after receiving the second dose of the vaccine; running eyes/tears were really warm; body aches; to a point where It is nausea with the headaches; suffering from extremely bad headache/headaches; chills; This spontaneous case was reported by a consumer and describes the occurrence of LOSS OF CONSCIOUSNESS (she could not function. When she tried to walk, she almost passed out/someone had to grab her) in a 56-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 037F21A. and 052E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Blood pressure. Concomitant products included AMLODIPINE from 22-Sep-2021 to an unknown date for Blood pressure abnormal. On 08-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 05-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 06-Sep-2021, the patient experienced INFLUENZA LIKE ILLNESS (Had flu like symptoms the day after receiving the second dose of the vaccine), LACRIMATION INCREASED (running eyes/tears were really warm), PAIN (body aches), NAUSEA (to a point where It is nausea with the headaches), HEADACHE (suffering from extremely bad headache/headaches) and CHILLS (chills). On an unknown date, the patient experienced LOSS OF CONSCIOUSNESS (she could not function. When she tried to walk, she almost passed out/someone had to grab her) (seriousness criterion medically significant), DYSARTHRIA (could barely talk to the point of people understanding) and CRYING (to the point she was crying). The patient was treated with IBUPROFEN (ADVIL [IBUPROFEN]) for Headache, at an unspecified dose and frequency. At the time of the report, LOSS OF CONSCIOUSNESS (she could not function. When she tried to walk, she almost passed out/someone had to grab her), INFLUENZA LIKE ILLNESS (Had flu like symptoms the day after receiving the second dose of the vaccine), LACRIMATION INCREASED (running eyes/tears were really warm), DYSARTHRIA (could barely talk to the point of people understanding), CRYING (to the point she was crying), PAIN (body aches), NAUSEA (to a point where It is nausea with the headaches), HEADACHE (suffering from extremely bad headache/headaches) and CHILLS (chills) outcome was unknown. The patient did not experience any side effects after receiving first dose.; Sender''s Comments: This case concerns a 56-year-old, female patient with previous relevant medical history of hypertension and use of concomitant medication, who experienced the unexpected event of loss of consciousness. The events occurred on an unknown number of days after the second dose of mRNA-1273. The rechallenge was not applicable since the events happened after the second dose. The medical history of hypertension and use of concomitant medication remains a confounder. The benefit-risk relationship of mRNA-1273 is not affected by this report. The event was downgrade to non-serious due there was no information in the source document supporting that the event resulted in a persistent or permanent incapacity or meet the criteria to be medically significant. The patient refers she almost passed out.


VAERS ID: 1753005 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-05
Onset:2021-09-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood disorder
SMQs:, Haematopoietic cytopenias affecting more than one type of blood cell (broad)

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

Write-up: Systemic: Blood Disorder (diagnosed by MD)-Medium


VAERS ID: 1753952 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-05
Onset:2021-09-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dizziness, Heart rate increased, Hyperthyroidism, Laboratory test, Pain, Thyroxine
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hyperthyroidism (narrow), Vestibular disorders (broad), Dehydration (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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Penicillin
Diagnostic Lab Data: At the Emergency Department, they ran thyroid tests and said her thyroid was "over reacting". Her T4 was at a 5. They believe that it may be an immune response to the vaccine. The doctor is sending her to another facility for another scan. The doctor at the ED thinks that it is possible that she has Pericarditis.
CDC Split Type:

Write-up: Patient''s heart rate increased into the 110 to 120 range for weeks. She experienced a shooting pain across her chest and became dizzy. Patient went to the Emergency Department.


VAERS ID: 1754541 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-09-04
Onset:2021-09-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pain in extremity, Peripheral swelling, Swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NO
Current Illness: no
Preexisting Conditions: I HAVE Sarcoidosis., Asthma and Diabetes
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: My (lt) arm is in pain with a knot in the upper arm. The whole arm , all the way to the neck has been aggravating me every since I received the vaccine I was skeptical about getting it and now I''m in pain every day I haven''t been to the Doctor . I have been suffering in silence, literally. Each day say it will get better and it hasn''t. I will not be getting #2 vaccine. My job has threaten all employees to get the vaccine or no job, I receive the vaccine and now my arm is in sad repair." What''s up with this".


VAERS ID: 1755592 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-02
Onset:2021-09-06
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dizziness, Heart rate increased, Impaired work ability
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: Several days after first dose I experienced chest pain that I never had before, fast heart rate , dizziness. I work as a dentist and had to cancel patients due to severe dizziness when I was putting my head down. If my heart rate continues to be greater than usually I will see my PCP.


VAERS ID: 1756676 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-04
Onset:2021-09-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site rash, 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: aspirin 81mg
Current Illness: none
Preexisting Conditions: none
Allergies: no known allergies
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Rash at site which proceeded to spread down the right arm down to middle finger and across the trunk. Slight Rash on neck, left arm, inner thigh and lower limbs


VAERS ID: 1757470 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-19
Onset:2021-09-06
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dry eye, Eye disorder, Fatigue, Headache, Impaired work ability, Photophobia, Serum ferritin decreased, Vitreous floaters
SMQs:, Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (narrow), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Dehydration (broad)

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: sensitivity to chemicals/fatigue, severe illness
Other Medications: Armour Thyroid, Adderall XR
Current Illness: none
Preexisting Conditions: hashimoto''s disease
Allergies: Predisone, Gluten/Wheat, Lentils, Garlic, Broccoli, most chemicals
Diagnostic Lab Data: Retinal eye exam- normal ferritin blood test- low "dangerously low" at 9 acupuncturist muscle testing that showed low immune function and low blood function
CDC Split Type:

Write-up: 18 days after the first dose, I had a flurry of eye floaters, light sensitivity, headache and dry eye that made it difficult to work. My eye doctor said my eyes and retinas were normal and had no explanation for my symptoms. These symptoms continued until a few days ago, when I had acupuncture, which remedied most of the issues. The acupuncturists said the vaccine destroyed my immune and blood system, which was confirmed with a blood test which showed my ferritin levels at 9, which are considered "dangerously low". I''ve never had any issues with my eyes or iron levels prior to the vaccine, and now I have to live with some remaining eye floaters. After the second dose, I had immense fatigue that made me miss work for almost 4 weeks, along with continued eye floaters and eye problems.


VAERS ID: 1757478 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-08-06
Onset:2021-09-06
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Face oedema, Lip swelling, Pharyngeal swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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:
Preexisting Conditions: Psoriasis
Allergies: Shellfish Lidocaine Pfizer Covid-19 Vaccine
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2nd episode of extreme facial adema. Swelling of lips, cheeks, the exterior of throat to up to 10X normal size. Feeling of tightness in the middle of lungs. Persisted for over 24 hours, with minor swelling up to a week later.


