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From the 11/12/2021 release of VAERS data:

Found 875,292 cases where Vaccine is COVID19 and Patient Did Not Die

Government Disclaimer on use of this data



Case Details (Reverse Sorted by Onset Date)

This is page 26 out of 8,753

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VAERS ID: 1850807 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Apraxia, Facial paralysis, Seizure like phenomena, Speech disorder, Wheelchair user
SMQs:, Dementia (broad), Convulsions (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, artificial tears, aspirin, atorvastatin, cholecalciferol, Cyanocobalamin, ferrous sulfate, levetiracetam, multivitamin, Psyllium powder, Zoloft,
Current Illness: None
Preexisting Conditions: Unspecified toxic encephalopathy, Benign prostatic hyperplasia, depression, type 2 diabetes, vit b12 deficiency, vit d deficiency, hyperlipidemia,
Allergies: Penicillin
Diagnostic Lab Data: Unsure what was done at the hospital.
CDC Split Type:

Write-up: Pt had no verbal response which is not normal for him was wheeling himself down the hallway and stopped and could not follow command even questioned drooping of face. Pt assisted to bed and while waiting for the ambulance had seizure like activity. Pt was transported per ambulance to the local Hospital.


VAERS ID: 1850820 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-24
Onset:2021-11-05
   Days after vaccination:254
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 - / IM

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

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

Write-up: None stated.


VAERS ID: 1850836 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

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

Write-up: Patient received Pfizer 5-11 y/o dose instead of adult dose. Pediatric vial was diluted as if it were the adult vial and 0.3ml was administered.


VAERS ID: 1850845 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dermatitis, Skin burning sensation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: WARFARIN 10MG DAILY SYNTHROID METFORMIN CARTIA XT ZETIA AMBIEN XANAX CALCIUM, MULTIVITAMIN, VITD3, PRILOSEC, ZYRTEC
Current Illness: NONE
Preexisting Conditions: VASCULITIS DIABETES WARFARIN FOR BLOOD CLOT IN LUNGS 4 YRS AGO
Allergies: NAPROSYN STATINS SULFA
Diagnostic Lab Data:
CDC Split Type:

Write-up: THE PATIENT FEELS LIKE HER SKIN IS BURNING AND IT STARTED IN HER LOWER EXTREMITIES AND IS MOVING UP HER BODY. SHE HAS HIVES AND INFLAMMATION OF HER SKIN


VAERS ID: 1850848 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

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

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

Write-up: Tiredness began 5 hours after immunization. Nausea began 12 hours after immunization. High fever accompanied nausea and persisted for 48 hours.


VAERS ID: 1850850 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Patient was given Pfizer 5 to 11 year old vaccine instead of adult vaccine. Vaccine was diluted as if it were adult vaccine and 0.3ml administered.


VAERS ID: 1850860 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Patient was given Pfizer 5 to 11 vaccine instead of adult vaccine. Vaccine was mixed as if it were adult vaccine and 0.3ml was administered.


VAERS ID: 1850862 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast swelling, Injection site swelling, Injection site warmth, Pain in extremity, Rash, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tamoxifen, Vitamin D+Calcium; Vitamin C, Tums
Current Illness: none
Preexisting Conditions: overweight, 5 years out from Breast Cancer diagnosis
Allergies: penicillin, latex, heart cath dye, neosporin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Tenderness in arm, then a rash on the arm, aches all thru the left arm down to the wrist. swelling of the underarm and the side of breast and hotness to the upper arm.


VAERS ID: 1850864 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046C21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site urticaria, Petechiae, Rash, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (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: Zoloft, Welbutrin, Omeprazole, Zyrtec, Singulair, Doxycycline
Current Illness: none
Preexisting Conditions: IBS, Depression, Anxiety, Reactive Airway Disease, Rosacea
Allergies: Sulfa antibiotics, Latex, Adhesive Tape
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received Moderna booster in the afternoon on 11/5/21, that evening had an itchy petechial rash down both arms, across chest and palms as well as a large hive at the injection site. I took a benadryl and the rash subsided, hive at injection site is slowly improving with time.


VAERS ID: 1850869 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-04
Onset:2021-11-05
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary normal, COVID-19, Oxygen saturation abnormal, SARS-CoV-2 test positive
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient had positive COVID test at outside facility. The facility told him he would have to leave, and after discussion with his wife, he came to ED where he was evaluated. An initial oxygen sat was 88%. He is therefore admitted. Oxygen then rapidly improved to then 95-100% x hours. CTA chest shows no pneumonia or PE.


VAERS ID: 1850875 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Patient received Pfizer 5 to 11 vaccine instead of adult vaccine. Vaccine was mixed as if it were adult vaccine and 0.3mL administered


VAERS ID: 1850879 (history)  
Form: Version 2.0  
Age: 7.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus, Pyrexia, Rash, Sleep disorder, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: SWOLLEN FACE, RASH ON FACE KNECK AND TORSO. HIVES AND ITCHING, UNABLE TO SLEEP DUE TO ITCHING. RASH STILL PRESENT 3 DAYS AFTER VACCINATION. LOW GRADE FEVER. TREATED AT URGENT CARE WITH STEROID INJECTION (DECADRON), ORAL PREDNISONE RX, INSTRUCTIONS TO CONTINUE BENADRYL AROUND THE CLOCK.


VAERS ID: 1850882 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-01
Onset:2021-11-05
   Days after vaccination:277
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Cardiac failure acute, Cough, Diarrhoea, Dyspnoea, Fatigue, Fluid intake reduced, Hypophagia, Myalgia, Nausea, Oxygen saturation decreased, Productive cough, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Patient presents to the ED 11/5/21 due to recent decline following COVID-19 diagnosis 5 days prior. The patient was recently admitted to hospital from 10/10/2021 to 10/16/2021 due to acute respiratory failure and suspected acute on chronic diastolic heart failure exacerbation. He was discharged to a nursing facility and subsequently tested positive for random rapid Covid test on 11/1/2021. He was moved to another nursing home following positive test. Initially he was asymptomatic but developed fever, myalgias, and increased fatigue on 11/2/2021. He then became more short of breath especially with ambulation. SPO2 reported down to 88% on room air with ambulation. He has reportedly not been eating or drinking well for the past several days and has had an increased cough that is intermittently productive. He has also experienced mild nausea and diarrhea. He denies any loss of taste or smell. He has reportedly had a significant functional decline over the last several months.


VAERS ID: 1850906 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-30
Onset:2021-11-05
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cyst, Fatigue, Lymphadenopathy, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Lymphadenopathy related to COVID vaccination administration. Sore muscles, especially left arm. Cysts on left side of neck producing pus. Fatigue. Doctor recommends return for treatment if no change within 7 days. As of 11/08/2021 conditions seam to be very slowly improving.


VAERS ID: 1850908 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939905 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Oedema peripheral, Pain in extremity, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Covid 1st and 2nd dose
Other Medications: Losartan 100mg, Hydrochlorothiazide 25mg
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm pain, fatigue, chills, little fever, headache, swollen armpit 2nd day after shot


VAERS ID: 1850928 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site bruising, Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling, Pruritus
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Site: Bruising at Injection Site-Mild, Site: Itching at Injection Site-Mild, Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Systemic: Allergic: Itch Generalized-Mild


VAERS ID: 1850931 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cellulitis, Injection site erythema, Injection site swelling, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Asprin 81 mg, Advair diskus 250/50, Armour Thyroid 120 mg , Janumet 50/1000 mg, Lisinopril 5 mg, Omeprazole 20 mg, Cetirizine 10, Multivitamins
Current Illness: none
Preexisting Conditions: Hypertension, DM Type II
Allergies: PCN, codeine, tetracycline
Diagnostic Lab Data: Physical exam by provider. Cellulitis from adverse reaction to vaccine. Treated with antibiotics. Currently monitoring symptoms for the next seven (7) days.
CDC Split Type:

Write-up: Arm soreness and fever started the day after vaccination. On Nov. 6, patient noted redness and swelling around injection site and symptoms remained to this day.


VAERS ID: 1850958 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-22
Onset:2021-11-05
   Days after vaccination:287
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11/5 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1850985 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-09
Onset:2021-11-05
   Days after vaccination:241
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA VACCINE 037A21B / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Malaise, Pyrexia, SARS-CoV-2 test positive
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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: History of diabetes, high cholesterol, hypertension
Allergies: Allergy to Penicillin
Diagnostic Lab Data: Positive rapid COVID-19 test on 11/5/2021
CDC Split Type:

Write-up: Patient presents to the ED with fever and began feeling ill today (11/5/2021). Reports chills, also.


VAERS ID: 1850988 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F21A / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, Fall, Haemorrhage, Head injury, Unresponsive to stimuli
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Medication errors (narrow), Hypoglycaemia (broad)

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

Write-up: Patient had received his vaccine at least 30 minutes prior to incident. Patient found by another person outside. Patient had reportedly fallen on sidewalk. When found, patient was unresponsive but was breathing and did have a pulse. Patient had laceration on forehead which was bleeding profusely. Patient became responsive after a few minutes. Patient could not remember how or why he fell, but did know his name and DOB. 911 was called and reported to scene about 15 minutes after fire department and two sheriffs showed up. Patient was transported to ER.


VAERS ID: 1850996 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Injected limb mobility decreased, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (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: Lipitor
Current Illness: Client stated he had a fall and hit his right shoulder 3 weeks before.
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: The client state he would be seeing his doctor to follow up
CDC Split Type:

Write-up: The client stated he had soreness at the (right deltoid) and then 2-3 hours later he couldn''t lift his arm above his shoulder.


VAERS ID: 1851011 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Dyspnoea, Headache, Lymphadenopathy, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Asthma, sleep apnea, obesity, diabetes type 2
Allergies: Bacitracin, latex, pcn, amitriptyline
Diagnostic Lab Data:
CDC Split Type:

Write-up: SOB, cough, fever, body aches, shaking chills, bad headache and then on Sunday swollen lymph nodes under my right arm


VAERS ID: 1851045 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Headache, Injection site pain, Lymphadenopathy, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Same symptoms with second dose of Moderna CV-19 shot, 4/13/21, age 36
Other Medications: Vital Proteins Collagen Peptides
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills, fatigue, muscle and joint ache, headache, swollen lymph nodes under left arm, pain at injection site


VAERS ID: 1851047 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 034F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Pruritus, Pyrexia, Rash erythematous, Skin discolouration, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (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: 66yr, 3/10/2021, Moderna Covid-19 2nd Dose, 3-4in raised itchy at injection site
Other Medications: Ibuprofen 600mg Gabapentin 800mg Fexofenadine Hydrochloride 180mg Famotidine 20mg
Current Illness: None
Preexisting Conditions: Asthma Back pain
Allergies: Latex
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Red area at shot site starting approximately 9 hours 1.5 inches, increasing to 2.5 in 24hrs to approximately 3 in at 36 hrs. Itchy at 42 hrs. Welt red inside right elbow 3-4 in at 6hr, lighter 48hr. Torso pink painted look plus red rash 10 hr -48hr fever 100 F with Ibuprofen 800