VAERS ID: 1757557 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-28
Onset:2021-09-06
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (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: No
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shingles


VAERS ID: 1758602 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-20
Onset:2021-09-06
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Eye discharge, Fatigue, Malaise, Ocular hyperaemia, Odynophagia, Oropharyngeal pain, SARS-CoV-2 test negative, Sinus pain, Streptococcus test, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Glaucoma (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: Kirkland brand Aller-Flex 180mg allergy medicine - taking prophylactically (no allergies-helps to clear nasal passages) Signature Care One Daily Men''s formula Multivitamin Finest Nutrition Vitamin E 1,000 IU d-Alpha Tocopheryl Acetate and
Current Illness: none
Preexisting Conditions: Non-Hodgkin''s Lymphoma diagnosed 1994
Allergies: none
Diagnostic Lab Data: 9-13-21 Immediate Care : SARS CoV-2 PCR- Negative; POCT COV-2, NAT-Negative; POCT Rapid Strep Antigen Group A: Negative
CDC Split Type:

Write-up: Weekend of 9-3-21 felt overly tired. Eye''s started to become red and bloodshot. Throat starting to become sore and hurt slightly to swallow. 9-8-21: Feeling exhausted and sinus''s starting to hurt. Overall not feeling well. Throat continuing to hurt and feel''s like burning -sensation at times. Start to have dry/non-productive cough during the night and occasionally during the day. Begin taking 60mg -Pseudoephedrine HCL 4x''s / day along with 400mg Guaifenesin 4x''s /day. Gargle with warm salt water 2-3x''s per day. 9-13-21: Wake up to discharge in left eye that progressively becomes worse throughout the day. Still feeling tired and throat sore and dry cough. Schedule visit to Immediate care. 9-30-21 Visit to Primary Care: Prescribed Predisone 40mg for 5 days and Albuteral Sulfate inhalate


VAERS ID: 1758783 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-25
Onset:2021-09-06
   Days after vaccination:134
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Computerised tomogram thorax abnormal, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow), Cardiomyopathy (broad)

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: ct chest PE protocol
CDC Split Type:

Write-up: pulmonary embolism


VAERS ID: 1758899 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-27
Onset:2021-09-06
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8734 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adenovirus test, Anticoagulant therapy, Bordetella test negative, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chest pain, Chlamydia test negative, Computerised tomogram thorax, Computerised tomogram thorax abnormal, Coronavirus test negative, Cough, Deep vein thrombosis, Dyspnoea, Enterovirus test negative, Human metapneumovirus test, Human rhinovirus test, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Lung infiltration, Musculoskeletal chest pain, Mycoplasma test negative, Painful respiration, Pulmonary embolism, Respiratory syncytial virus test negative, SARS-CoV-2 test positive, Scan with contrast abnormal, Ultrasound Doppler abnormal
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol HFA (PROAIR HFA) 90 mcg/actuation inhaler amLODIPine (NORVASC) 5 mg tablet amoxicillin 500 mg oral tablet apixaban (ELIQUIS) 5 mg tablet atorvastatin (LIPITOR) 10 mg tablet calcitrioL (ROCALTROL) 0.25 mcg capsule lansoprazol
Current Illness:
Preexisting Conditions: Nervous Effort syncope Respiratory Asthma Pneumonia due to COVID-19 virus Circulatory High blood pressure Acute pulmonary embolism without acute cor pulmonale (CMS/HCC) Digestive GERD (gastroesophageal reflux disease) Genitourinary Renal calculus, left Urinary tract infection with hematuria Kidney cysts Endocrine/Metabolic High blood cholesterol
Allergies: Cefuroxime AxetilNausea Only MorphineOther (document details in comments), Nausea and Vomiting
Diagnostic Lab Data: 09/21/21 1727 Respiratory virus detection panel Collected: 09/21/21 1621 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result Detected Critical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected 09/13/21 2004 POCT COVID-19 PCR Collected: 09/13/21 2004 | Final result | Specimen: Swab from Nares POC COVID-19 PCR Detected Abnormal Lot # 1000285225 Point of Care COVID-19 PCR Testing Method Cepheid Lot Expiration Date 8/21/22 Procedure Component Value Ref Range Date/Time Ultrasound lower extremity venous bilateral [3304394900] Resulted: 09/22/21 0721 Order Status: Completed Updated: 09/22/21 0721 Narrative: US LOWER EXTREMITY VENOUS BILATERAL IMPRESSION: Bilateral lower extremity venous Doppler ultrasound is positive for deep venous thrombosis in the left posterior tibial vein. The remaining deep veins of the left leg and the deep veins of the right leg are patent. END OF IMPRESSION: INDICATION: Deep venous thrombosis. Shortness of breath. TECHNIQUE: Multiple longitudinal and transverse 2D real-time ultrasound images were performed from groin to knee, and at the calf and ankle. Color and grayscale and duplex Doppler imaging was also performed. Permanently recorded images were obtained and stored. COMPARISON: January 18, 2017. FINDINGS: Right leg: No evidence of deep venous thrombosis. There is normal flow, compressibility and augmentation in the common femoral, greater saphenous, superficial and deep femoral veins and popliteal veins. There is also normal flow, compressibility and augmentation in the posterior tibial veins, peroneal veins and small saphenous veins in the calves. Left leg: The patient has deep venous thrombosis in the left posterior tibial vein. There is normal flow, compressibility and augmentation in the common femoral vein, profunda, femoral vein, popliteal vein and peroneal vein. The superficial veins are patent bilaterally. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. CT angiogram chest pulmonary embolism with and without contrast [3304358600] Resulted: 09/21/21 2039 Order Status: Completed Updated: 09/21/21 2039 Narrative: CTA CHEST PULMONARY EMBOLISM W WO CONTRAST IMPRESSION: Small peripheral left lower lobe pulmonary artery embolus. END OF IMPRESSION: INDICATION: COVID-19. Evaluate for PE. Assess for pulmonary artery embolism. TECHNIQUE: Enhanced helical CT scan of the chest was performed from the lung apices to below the diaphragm. 2 mm axial reconstructions with MPR coronal, oblique and sagittal images were created. 3D shaded surface images also created on a separate workstation and permanently stored. CONTRAST: 80 mL of IOHEXOL 350 MG IODINE/ML INTRAVENOUS SOLUTION administered INTRAVENOUS. COMPARISON: None available. FINDINGS: There is air-space disease in both lungs, compatible with COVID pneumonia. There is a small embolus to a left lower lobe pulmonary artery branch. There is no pleural fluid. There are no enlarged hilar or mediastinal lymph nodes. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray ribs right with PA chest [3302815767] Resulted: 09/21/21 1205 Order Status: Completed Updated: 09/21/21 1205 Narrative: XR RIBS RIGHT W PA CHEST IMPRESSION: Extensive bilateral infiltrates, consistent with COVID-19 pneumonia. Focal dense consolidation in the right upper lobe. END OF IMPRESSION: INDICATION: Right ribs pain. COVID-19. Cough TECHNIQUE: PA view of the chest, PA view of the right ribs, cone down view of the lower ribs, and oblique view of the ribs were obtained. COMPARISON: 3/26/2018 FINDINGS: Bilateral infiltrates are noted, consistent with COVID-19 pneumonia. There is a a dense consolidation along the minor fissure as well as infiltrates in both lower lobes. Ribs appear normal. No pleural effusion.
CDC Split Type:

Write-up: ED to Hosp-Admission Discharged 9/21/2021 - 9/24/2021 (3 days) Last attending ? Treatment team Pneumonia due to COVID-19 virus Hospital Course This is a 77-year-old lady with history of asthma, hypertension, hyperlipidemia who came to Hospital emergency department with chest pain and shortness of breath. She was admitted for work-up and she was recently diagnosed with COVID-19 infection on September 13. Her repeat test was also positive. CT scan of the chest showed bilateral pneumonia as well as pulmonary embolism. Ultrasound scan of the leg shows left leg DVT. She was initially treated with heparin infusion now changed to oral Eliquis which she needs to take 10 mg twice a day for 5 days then change to 5 mg twice a day. She was also started on dexamethasone due to COVID-19 pneumonia. Her oxygen saturation remained stable on room air. On day of discharge her chest pain is better. She still has trouble having deep breaths. Denies any cough sputum. Afebrile. Denies any pain swelling in the legs. Denies any nausea vomiting or abdominal pain. No unusual bleeding. No other new symptoms or acute event as per nursing staff


VAERS ID: 1759007 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-02-12
Onset:2021-09-06
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adenovirus test, Atrial fibrillation, Bordetella test negative, COVID-19, COVID-19 pneumonia, Cardiac failure congestive, Cardiomegaly, Chest X-ray abnormal, Chlamydia test negative, Condition aggravated, Coronavirus test negative, Cough, Dyspnoea, Echocardiogram abnormal, Ejection fraction decreased, Enterovirus test negative, Human metapneumovirus test, Human rhinovirus test, Hypervolaemia, Hypoxia, Inflammatory marker decreased, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Left ventricular dilatation, Left ventricular dysfunction, Left ventricular failure, Lung consolidation, Lung infiltration, Mycoplasma test negative, Organ failure, Pleural effusion, Pulmonary hypertension, Pulmonary oedema, Rales, Respiratory failure, Respiratory syncytial virus test negative, Respiratory viral panel, SARS-CoV-2 test positive, Sepsis, Tachycardia, Tachypnoea, Viral test negative
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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), Pulmonary hypertension (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), 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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL EXTRA STRENGTH) 500 mg tablet albuterol HFA (PROVENTIL;VENTOLIN) 90 mcg/actuation inhaler apixaban (ELIQUIS) 5 mg tablet ascorbic acid, vitamin C, (ascorbic acid with rose hips) 500 mg tablet aspirin 81 mg tablet
Current Illness:
Preexisting Conditions: Nervous Neuropathy Periorbital hematoma of left eye Intractable back pain Diabetic peripheral neuropathy Respiratory Pulmonary nodule OSA (obstructive sleep apnea) Allergic rhinitis Restrictive airway disease Acute respiratory failure with hypoxia Pneumonia due to COVID-19 virus Acute hypoxemic respiratory failure due to COVID-19 Circulatory Essential hypertension Paroxysmal atrial fibrillation Coronary artery disease involving native coronary artery of native heart without angina pectoris Chronic systolic (congestive) heart failure Mitral regurgitation Pulmonary hypertension Third degree AV block Postsurgical cardiac pacemaker in situ Digestive Morbid obesity Acute superficial gastritis without hemorrhage Gastroesophageal reflux disease Genitourinary Thickened endometrium ARF (acute renal failure) Musculoskeletal Degeneration of intervertebral disc of lumbar region Discitis of lumbar region DJD (degenerative joint disease) Dermatitis fungal Endocrine/Metabolic Type 2 diabetes mellitus with complication Mixed hyperlipidemia Diuretic-induced hypokalemia Other History of coronary artery stent placement Spinal stenosis Anxiety Malignant neoplasm of upper-outer quadrant of female breast
Allergies: LisinoprilOther (document details in comments) PenicillinsRash, Other (document details in comments) TramadolItching
Diagnostic Lab Data: Updated Procedure 09/13/21 0725 Respiratory virus detection panel Collected: 09/13/21 0544 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result Detected Critical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected Procedure Component Value Ref Range Date/Time X-ray chest 1 view, Portable Resulted: 09/13/21 0842 Order Status: Completed Updated: 09/13/21 0842 Narrative: XR CHEST 1 VW PORT IMPRESSION: Peripheral right upper lobe mildly consolidated infiltrate. Somewhat rounded mildly consolidated right lower lung infiltrate. Patchy infiltrates at the left base. Nonspecific but could reflect COVID-19 infection. END OF IMPRESSION: INDICATION: Shortness of breath. TECHNIQUE: AP portable erect projection of the chest is acquired. COMPARISON: 6/29/2021. FINDINGS: There is no acute widening or shift of the mediastinum and the heart size is top normal. Pacemaker leads are present in the area of the right atrium and right ventricle and there is a defibrillator lead. There is a mild area of consolidation in the right upper outer lung bordering the fissure. There is another rounded infiltrate in the right lower lung measuring about 4 cm. There are patchy increased markings along the left heart border. There is no effusion. Since the patient is COVID positive it is likely these are related to COVID areas of infection/pneumonia but the appearance is nonspecific and may reflect infectious etiology of another atypical source. Follow-up to resolution recommended.
CDC Split Type:

Write-up: ED to Hosp-Admission Discharged 9/13/2021 - 9/15/2021 (2 days) Hospital Doctor Last attending ? Treatment team Severe sepsis; Medical Problems Hospital Problems POA * (Principal) Severe sepsis. Yes Essential hypertension Yes Paroxysmal atrial fibrillation Yes Coronary artery disease involving native coronary artery of native heart without angina pectoris Yes History of coronary artery stent placement Not Applicable Restrictive airway disease Yes Overview Addendum 7/14/2021 11:17 AM by (doctors name omitted) 02/08/2019 Pre-BD: FEV1/FVC: 1.25/1.44 (67% / 58%) ratio: 87% Post-BD: FEV1/FVC: 1.20/1.20 (64% / 48%) ratio: 100% DlCO: 31% DlCO/VA: 82% 07/09/2021 Pre-BD: FEV1/FVC: 1.52/1.85 (83% / 77%) ratio: 82% DlCO: 45% DlCO VA: 61% 06/29/2021 1. Findings most consistent with new CHF/volume overload. (Patient was in CHF @ time of CT) 2. No pulmonary emboli are seen. 3. New mild pulmonary edema. 4. New small bilateral pleural effusions. 5. Stable mild cardiomegaly and significant appearing left ventricular dilation. 6. Incidental findings as described. 06/30/2021 Echo Low normal left ventricular systolic function. Left ventricular ejection fraction is estimated at 50%. Abnormal septal motion consistent with pacemaker. Mild to Moderate mitral valve regurgitation. Morbid obesity Yes Pulmonary hypertension Yes OSA (obstructive sleep apnea) Yes Overview Signed 7/12/2020 9:51 AM by (doctors name omitted) Declined treatment Gastroesophageal reflux disease Yes Overview Signed 10/2/2020 11:13 AM by Update, (name omitted) Regulatory Update to replace inactivated diagnosis. Acute respiratory failure with hypoxia Yes Chronic systolic (congestive) heart failure Yes Type 2 diabetes mellitus with complication Yes Diabetic peripheral neuropathy Yes Pneumonia due to COVID-19 virus Yes Acute hypoxemic respiratory failure due to COVID-19 Yes Active Issues Requiring Follow-up Front Page AVS: o Admitted to the hospital with hypoxia secondary to COVID-19 infection. o You were admitted, you were started on Decadron Remdesivir for treatment of the COVID-19 infection. o You respiratory status improved, eventually weaned down to room air, tolerating well. o Continue taking oral Decadron, continue supportive therapy with albuterol nebs, Tessalon Perles. o Please follow-up with your PCP in 1 week, continue COVID-19 precautions/isolation for additional 7 days after discharge per protocol. Please see information below regarding COVID-19 infection and Covid isolation. Presenting Problem/History of Present Illness/Reason for Admission Shortness of breath Third degree AV block Paroxysmal atrial fibrillation Essential hypertension OSA (obstructive sleep apnea) Hypoxia Diabetic peripheral neuropathy Restrictive airway disease Acute respiratory failure with hypoxia Intractable back pain Postsurgical cardiac pacemaker in situ Severe sepsis Type 2 diabetes mellitus with complication Chronic systolic (congestive) heart failure Acute hypoxemic respiratory failure due to COVID-19 Pneumonia due to COVID-19 virus COVID-19 Hospital Course 77-year-old female with a past medical history of congestive heart failure, atrial fibrillation, third-degree heart block status post pacemaker, obstructive sleep apnea on 2 L nightly, type 2 diabetes, diabetic neuropathy, restrictive lung disease, pulmonary hypertension who presented to the emergency department with 1 week history of cough, shortness of breath. Notes that her cough and shortness of breath has been getting worse over the past week, no GI symptoms, denied significant fevers and chills. Reports that she does not wear mask when she goes out in public, she is vaccinated, just got back from vacation. Patient presented with hypoxia emergency department, was admitted to hospital service for treatment of COVID-19 pneumonia. 1. Severe sepsis, COVID-19 pneumonia, hypoxic respiratory failure Presented with severe sepsis with her tachycardia, tachypnea, COVID-19 and source of infection. Hypoxia is source of her organ failure. She was started on Decadron and Remdesivir for her COVID-19 infection, no indication for therapeutic improvement therapy, steroids, Mucinex, and Tessalon Perles. Inflammatory markers trended down, she was weaned down to room air at time of discharge. Patient was medically cleared and stable for discharge, she denied oxygen with activity stating that she has oxygen at home and can use it if she needs. 2. Systolic heart failure, atrial fibrillation History of systolic heart failure, who is euvolemic and without exacerbation during this hospitalization. Does have some mild rales however this is likely from her COVID-19 infection, continued on her home dose of Lasix and Coreg, stable for discharge. She was rate controlled, continue on Coreg and Eliquis 3. OSA, check lung disease, pulmonary hypertension Previous history of OSA, does use oxygen at home occasionally however notes that she is not always compliant. Her respiratory status improved well with Decadron and Remdesivir, she was weaned down to room air at time of discharge. We will continue home medications at discharge, follow-up with PCP in 1 week. On day of discharge, her symptoms significantly improved, she was weaned to room air, notes that her shortness of breath and coughing has improved. Stable for discharge, will be sent home on p.o. Decadron to complete course, instructed to follow-up with PCP in 1 week.


VAERS ID: 1759115 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-03-08
Onset:2021-09-06
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Ageusia, COVID-19 pneumonia, Cough, Diarrhoea, Dyspnoea, Fatigue, Hypoxia, Malaise, Nausea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Hydrocodone, Fluoxetine, Levothyroxine, Mestinon, Hydroxyzine, Prednisone, Metformin, Empagliflozin, Methocarbamol, & Atorvastatin
Current Illness:
Preexisting Conditions: Myasthenia Gravis
Allergies: Lisinopril, Amlodipine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, Cough, Shortness of breath, loss taste, Nausea, Diarrhea, fatigue,. did not feel well and breathing became hard, called 911 and was transported to the hospital. Was admitted with Hypoxia and Covid Pneumonia. Was in the hospital 6 days. Sent home and use oxygen at 4 liters.


VAERS ID: 1759381 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-13
Onset:2021-09-06
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, COVID-19, Chest X-ray abnormal, Cough, Fatigue, Lung infiltration, SARS-CoV-2 test positive, Urinary tract infection
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Novel Coronavirus PCR- Detected (9/6/2021)
CDC Split Type:

Write-up: Pt is 90 yo female s/p Pfizer COVID-19 vaccination: dose 1 on 1/23 and dose 2 on 2/13. PMH significant for heart failure, atrial fibrillation. Pt presented with 9/7/21 with 6 days of progressive fatigue and cough. CXR on admission with RLL infiltrate, and patient tested positive for COVID19. She was started on remdesivir, dexamethasone, and supplemental O2. Symptoms slowly improved and O2 was weaned to 1-2L prior to DC. She completed 10 day course of remdesivir/dexamethasone while inpt. She was noted to have UTI which was treated with ciprofloxacin to finish 10 day course ending 9/23/21. Given COVID19''s clotting risk, patient discharged on low dose eliquis as well for 1 month.


VAERS ID: 1759483 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-16
Onset:2021-09-06
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 RA / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1759779 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-09-03
Onset:2021-09-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Aphthous ulcer, Fatigue, Headache, Noninfective gingivitis, Oral disorder, Pain, Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Taste and smell disorders (narrow), Gingival disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (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: lexapro-10mg, prenatal vitamin, microgestin
Current Illness: No.
Preexisting Conditions: asthma, celiac disease
Allergies: celiac disease
Diagnostic Lab Data: Thrush, not it. Cold sores, not it. I haven''t gotten blood tests yet. I will with the next mouth sore outbreak.
CDC Split Type:

Write-up: Mouth sores and lesions. Canker sores all over tongue and under tongue. Sores on and in my gums and sockets. Tongue is swollen. Cheeks and lips are swollen, red, irritated. Can''t taste or smell anything. Taste buds feel "burnt off". Inside of my cheeks, lips, gums, tongue also feel burnt. Sores heals, new sores pop up. I had two giant canker sores under my tongue. Very painful. Couldn''t eat or drink very well. 9/9/21 I went to a health clinic. A Nurse Practioner prescribed me thrush medication. I took that for awhile, but that made things worse, and burned so bad. I quit taking that. The following week I went to my OB and kid''s pediatric Dr. He thought a bad virus, and told me to wait it out an d, if it wasn''t better in a couple weeks, we could do blood tests. But, I wasn''t satisfied. That same week I kept getting sores and headaches and made an appointment with my internal medical Dr. I drove 2 hours to get there for him to tell me that they are cold sores, and he prescribed me a cold sore medicine, which I already have on hand, when I do get cold sores. BUT they aren''t cold sores! They are canker sores.....that Dr told me cold sores and canker sores are the same thing. I said no they aren''t. So here I am, no answers. The sores are healing again. My mouth is still irritated and swollen. I can''t taste or smell anything, and I''m extremely tired. My 2nd dose of the Moderna vaccine is tomorrow, and I''m not looking forward to the side effects.


VAERS ID: 1760270 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-06
Onset:2021-09-06
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Menstruation irregular
SMQs:, Fertility disorders (broad)

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

Write-up: First Pfizer dose was 08/06/2021 of which was the last day of patients menstruation cycle. Second dose of Pfizer given 08/29/2021. Patient has not had a period since her last cycle 08/01/21-08/06/21


VAERS ID: 1761594 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-08
Onset:2021-09-06
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 UN / UN

Administered by: Unknown       Purchased by: ?
Symptoms: Productive cough, Sputum discoloured
SMQs:, Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Codeine, Dulera, Iodine, IV Contrast Dye, Penicillin, Scopolamine topical, Sulfa drugs, Tramadol.
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Coughing up green sputum, possible fever per patient, productive cough


VAERS ID: 1761602 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-31
Onset:2021-09-06
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Arthralgia, Axillary pain, Blood test, Contusion, Eczema, Impaired work ability, Inappropriate schedule of product administration, Inflammation, Laboratory test, Loss of personal independence in daily activities, Memory impairment, Nail pitting, Pain, Pain in extremity, Rash, Thyroid disorder, Vision blurred, Visual impairment, X-ray
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: COVID 1st Dose Moderna - 4/29/2021 - Large bruises from my knees to ankles; open, raised bumps on elbows and knees and fingers -
Other Medications: Tirosent, Busprone; Phentermine, multivitamin; Hydroclorathyrozide
Current Illness: no
Preexisting Conditions: Thyroid Cancer; Factor 5; Arthritis in knee and in my hip
Allergies: Ibuprofen; pumpkin; spinach and eggs (blood work after the first COVID vaccine stated these last three allergies)
Diagnostic Lab Data: bloodwork for autoimmune disease -at Labcorp; X-rays - ankles, feet, wrists, hands, and shoulders; Swallowing tests - Providence - which was also imagine - get food stuck in my throat - that has gotten worse since the shots; I have had lots of bloodwork done - my thyroid is all over the place - it jumps around everywhere so I''m always getting bloodwork for that which is ongoing;
CDC Split Type: vsafe

Write-up: This is after the 2nd vaccine - Right eye has been blurry (feels like there is a blurry film over it) - no treatment at this time yet; I''ve tried eye drops but my it seems to move around but not go away. Eyesight is off. . My right shoulder (underside of arm) and right side of leg and right hip aches really bad. My wrists and my fingers in both hands in wrists and fingers hurt really bad - x-rays on these and doctor put me on Prednisone for this - it''s a month taper. It''s getting better with that. Spongiotic Dermatitis - causes water retention under the skin and outside of skin raised but flat bumps that turn brown - they come and go; the prednisone I''m taking helps with that - it''s up my ankles to calves to thighs to inside left arm and outside of right arm was diagnosed; I have bruises below my knees; I''m still getting something on my scalp - it comes up and goes down - I put cortisone cream on legs and arm. I have pitting in my fingernails. Dermatologist - can''t get in to him currently because of COVID so I''m going to another Dermatology next week so I can have someone look at my skin. My memory is not good - I can''t remember things I was going to do. I forget what I need to do. I can''t work because of all of this. My right leg is really painful and my arm - on the outside - putting my shirt on is really painful. The pain moves to different areas of my body. I don''t know where the pain will be next. Everything seems to be inflamed. I had to see a psychologist. Will also see my psychiatrist to help with the anxiety I''m having. To see if I can get on another anxiety medication. Note: I had first COVID vaccine 4 months before on 4/29/2021.


VAERS ID: 1761707 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1761710 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1761715 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1761723 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Unknown  
Location: Georgia  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1761725 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: Vaccine error - Vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.


VAERS ID: 1761766 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Muscle twitching
SMQs:, Dyskinesia (broad), Dystonia (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: metformin 500mg XR qd
Current Illness: none
Preexisting Conditions: obesity insulin resistance
Allergies: NKDA
Diagnostic Lab Data: patient referred to neurologist and trial of treatment with muscle relaxer
CDC Split Type:

Write-up: patient that evening started to have twitching to her whole body. involved the hands mostly for 2 weeks after the vaccine and then 2 isolated episodes of facial twitching during that time. Now 4 weeks out is still reporting continued diffuse muscle twitching to her body worse while resting or trying to sleep.


VAERS ID: 1761780 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-02
Onset:2021-09-06
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Chills, Ear pain, Fatigue, Headache, Influenza like illness, Pyrexia, SARS-CoV-2 test positive, Sinusitis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan Metformin Atorvastatin
Current Illness: N/A
Preexisting Conditions: Hypertension Pre-diabetic
Allergies: Seasonal Allergies
Diagnostic Lab Data: Covid-19 Positive 09/15/2021
CDC Split Type: vsafe

Write-up: I had flu-like symptoms and I stayed home for ten days. I had a fever and chills and extremely tired. I returned to work and after two days but I had a lot of headaches and my ear was painful. I have not had an earache since I was a child. For five days after that I could not do much but sleep. I did not have a cough, it just felt like a really bad Sinus Infection. I was prescribed some antibiotics for the ear infection and an antihistamine. I checked my temperature every day and now it has been two weeks since I tested positive. I am still experiencing a lot of fatigue. I do not have any other symptoms.