VAERS ID: 1851049 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-03
Onset:2021-11-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dizziness, Extra dose administered, Hypersomnia, Impaired work ability, Injection site pain, Injection site warmth, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexapro, Lisinopril, Januvia
Current Illness: none
Preexisting Conditions: Depression, diabetes, HTN, high cholesterol
Allergies: Amoxicillin, Bactrim DS
Diagnostic Lab Data: Doxycycline prescribed for local skin reaction from injection.
CDC Split Type:

Write-up: After receiving COVID booster vaccine to right deltoid on 11/03/2021. developed fever, chills, light headedness, pain at right deltoid infection site, "heat coming from injection site" 11/05/2021,. Reports she had to leave work on 11/05/2021 due to symptoms. Reports she has taken OTC Tylenol and Motrin. Reports she increased sleeping due to symptoms. Reports symptoms are somewhat better, but continues to have right arm pain and "feels heat coming from injection site." Upon examination, tenderness over injection site to deltoid muscle. No fluctuance or induration. No erythema or lymphatic streaking.


VAERS ID: 1851054 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Dizziness, Dysgeusia, Palpitations, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: SVT, Migraines, IBS
Allergies: Keplex, Macrodantin, Macrobid, Zofran, Amitryptaline,
Diagnostic Lab Data:
CDC Split Type:

Write-up: Loss of taste within 1 hour of vaccine. Shortly after everything tasted like pennies or a metal taste. Day after vaccine I had extreme dizziness with a random moment of passing out. Rapid heart racing.


VAERS ID: 1851068 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O77C21B / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: No adverse event
SMQs:

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

Write-up: None, patient is doing well.


VAERS ID: 1851080 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Condition aggravated, Discomfort, Fatigue, Headache, Interchange of vaccine products, Pain, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Medication errors (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: I had a similar reaction to the Johnson and Johnson vaccine I received in April 2021 (fatigue, headache, chills, body aches etc)
Other Medications:
Current Illness:
Preexisting Conditions: Alcoholism Overweight Asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I received a Moderna dose to augment a Johnson & Johnson dose I received in April 2021.About 10 hours after receiving the vaccine I felt fatigue and headache. A few hours later I was in bed with chills, tremors, body ache, etc, which were quite uncomfortable. In the morning I took tylenol and ibuprofen which managed most of this. I continued to feel fatigued and some generalized body ache for the next few days. As of 11/8 AM I am fine.


VAERS ID: 1851092 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8ONE (NOT SUR / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Discomfort, Extra dose administered, Fatigue, Injection site erythema, Injection site swelling, Injection site warmth, Limb discomfort, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: after first two Pfizer covid I had fatigue and pain but nothing like this last one.
Other Medications: vit. B12, B complex, daily vitamin, Alpha Lipoic Acid, bone strength,
Current Illness: none
Preexisting Conditions: Fibromyalgia
Allergies: augmentum
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: severe fatigue and pain all over my body. extreme discomfort. (I''ve been told by a neurologist that I have a dangerously high tolerance for pain so this is what concerned me. I noticed yesterday (3 days after receiving vaccine) that on my upper arm, about 2" below needle insertion site, there is an oval shaped, raised bump 2" x 4" that is pink and warm to the touch. My arm (actually both arms) feels heavy but does move easily without pain now.


VAERS ID: 1851101 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-07
Onset:2021-11-05
   Days after vaccination:302
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11/5 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1851122 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-11-03
Onset:2021-11-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2539 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Computerised tomogram, Electrocardiogram ST segment elevation, Laboratory test, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Denies any use.
Current Illness: Denies recent illnesses.
Preexisting Conditions: Obesity.
Allergies:
Diagnostic Lab Data: Initial testing at Hospital with elevated CRP6.6, troponin elevated, and ST elevation changes. At other facility, pt initially with troponin of 6, ST elevation in leads II, III, AVF. Troponin on 11/8 trending down to 4. Pending CT results and lab serology results.
CDC Split Type:

Write-up: myocarditis presentation ~2 days after vaccination


VAERS ID: 1851140 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: cetirizine (ZYRTEC) 10 mg tablet pioglitazone (ACTOS) 15 mg tablet SITagliptin-metformin (JANUMET) 50-1,000 mg per tablet FARXIGA 10 mg tab TRELEGY ELLIPTA 100-62.5-25 mcg dsdv atorvastatin (LIPITOR) 80 mg tablet benzonatate (TESSALON) 200
Current Illness: Tinea cruris
Preexisting Conditions: Bipolar disorder, schizophrenia, panic disorder, personality disorderhypertension, GERD, diabetes type 2, asthma
Allergies: Cat Dander, Diflunisal, Dogs , Grass Pollen, Pollen Extracts, Quetiapine, Metformin, Pantoprazole
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Not so much an "adverse event" however, pt came into the office on 11/05/2021 to see provider for a routine follow-up appointment and his second dose of Pfizer. Upon speaking with the provider, he did confess that he has received 5 doses of Moderna (3/21, 4/21, 7/21, 8/21, and 9/21). Unfortunately, he was not honest during his 10/14/21 appt and did receive a dose of Pfizer from our facility as he stated he had not been vaccinated against covid-19.