VAERS ID: 1764578 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-09-02
Onset:2021-09-06
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal pain, Diarrhoea, Dyspepsia
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: She got her vaccine, really didn''t have any reactions right away. Then about #4 that she started having loose stools that turned into watery diarrhea, everything was going right through her. She would get cramping in her abdomen and would have to go immediately and then throughout the day. She was concerned due to possibly getting weakness. This went on for 2 1/2 weeks or so, then slowed down to loose stools, and now back to the liquid stools again. She called the pharmacy as she is a NP, and is otherwise not sick but her stomach is inflamed and having the digestive issues. No fever, has energy to work, but just has to have a bathroom close by.


VAERS ID: 1764857 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-05
Onset:2021-09-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Muscular weakness, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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: None.
Current Illness: None.
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: I broke out with hives all over my body which I have the pictures to prove and my muscles in my leg makes me feel like my legs are giving out on me I wasn?t having these problems until I took the shot it is abnormal for me and I?m scared.


VAERS ID: 1765673 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-09-03
Onset:2021-09-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood urine absent, Dizziness, Pollakiuria
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: blood urin testing, came back goo. Seeing a urologist now
CDC Split Type:

Write-up: Unrinated a lot of blood almost passing out.


VAERS ID: 1765717 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-03
Onset:2021-09-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Menstruation delayed, Paraesthesia, Pruritus, Rash, Rash vesicular, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Fertility 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: iron supplement over-the-counter
Current Illness: N/A
Preexisting Conditions: iron deficiency anemia, uterine fibroids
Allergies: No known drug allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reports intermittent generalized skin rash with blisters, "welts", and associated intermittent itching and "pins and needles" sensation. Occurs 4-5x per day and began 3 days after she received her first dose of Pfizer COVID-19 vaccine. Mainly occurs on her extremities and back but she also notices it on her face. Also reports her menstrual cycle is 2 days late and it is usually regular and always on time.


VAERS ID: 1767479 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-27
Onset:2021-09-06
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Antibody test, Ischaemic stroke
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high; High cholesterol
Allergies:
Diagnostic Lab Data: Test Name: Antibody test to platelet factor IV; Result Unstructured Data: Test Result:Unknown results
CDC Split Type: USPFIZER INC202101252879

Write-up: acute ischemic stroke; This is a spontaneous report from a contactable consumer (brother and care giver). A 77-years-old female patient received second dose of BNT162B2 (PFIZER BIONTECH COVID-19 VACCINE), via an unspecified route of administration administered in arm left on 27Aug2021 (at the age of 77-years-old) (Batch/Lot number was not reported) as single dose for covid-19 immunisation. Medical history included high BP (blood pressure) and high cholesterol. The patient''s concomitant medications were not reported. The patient previously received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Lot number: EWO178) via an unspecified route of administration in left arm on 06Aug2021 at 13:20 (at the age of 77-year-old) as single dose for COVID-19 immunization and followed by Right hip really hurt/sore right hip (last couple weeks) on 08Aug2021. The patient concerned about her high blood pressure and high cholesterol. She contacted her doctor to get this second shot. Doctor said ok via phone appointment call. 9 days later on 06Sep2021, the patient had a stroke ''Acute Ischemic Stroke'' was hospitalize 2 days and reclosed. Follow up care was needed as she tried to recovered. The patient underwent lab test which included antibody test to platelet factor IV with unknown results. The outcome of the event was not recovered. The lot number for BNT162B2, was not provided and will be requested during follow up.


VAERS ID: 1767505 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-09-03
Onset:2021-09-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aura, Confusional state, Dizziness, Dysstasia, Headache, Migraine, Nausea, SARS-CoV-2 test, Speech disorder, Tinnitus
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ADDERALL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Migraine
Allergies:
Diagnostic Lab Data: Test Date: 20210909; Test Name: covid test; Test Result: Negative ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC202101256189

Write-up: got my first severe migraine; nauseous; headache; difficulty speaking; difficulty standing; severe aura; ringing in ears; dizziness; extreme confusion; This is a spontaneous report from a contactable consumer (patient). A 28-year-old non-pregnant female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), via an unspecified route of administration, administered in arm right on 03Sep2021 at 18:30 (Batch/Lot number was not reported) as dose 1, single (at the age of 28 years old) for COVID-19 immunization. Medical history included complex migraine in 2017. No known allergies. Concomitant medications included amfetamine aspartate, amfetamine sulfate, dexamfetamine saccharate, dexamfetamine sulfate (ADDERALL) taken for an unspecified indication, start and stop date were not reported. No other vaccine in four weeks. It was reported that the patient had no side effects first 48 hours after the shot. On 06Sep2021, she felt nauseous and got her first severe migraine that would go on daily for 15 days. That day of the report was the first day she only had a headache and no migraine. Migraines were debilitating 90% of the time difficulty speaking, difficulty standing, severe aura, ringing in ears, dizziness, extreme confusion. She had a history of less than 5 severe migraines, one in which she went to ER for in 2017 but had not experienced severe migraine since then. AE resulted in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. It was unknown if patient had COVID prior vaccination and was tested post vaccination. The patient underwent lab tests and procedures which included covid test: negative on 09Sep2021 via nasal swab. Therapeutic measures were taken as result of the events, ae treatment Inhaler, migraine prescription. The outcome of the events was recovering. The lot number for the vaccine, BNT162B2, was not provided and will be requested during follow up.


VAERS ID: 1767951 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-05
Onset:2021-09-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC 3183 / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthma, Dyskinesia, Dyspnoea, Headache, Hypoaesthesia, Incontinence, Joint swelling, Skin discolouration, Tremor
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft, ability, gabapentin, ibuprofen, baclafan
Current Illness: None
Preexisting Conditions: Pain Depression Anxiety Ptsd Obese
Allergies: Coconut
Diagnostic Lab Data: See my Doctor I am not sure of all.
CDC Split Type:

Write-up: Left side numb Extremely head ache Shaking Involuntary muscle movements Joints are on fire and swollen Dead spots on my skin appearing. Still appearing. Incontinence Multiple Asthma attacks and labored breathing.