VAERS ID: 1851161 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-17
Onset:2021-11-05
   Days after vaccination:261
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11/05/2021 Covid +
CDC Split Type:

Write-up: Breakthrough Case


VAERS ID: 1851165 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Feeling abnormal, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ursodiol, Duloxetine, Omeprazole, Benzonatate, Losartan, Vitamin D3, Calcium Citrate w/Vitamin D3, Magnesium Oxide, Cetirizine HCL
Current Illness: none
Preexisting Conditions: primary biliary cholangitis, inflammatory arthritis (not rheumatoid), reynaud''s,
Allergies: Ace inhibitors (cough), bee sting, tetanus, valent 23 pneumonia vaccine, sulfasalazine, soy, sensitive to: lactose, milk, yeast, gluten
Diagnostic Lab Data:
CDC Split Type:

Write-up: muscle aches, joint aches. waves of nausea, foggy head, severe fatigue x3 days. Ongoing waves of nausea, foggy head, fatigue. Taking OTC acetaminophen


VAERS ID: 1851188 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-04
Onset:2021-11-05
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Covid + on 11/05/2021
CDC Split Type:

Write-up: Breakthrough Case


VAERS ID: 1851190 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2590 / 3 LA / IM

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

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

Write-up: Fever up to 103.2. Chills, fatigue, joint pain, headache, dizziness, muscle aches


VAERS ID: 1851195 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058F31A / 3 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Cold sweat, Dizziness, Fatigue, Headache, Nausea, Nightmare, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular 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: Not as severe
Other Medications: Prozac, I was also given an updated tetnus shot at the same time.
Current Illness: None
Preexisting Conditions: Anxiety, Arthritis
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Chills, fever, cold sweats, nausea, dizzy,head ache, fatigue, night mares. Lasted two days.


VAERS ID: 1851229 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1855194 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate increased, Hyperhidrosis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Very high heart beat. Lasted about 4-6 hours. Fever - lasted appoximately 48 hours Constant sweating , still persisting over 80 hours after vaccine administration, yet no fever at this time.


VAERS ID: 1851236 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bedridden, Chills, Dizziness, Fatigue, Injection site pain, Nausea, Pain, Pyrexia, Vertigo, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: Borderline high blood pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: I took my Covid booster shot at around 2:30 on thursday afternoon(Nov 4th). About 10 hours later, I felt extremely dizzy. The dizziness continued the whole of the next day where I was unable to get out of bed. The vertigo (dizziness) was accompanied with vomiting every time I stood up to go to the bathroom. I was unable to keep down any food or water for the entire next day. I am an otherwise healthy person but I needed physical help to get to the bathroom all of friday. On saturday, the nausea went away but the vertigo persisted mildly. It is now Monday and I am still feeling tired and not back to my usual self. In addition to the vertigo and nausea, I did have fever, chills, injection site pain and body aches. The most debilitating symptom was the vertigo and nausea. My husband informed the primary care doctor about the reaction and they wanted me to get admitted in the hospital for IV fluids. But, we decided against it due to my physical inability to get out of bed.


VAERS ID: 1851237 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA HRSA011F21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None Reported
Preexisting Conditions: Glioma
Allergies: Molds & Smuts
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Vaccine Administration Error with No Adverse Event Reported by Patient Patient was scheduled to receive their second dose of the Moderna COVID-19 vaccine (0.5ML) and instead received a Moderna COVID-19 booster dose (0.25ML). Patient is deciding whether or not they want to receive additional vaccine to equal the "full" 0.5ML dose.


VAERS ID: 1851261 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event
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: albuterol, Fosamax, Elavil, Norvasc, Lipitor, baclofen, Wellbutrin SR, Buspar, Zyrtec, vitamin D3, b12 tablet, Voltaren gel, Nexium, Flonase, Lasix, Toujeo, Atrovent, lisinopril, metformin, omega 3 fatty acid capsule, Seroquel, Xarelto
Current Illness:
Preexisting Conditions: depression, obesity, HTN, hyperlipidemia, arthritis, fibromyalgia, macronodular cirrhosis, OSA, tobacco abuse, polyneuropathy, type 2 Diabetes, COPD, osteoporosis, paroxysmal atrial fibrillation, iron deficiency anemia, bilateral carotid stenosis,
Allergies: penicillin- anaphylaxis, Motrin, Chantix
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine expired on 11/1/21. administered 11/5/21. Reported no side effects after vaccine


VAERS ID: 1851269 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 3 RA / IM

Administered by: Private       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: acetaminophen (TYLENOL) 500 mg oral tablet Take 2 tablets by mouth every 6 hours as needed. albuterol HFA (PROAIR HFA) 90 mcg/actuation inhalation inhaler Inhale 2 puffs (180 mcg total) every 6 hours as needed. aspirin 81 mg oral tablet
Current Illness:
Preexisting Conditions: Hyperlipidemia associated with type 2 diabetes mellitus (*) Chronic back pain Hypertension associated with diabetes (*) Shoulder pain, bilateral Deviated septum Sleep apnea Arthritis Insomnia Diabetes mellitus (*) Recurrent major depressive disorder, in partial remission (*) Generalized anxiety disorder At moderate risk for fall
Allergies: keflex, aspirin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Expired vaccine administrated, 4 days past expiration date. vaccine expired 11/1/2021. dose administered on 11/5/2021. patient reported no side effects after vaccine


VAERS ID: 1851284 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA CB7F21A / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna
Other Medications: Nadolol, Simvastatin, Amitriptyline, Buspirone hydrochloride, Famotidine, Valsartan/hydrochlorothiazide, anti-diarrhea, B-complex, St.Johns wort, Passionflower, Fish oil, calcium plus D3, Glucosamine/chondroitin/MSM, Biotin, Cholestytamine
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache, nausea, temperature


VAERS ID: 1851307 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2585 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye pruritus, Eye swelling, Ocular hyperaemia, Pruritus
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Glaucoma (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: Patient did not list any out
Current Illness: none stated
Preexisting Conditions: none stated
Allergies: Patient stated allergic to chicken pox vaccine
Diagnostic Lab Data: none stated
CDC Split Type:

Write-up: patient stated woke up on 11/5 with left eye swollen, red, itchy and blood shot. States face, hands, arms, and legs itch as well. Face is the worst .


VAERS ID: 1851320 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: administered expired vaccine. vaccine expired on 11/1/2021- administered 4 days past expiration on 11/5/21. patient reports no symptoms post vaccine


VAERS ID: 1851331 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-16
Onset:2021-11-05
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0169 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Chills, Cough, Dyspnoea, Ear discomfort, Eye pruritus, Nasal congestion, Rhinorrhoea, Sneezing, Upper-airway cough syndrome
SMQs:, Anaphylactic reaction (narrow), Taste and smell disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ?Vitamin D 2000 UNIT Tablet 3 capsules Orally Once a day ?Multi For Her - Tablet as directed Orally
Current Illness: none
Preexisting Conditions: History of Depression. Menopause at age 44.
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: nonproductive cough, chills, shortness of breath, loss of taste, loss of smell, nasal congestion, post nasal drainage, sneezing, itchy eyes runny nose, ear fullness. starting on 11/5/2021


VAERS ID: 1851334 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / UNK LA / IM

Administered by: Private       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: lovastatin 40mg
Current Illness:
Preexisting Conditions: Tobacco dependence Vertigo Perimenopausal Generalized headaches Onychomycosis Rash Acne rosacea LBP (low back pain) Obesity (BMI 30-39.9) Prolonged grief reaction Major depressive disorder, single episode Dyslipidemia Essential hypertension with goal blood pressure less than 140/90 Prediabetes Myalgia
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: expired vaccine administered. vaccine expired on 11/1/21, it was administered 4 days past expiration date on 11/5/21


VAERS ID: 1851339 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-27
Onset:2021-11-05
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dementia (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: N/a
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives, whole body. All around misery!


VAERS ID: 1851341 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal discomfort, Dizziness, Hyperhidrosis, Injection site pain, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

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

Write-up: Body aches, sweating, upset stomach, dizziness, and localized pain to my left arm and left side of my upper body.


VAERS ID: 1851361 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-02
Onset:2021-11-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 3 LA / -
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. - / 1 RA / -

Administered by: Public       Purchased by: ?
Symptoms: Erythema, Pain in extremity, Peripheral swelling, Skin induration, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: severe arm pain, swollen, arm very red, hot, and hard


VAERS ID: 1851383 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye pain, Gastrooesophageal reflux disease, Headache
SMQs:, Gastrointestinal nonspecific dysfunction (narrow), Glaucoma (broad)

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

Write-up: Patient reported having headache, eye pain, and acid reflux ongoing since shortly after receiving vaccine. Patient said he tried APAP, ibuprofen and Excedrin for the headache and eye pain but it was not working. He also said he took Nexium OTC for the acid reflux but it did not provide relief. Patient was advised to contact his primary care physician.


VAERS ID: 1851401 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Senior Living       Purchased by: ?
Symptoms: Back pain, Mobility decreased, Pain in extremity
SMQs:, Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: I felt back pain and arm pain around 21:30 on Friday. I could not raise my arm on Saturday.


VAERS ID: 1851605 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8208 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Computerised tomogram normal, Dizziness, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), 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: Pfizer-BioNTech
Other Medications: Vitamins D6 B12 D, Gabapentin, IUD, Acetaphetamine, Ibuprofen Protozole, lomododine , lamotrigine, Zaleplon, Probiotic
Current Illness: Fibromyalgia
Preexisting Conditions: Fibromyalgia
Allergies: Shrimp and Sulfur edications
Diagnostic Lab Data: CT Scan - Nov. 5th 2021. To check for a brain bleed that came as negative.
CDC Split Type: vsafe

Write-up: I started developing a headache 6 to 7 hours after the injection. Around 5 am the next morning it was the most excruciating headache I have ever experienced. Nothing helped, not medication, cool cloth. I called and had a tele-medicine appointment. The Dr. She thought it was worse and extreme version of the Pfizer headache. I had a CT Scan to check for a brain Bleed. I was told to take Valium. The CT Scan was negative and given the option to receive ketorolac. I turned it the down because I have pain after injections. I was told to take Naproxen, valium and Benadryl. It was bad but tolerable, but virtually gone by the next day. I had had also light head, joint pain, and nausea.


VAERS ID: 1851610 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Inappropriate schedule of product administration, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient''s second dose in the series was on 5/31/2021. He received the booster dose about 26 days early on 11/5/2021. We have left messages with the patient but not talked to him about the situation. There have been no reported adverse events.


VAERS ID: 1851788 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: New York  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / IM

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

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

Write-up: Vaccine administration error. The patient is 17. It is not FDA approved for anyone under the age of 18 to get a Pfizer COVID 19 booster or 3rd dose. The patient reported no adverse effects.