VAERS ID: 1768414 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Unknown  
Location: Illinois  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 3 - / IM

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

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

Write-up: Pt given expired vaccine. Moderna contacted and recommended to repeat dose. Patient contact and asked to return to clinic


VAERS ID: 1768663 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-31
Onset:2021-09-06
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood test normal, Cardiac monitoring, Chest pain, Computerised tomogram normal, Dizziness, Electrocardiogram normal, Headache, Heart rate increased, Loss of consciousness, Pain
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness: No
Preexisting Conditions: No
Allergies: Penicillin
Diagnostic Lab Data: 09/13/2021-bloodwork-Normal. CT Scan-Normal. EKG-normal. 9/14/2021-EKG-normal.
CDC Split Type: vsafe

Write-up: 09/06/2021 I passed out for ten mins. I have had several episodes of passing out since then. Still happening at random till this day. Each time I pass out something gets added to that, like dizziness, headache, pulse raises. Right arm sometimes has shooting pains. Now I am also having chest pains before passing out. 09/13/2021 passed out, taken to ER. 09/14/2021 taken to the ER again. Still passing out to the present day. On the 09/14/2021 I was give a shot called Toradol. On 10/05/2021 I was given a heart monitor to wear, till tomorrow is my last day wearing it, given to me by my doctor. I will not know the results of the heart monitor for a few weeks.


VAERS ID: 1770584 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Deafness neurosensory, Extra dose administered, Off label use, Tinnitus
SMQs:, Hearing impairment (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: VIT C; VIT D3; CALCIUM + MAGNESIUM; LIPOIC ACID; MILK THISTLE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Breast cancer (breast cancer & double mastectomy in 2007); Mastectomy (breast cancer & double mastectomy in 2007); Osteopenia (treated with prolia)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101265806

Write-up: Sudden Sensorineural Hearing Loss in left ear within 24 hour of receiving 3rd Pfizer Vaccine; Tinnitus in left ear; received a 3rd dose of the vaccine; received a 3rd dose of the vaccine; This is a spontaneous report from a contactable consumer (patient). A 70-year-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection) (at the age of 70-year-old), dose 3 via an unspecified route of administration, administered in arm left on 06Sep2021 11:15 (Batch/Lot number was not reported) as DOSE 3, SINGLE for COVID-19 immunisation. The vaccine was given in a pharmacy or drug store. Medical history included osteopenia treated with prolia; breast cancer and double mastectomy in 2007. Concomitant medications included ascorbic acid (VIT C); colecalciferol (VIT D3); calcium, magnesium (CALCIUM + MAGNESIUM); lipoic acid; silybum marianum (MILK THISTLE) and multivitamins. The patient previously took codeine and experienced nausea. Historical vaccine included BNT162B2 dose 1 and dose 2 on an unspecified date for COVID-19 immunisation. The patient was not pregnant. The patient had no other vaccines within four weeks prior to COVID-19 vaccine. The patient had no covid prior vaccination. She had not been tested post vaccination. The patient experienced sudden sensorineural hearing loss in left ear within 24 hour of receiving 3rd pfizer vaccine and tinnitus in left ear on 07Sep2021 07:00 with outcome of not recovered. It was reported that the patient received a 3rd dose of the vaccine on 06Sep2021 11:15. Therapeutic measures were taken as sensorineural hearing loss and tinnitus in left ear with prednisone; IT Steroids. The events resulted to doctor or other healthcare professional office/clinic visit, Emergency room/department or urgent care, Disability or permanent damage. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.


VAERS ID: 1771527 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-06-23
Onset:2021-09-06
   Days after vaccination:75
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Antinuclear antibody, Biopsy kidney abnormal, Chromaturia, Complement factor decreased, Dyspnoea, Dyspnoea exertional, Dyspnoea paroxysmal nocturnal, Joint swelling, Lupus nephritis, Malaise, Orthopnoea, Peripheral swelling, Urine output decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Systemic lupus erythematosus (narrow), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Arthritis (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: "...underwent a kidney biopsy on 10/6 with preliminary read concerning for class IV and V lupus nephritis. ANA still pending, but found to have low complements" Workup still in process but being treated for lupus nephritis.
CDC Split Type:

Write-up: Per HCP on 10/5, "Female with no significant past medical history who presents with one month history of shortness of breath and lower extremity swelling. The patient reports feeling well until one month ago when she started to notice progressive shortness of breath initially with exertion then progressed to being present at rest. At baseline, she can walk 2-3 blocks without limitation but can currently walk less than one block before feeling dyspneic. Also reports associated orthopnea, PND and LE swelling, swelling initially involved feet only but now have extended up to the knees. During this time, she also noticed darkening of the urine and decreased urine output. Denied any dysuria, frequency, urgency, hesitancy. Denies any hx of oral ulcers, skin rashes, light sensitivity, joint pain/swelling. "


VAERS ID: 1772139 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-28
Onset:2021-09-06
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038121A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 20 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: hospitalization with covid pneumonia


VAERS ID: 1772773 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-01
Onset:2021-09-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 1 LA / IM

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

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

Write-up: husband reports pt was hospitalized 5 days after vaccine and multiple hospital visits thereafter; stated problems keeping blood pressure under control, reports high blood pressure developed 5 days after shot


VAERS ID: 1773652 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Borderline personality disorder, Cerebral disorder, Fatigue, Feeding disorder, Malaise, Nightmare, Product use issue, Suicidal ideation, Suicide attempt, Violence-related symptom, Vomiting
SMQs:, Acute pancreatitis (broad), Suicide/self-injury (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (narrow), Medication errors (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: IBUPROFEN
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101312535

Write-up: took an entire bottle of Tylenol PM. I wanted to die; emotionally unstable even suicidal; emotionally unstable even suicidal; Emotions became violently unable to control/a day where I was PURE rage; feel sick and run down; feel sick and run down; Throwing up; unable to eat; The dreams of my ex abuser I escaped are prominent in my mind and dream''s again now too; I genuinely feel the vaccine did something to my brain/chemical balance/emotional state; Other vaccine same date product: Covid-19/moderna, 06Sep2021; This is a spontaneous report from a contactable consumer (patient). A 42-year-old non-pregnant female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), via an unspecified route of administration, administered in Arm Right on 06Sep2021 18:00 (Batch/Lot number was not reported) as dose 1, single for COVID-19 immunization at a pharmacy; COVID-19 vaccine mrna (mrna 1273) (MODERNA COVID-19 VACCINE), via an unspecified route of administration on Arm Right on 06Sep2021 18:00 (Batch/Lot number was not reported) as dose 1, single for COVID-19 immunization at a pharmacy. Medical history was reported as none. No COVID prior to vaccination. Not tested for COVID post vaccination. No known allergies. Concomitant medication included ibuprofen taken for an unspecified indication, start and stop date were not reported. On 07Sep2021 03:00, the patient took an entire bottle of Tylenol PM reporting that "I wanted to die." At the same time, the patient became emotionally unstable even suicidal, emotions became violently unable to control, there was a day where I was pure rage, feel sick and run down, throwing up everyday for no reason, unable to eat for days, had dreams of my ex abuser I escaped are prominent in my mind and dream''s again now too and the patient genuinely feel the vaccine did something to her brain/chemical balance/emotional state. The patient added that "I know it sounds crazy but there''s no other correlation, nothing else odd happened to me. Can a shot do that to me?" The patient considered the events as life threatening and have case disability or permanent damage. The events required emergency room visit. No treatment was given for the events. It was also reported that other vaccine same date product: covid-19/Moderna on 06Sep2021. The outcome of the events was not recovered. The lot number for BNT162B2, was not provided and will be requested during follow up.


VAERS ID: 1775769 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-01
Onset:2021-09-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Menstruation delayed, Oral herpes
SMQs:, Oropharyngeal infections (narrow), Fertility disorders (broad), Opportunistic infections (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: Iron supplements
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cold sore outbreak and late mentrual period by 1 week


VAERS ID: 1775977 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031A21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Gait disturbance, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Unsteady on feet; Aches; Fever; Chills; This spontaneous case was reported by a consumer and describes the occurrence of GAIT DISTURBANCE (Unsteady on feet), MYALGIA (Aches), PYREXIA (Fever) and CHILLS (Chills) in a 67-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 031A21A) for COVID-19 vaccination. No Medical History information was reported. On 06-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 06-Sep-2021, the patient experienced GAIT DISTURBANCE (Unsteady on feet), MYALGIA (Aches), PYREXIA (Fever) and CHILLS (Chills). On 20-Sep-2021, GAIT DISTURBANCE (Unsteady on feet), MYALGIA (Aches), PYREXIA (Fever) and CHILLS (Chills) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were reported. Patient took appointment on 8 Oct 2021 to take second dose and said that no rash was experienced as a side effect. treatment medications were reported. Most recent FOLLOW-UP information incorporated above includes: On 04-Oct-2021: Removed event Rash.


VAERS ID: 1776398 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-04
Onset:2021-09-06
   Days after vaccination:186
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 UN / UN
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 2 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Alveolar lung disease, Asthenia, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Cough, Dyspnoea, Fatigue, Palpitations, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (narrow), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin cholecalciferol Cyanocobalamin Docusate sodium Furosemide Polyethylene glycol Metoprolol succinate
Current Illness: None
Preexisting Conditions: She has a past medical history of Carotid stenosis, right (10/27/2016), HFrEF (heart failure with reduced ejection fraction) (9/10/2020), HTN (hypertension) (9/10/2020), Hypothyroidism, Kidney stones, Malignant neoplasm of ovary (10/27/2016), Osteoporosis, Paroxysmal atrial fibrillation with RVR (9/10/2020), Transient cerebral ischemia (11/10/2016), and Unspecified osteoarthritis, unspecified site.
Allergies: Doxycycline
Diagnostic Lab Data: COVID PCR positive on 09/06/2021
CDC Split Type:

Write-up: Pt is a 89 y.o. female with ovarian cancer and HFrEF, HTN, and atrial fibrillation who presents with significant weakness after being diagnosed with COVID on 9/1. She came in today because as she states it she "didn''t think she was going to make it". This is a lady that at baseline does aerobics for 50 minutes three times per week. She lives alone and due to her weakness and fatigue felt like she could fall. She has not fallen and denies feeling light headed, she just feels weak. Respiratory: Positive for cough and shortness of breath. Cardiovascular: Positive for palpitations. Negative for chest pain. COVID-19 pneumonia - on 2L this morning, saturating 98% - CXR 9/6 with bibasilar airspace disease - She has had 2 doses of moderna vaccine Plan: - hold off lasix today, seems euvolemic, likely can get off oxygen - wean off oxygen - remdesivir, dexamethasone On discharge: COVID-19 pneumonia - was requiring 2L oxygen, successfully weaned down - ambulatory pulse ox was 97% on room air - She has had 2 doses of moderna vaccine - s/p 5 days of remdesivir and 7 days of dexamethasone - to continue 3 more days of dexamethasone at rehab - not received antibiotic Discharge Disposition/Condition Condition: Stable (s/sx potential problems absent or manageable)


VAERS ID: 1776584 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-24
Onset:2021-09-06
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test abnormal, Blood urine present, Cystitis, Epididymitis, Prostatitis, Urine analysis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (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: No
Preexisting Conditions: scoliosis
Allergies: No
Diagnostic Lab Data: urine anaysis and blood test for the diagnosis of Epididymitis. On schedule to receive a CAT Scan and
CDC Split Type:

Write-up: Diagnosis with Pratatsisi, Epididymitis -virus with bladder infection which was a new health condition after the vaccination. Urination of blood within a week or two post vaccination, other side effects included,


VAERS ID: 1776654 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-09-06
Onset:2021-09-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cellulitis, Injection site pain, Nausea, Oedema peripheral, Pyrexia, Rash, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (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), 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: no
Current Illness: No
Preexisting Conditions: No
Allergies: Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient states after she got her second dose she had tenderness and soreness at the site of inject she also experienced tenderness, swelling, rash, and redness in her left armpit. she also had fever 103 and nausea. she ended up going to the hospital and the ER doctor told her she has cellulitis.


VAERS ID: 1776841 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-04
Onset:2021-09-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Biopsy skin normal, Burning sensation, Laboratory test normal, Pruritus, Skin warm, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (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: Seasonal Allergies
Diagnostic Lab Data: Client reports she was seen on 9/10/2021 where she was prescribed 4 days of prednisone and topical triamcinolone cream. Client reports no symptom improvement so she went to a specialist on 9/13/21. Client reports they ran tests and biopsy''s which did not show cause for the rash. Client was treated with a longer course of prednisone, topical betamethasone, and hydroxyzine.
CDC Split Type:

Write-up: PHN received phone call from client on 10/11/2021 stating that she received her first dose of Pfizer vaccine on 09/04/2021 and that about two days later she began with a hive-like rash on her bilateral legs beginning at the knee and extending to the feet and on bilateral arms beginning at the elbow and extending to the hands. Client reports that over the next few days the rash progressed and spread up toward the trunk of her body. About 8 days after receiving the vaccine she had this hive-like rash covering her entire body. Client reports that the rash was hot to the touch, burned, and itched. Client reports she was seen on 9/10/2021 where she was prescribed 4 days of prednisone and topical triamcinolone cream. Client reports no symptom improvement so she went to a specialist on 9/13/21. Client reports they ran tests and biopsy''s which did not show cause for the rash. Client was treated with a longer course of prednisone, topical betamethasone, and hydroxyzine. Client reports the dermatologist told her the rash was from the vaccine, and that she could call the government agency. PHN referred client to her PCP to determine course of action for 2nd dose of vaccine. Client verbalized understanding. Client reports rash improvement, but still experiencing hives on her trunk to date.


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