VAERS ID: 1851817 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-11-01
Onset:2021-11-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, 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? 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: Patient complained of "COVID Arm" with redness and rash that traveled down her arm.


VAERS ID: 1851825 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / UNK - / IM

Administered by: Military       Purchased by: ?
Symptoms: Cough, Decreased appetite, Dental discomfort, Discomfort, Dizziness, Ear discomfort, Ear pain, Fatigue, Feeling hot, Headache, Influenza like illness, Nasal congestion, Neck pain, Pain, Pyrexia, Restlessness, Sinus pain, Sinusitis, Sleep apnoea syndrome, Submaxillary gland enlargement, Toothache
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Akathisia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: a) Pfizer shot #1 on 2/10/21, Lot EN9581, mild fever symptoms, aches and shooting pains. Age 53. b) Pfizer shot #2 on 3/3/21
Other Medications: Vitamin D3 Levothyroxine Loratadine Pseudoephedrine Omeprazole
Current Illness: None
Preexisting Conditions: Allergies - pollen, dust, animal dander Charcot Marie Tooth Syndrome - peroneal neuropathy Thyroid Condition GERD/Acid Reflux Overweight
Allergies: Meds = none Food = mild reaction to whole corn Other = grass and tree pollen, seasonal
Diagnostic Lab Data: None yet
CDC Split Type:

Write-up: Starting on the late afternoon after injection, I started to get light flu like symptoms (warmish, aches, tiredness). Had lack of appetite. Overnight the symptoms got worse quickly and lasted over 36 hour period. Restlessness at night from feverish, aches and pains, headache, ear pain, sinus pain... just like a server sinus infection, but with only minor nasal congestion. Neckache. Cough. Sever tiredness and lightheadedness. Second night I got out bed at night I took my mouth piece out I have for sleep apnea because my teeth were unusually uncomfortable and in pain. Conditions got better thru the day on Sunday, but still had lightheadedness. Have been able to eat a little. Had an onset of great discomfort and swelling under armpits making Sunday-to-Monday sleep uncomfortable. And also periodic headaches. Monday morning the armpit discomfort was much better, but still lightheaded. As day progressed the armpit discomfort got a little worse, but not as bad as the night before. Ears bothering me again a little. I had the same manufacture and does amounts for shot #1 and #2 previously with feverish results, but not as bad as this. This time felt like being run through the meatgrinder and being tortured. Treatment: took severe cold/flu meds and liquids


VAERS ID: 1851828 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FJ1611 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 25 mg Adderall taken 07:00 am 11/05/2021
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 2 in induration of injection site/ redness measuring at 3 inches/ tenderness/ warm to touch. (ongoing )


VAERS ID: 1851841 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: California  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039F21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Underdose
SMQs:, Medication errors (broad)

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

Write-up: Patient came in for her 2nd dose of the Moderna vaccine 11/5/21 which should have been 0.5ml, we accidentally gave her a booster dose which is 0.25ml. Patient was contacted the same day to be notified of the error and returned today 11/8/21 for the other 0.25ml.


VAERS ID: 1851852 (history)  
Form: Version 2.0  
Age: 6.0  
Sex: Male  
Location: California  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Body temperature increased, Malaise, Sleep disorder, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: 11/04/2021 sore throat; 10/15/2021 flank pain with urination
Preexisting Conditions: None
Allergies: Amoxicillin (rash) 2016
Diagnostic Lab Data: None so far.
CDC Split Type:

Write-up: Received dose Friday evening. Awoke in middle of night with large emesis. Felt unwell next morning but fine by Saturday evening. He felt well on Sunday but today 11/08/2021, he felt ill. Temperature 100.8, vomiting and not able to keep fluids down. Low energy. Had BM today that was normal. Ordered ondansetron. Mom will hydrate and if he is continuing to vomit, he will go to the ER.


VAERS ID: 1852031 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 065F21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary pain, Chest pain, Dyspnoea, Nausea, Pain
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), 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? No
Previous Vaccinations:
Other Medications: OTC prescription strength Off brand Allegra (taking since very little) Singulair Lexapro Maybe 4 fiber pills Birth control/tri-lo-sprintec Probiotic
Current Illness: Asthma and allergies
Preexisting Conditions: Asthma
Allergies: Dairy
Diagnostic Lab Data: Nothing
CDC Split Type:

Write-up: Bad chest pains. Center to left side, same side I got my shot. It''s deep and my armpit hurts too. I''ve felt nauseous and hard to breathe. But above all shabby ache in. Does not worsen with breathing


VAERS ID: 1852044 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032F21A / 3 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Chills, Headache, Heart rate increased, Pain, Pain in extremity, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Dehydration (broad)

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

Write-up: Friday I had high heart beat achy chills vomit Sore arm It stayed till Sunday Sunday symptoms got better but stayed masons and weak Monday very Nadia?s and severe headache


VAERS ID: 1852238 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-29
Onset:2021-11-05
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pain, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Urged to go to hospital immediately, RE: Rapid heart rate and throbbing pains
CDC Split Type:

Write-up: Answered phone and someone began talking about suspected adverse reaction to vaccine administered, stating she had texted a number that asked her about vaccine side affects that failed to respond to her. I asked to verify ID and led to patients chart. Client then said she wanted it reported that she had adverse affects. She reported that she has "terrible throbbing pain in head and neck and legs, and rapid heart beat". I told her to go to hospital or call 911 if she cannot make it to the hospital. She demanded I take note of her symptoms which I was in her EHR. I stated again that these symptoms sound worrying and she should go to the hospital right away. continued on next page... She questioned if I was taking note of her symptoms, I assured the patient I was noting what she told me and emphasized due to her symptoms she should see a doctor right away. She then stated she wanted us to report this so ''her attorney could reference it''. I told her she needs to be examined by a doctor immediately, she stated ''she will see her own doctor virtually''. Made clear point to go to emergency room.


VAERS ID: 1853147 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-11-05
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211114994

Write-up: POSSIBLE FAKE VACCINE CARD OR EXPIRED VACCINE WAS GIVEN; This spontaneous report received from a health care professional concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 041A21A, and expiry: 19-SEP-2021) dose was not reported, administered on 05-NOV-2021 for prophylactic vaccination. No concomitant medications were reported. On 05-NOV-2021, the patient experienced possible fake vaccine card or expired vaccine was given. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of possible fake vaccine card or expired vaccine was given was not reported. This report was non-serious.


VAERS ID: 1853148 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:0000-00-00
Onset:2021-11-05
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211115080

Write-up: EXPIRED VACCINE ADMINISTERED; This spontaneous report received from a pharmacist concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 05-NOV-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 05-NOV-2021, the patient experienced expired vaccine administered. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of expired vaccine administered was not reported. This report was non-serious.


VAERS ID: 1853154 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Washington  
Vaccinated:0000-00-00
Onset:2021-11-05
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality 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: USJNJFOC20211115392

Write-up: ADMINISTRATION OF JANSSEN COVID-19 VACCINE AFTER BEING PUNCTURED FOR MORE THAN 6HRS; VIAL OF VACCINE PUNCTURED OUTSIDE OF THE 6 HOUR TIME HOUR; This spontaneous report received from a health care professional concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 211A21A, and expiry: 14-DEC-2021) dose was not reported, administered on 05-NOV-2021 for prophylactic vaccination. No concomitant medications were reported. On 05-NOV-2021, the patient experienced administration of janssen covid-19 vaccine after being punctured for more than 6 hrs. On 05-NOV-2021, the patient experienced vial of vaccine punctured outside of the 6 hour time hour. The action taken with covid-19 vaccine was not applicable. The outcome of the administration of janssen covid-19 vaccine after being punctured for more than 6hrs and vial of vaccine punctured outside of the 6 hour time hour was not reported. This report was non-serious.


VAERS ID: 1853156 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: West Virginia  
Vaccinated:0000-00-00
Onset:2021-11-05
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 213D21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality 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: USJNJFOC20211116251

Write-up: ADMINISTRATION OF VACCINE FROM A PUNCTURED VIAL AFTER THREE HOURS AT ROOM TEMPERATURE; OUT OF SPECIFICATION PRODUCT USE; This spontaneous report received from a pharmacist concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 213D21A, expiry: UNKNOWN) dose was not reported, administered on 05-NOV-2021 for prophylactic vaccination. No concomitant medications were reported. On 05-NOV-2021, the patient experienced administration of vaccine from a punctured vial after three hours at room temperature. On 05-NOV-2021, the patient experienced out of specification product use. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the administration of vaccine from a punctured vial after three hours at room temperature and out of specification product use was not reported. This report was non-serious.


VAERS ID: 1853518 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-02
Onset:2021-11-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram abnormal, Epiglottitis, Oropharyngeal pain
SMQs:, Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: lisinopril 10mg
Current Illness: none
Preexisting Conditions: hypertension, prediabetes
Allergies: None
Diagnostic Lab Data: CT to show
CDC Split Type:

Write-up: Pt developed a sore throat and then epiglottis, no signs of an abscess.


VAERS ID: 1853523 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012F21A / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Induration, Pruritus, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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? No
Hospitalized? No
Previous Vaccinations: Moderna Covid initial & 2nd dose - fatigue
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: redness (baseball diameter), warm, hard lump, sometimes itchy on upper right arm after Moderna booster.Zyrtec taken nightly for allergies. still active for +4 days


VAERS ID: 1853550 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-11-05
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Chills, Feeling abnormal, Headache, Insomnia, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Body temperature; Result Unstructured Data: Temp 101.5
CDC Split Type: USJNJFOC20211117500

Write-up: BODY ACHES; CHILLS; SPLITTING HEADACHE; TEMP 101.5; FEEL LIKE ABSOLUTE CRUD; COULDN''T SLEEP; This spontaneous report received from a patient via a company representative . The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient was previously treated with covid-19 vaccine for prophylactic vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 05-NOV-2021, the patient experienced couldn''t sleep. On 06-NOV-2021, the patient experienced feel like absolute crud. On an unspecified date, the patient experienced body aches, chills, splitting headache, and temp 101.5. Laboratory data (dates unspecified) included: Body temperature (NR: not provided) Temp 101.5. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the temp 101.5, splitting headache, chills, body aches, couldn''t sleep and feel like absolute crud was not reported. This report was non-serious.


VAERS ID: 1853570 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New York  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA LOT 071F21A EXP / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Contusion, Injection site haemorrhage, Product administered at inappropriate site
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Drug abuse and dependence (broad), Accidents and injuries (narrow), 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: medical appointments being scheduled
CDC Split Type:

Write-up: injection site too low (injection site measures 3.5? from shoulder acromion process instead of medical guidelines 2?) on low deltoid and punctured vein with immediate excess bleeding at vaccine site with resultant 3cm horizontal x3.5cm vertical Bruise Left upper Arm - and especially with concerns whether the mMRA-1273 administration was intravenously instead of intramuscular especially w concerns whether the mMRA-1273 administration was intravenously instead of intramuscular especially with recent research articles highlighting potential harm of inadvertent IV mRNA vaccines causing myocarditis, pericarditis or being rendered less effective or ineffective as would be vulnerable to being inactivated intravascularly


VAERS ID: 1853601 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-10-30
Onset:2021-11-05
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram abnormal, Fibrin D dimer, Full blood count, Metabolic function test, Pain, Pericarditis, Pleuritic pain, Troponin normal
SMQs:, Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: Remote history of Hodgkins lymphoma in long remission
Allergies: Penicillins (rash)
Diagnostic Lab Data: CBC, CMP, D-dimer, Troponin in normal limits. EKG showed acute pericarditis
CDC Split Type:

Write-up: Patient is a 57-year-old whom had his booster shot (Moderna) October 30. He reports beginning the night of November 5 he developed constant sharp substernal chest pain. This peaked in intensity overnight and he presented to the ER November 6 with constant pleuritic chest pain worse when lying on his back. EKG suggested pericarditis. The pain has gradually subsided and is almost gone today. He has no known history of CAD.


VAERS ID: 1853615 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 33056BD / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Site: Swelling at Injection Site-Medium


VAERS ID: 1853650 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F71A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Facial paralysis, Hypoaesthesia oral, Lagophthalmos
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Periorbital and eyelid 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? No
Previous Vaccinations: on first moderna injection 3.13.2021 felt slight tightness right side of lip but was minor and went away the next day.
Other Medications: Adderall 20 Prozac Synthroid Gabapentin Lomotrigine Lipitore Hyzar vitamin D
Current Illness: none
Preexisting Conditions: None
Allergies: none
Diagnostic Lab Data: Steroids Getting blood test tomorrow
CDC Split Type:

Write-up: numbness developed right lip and advanced to sagging right side and right eye would not close late day after injection, (Note I also received the flu vaccination in my left arm same day.) Symptoms worsened over weekend. Went to ER on Monday. Saw Dr. very brief'' , no other testing "confidently" diagnosed it as bell''s Palsy. Prescribed steroids and eye drops once every hour. I am seeing my primary care Dr. on Friday at her recommendation for more detailed medical advice.


VAERS ID: 1853651 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / UN

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Injection site pain, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), 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: With previous two Moderna injections
Other Medications: Zyrtec Additional side effect after vaccination: Sore arm, beginning at 5:30pm that day.
Current Illness: No
Preexisting Conditions: Environmental allergies which I take Zyrtec for.
Allergies: No
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Generalized severe muscle aching from 11pm on 11/05/2021 to waking up on 11/07/2021. Injection site soreness from 5:30pm on 11/05/21 to waking up on 11/08/2021.


VAERS ID: 1853660 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Disorientation, Extra dose administered, Headache, Mobility decreased, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Woke Friday 11/05/2021 to sore, swollen, painful arm and H/A, stayed in bed for 36 hours and c/o disorientation. Woke up Saturday afternoon feeling normal.


VAERS ID: 1853690 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: She had fever and body aches. She complains of pain under her armpits.


VAERS ID: 1853691 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-05
Onset:2021-11-05
   Days after vaccination:245
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Positive airway pressure therapy, Respiratory distress
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Respiratory Distress (Patient presents with respiratory distress. Brought in by ambulance with patient on C-Pap. Patient states that he woke with SOB. Hx of COPD and CHF. Denies any chest pain. )


VAERS ID: 1853723 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-27
Onset:2021-11-05
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest pain, Computerised tomogram, Electrocardiogram, Ovarian cyst ruptured
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Amoxicillin and lidocaine
Diagnostic Lab Data: Ct scan, blood draws, EKG, chest X-ray
CDC Split Type:

Write-up: Ruptured ovarian cyst and chest pains.


VAERS ID: 1853737 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-17
Onset:2021-11-05
   Days after vaccination:261
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / UNK - / 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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: transferred from an outside hospital # COVID, 1st diagnosed 10/14 Likely represents continued shedding of virus. Will touch base with facility in the morning to discuss removing isolation.


VAERS ID: 1853744 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: D.C.  
Vaccinated:2021-10-25
Onset:2021-11-05
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Exposure during pregnancy, Ultrasound antenatal screen normal, Vaginal haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Baby Aspirin, Prenatal Vitamin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: ultrasound- normal (11/5/2021)
CDC Split Type: vsafe

Write-up: I started having vaginal bleeding. It was light in quantity and brownish in color. I have never had vaginal bleeding with this pregnancy before. When I was out of town I went to the nearest Medical Center on 11/5/2021. They hooked me up to a monitor to check the baby''s heart rate. They checked my cervix. They did an ultrasound, but could not find anything, and they didn''t find a cause as to why I am experiencing vaginal bleeding. They really wasn''t concerned because it was just light bleeding. Today, 11/9/2021, I went to see my PCP doctor at Wellness Center. They checked the baby''s heart beat. They checked my cervix also and didn''t find anything concerning. I was told to go back to the ER if the vaginal bleeding had increased. I am still experiencing the light bleeding. This is my first time having a baby, and the baby''s due date is February 8, 2022.


VAERS ID: 1853756 (history)  
Form: Version 2.0  
Age: 9.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-11-03
Onset:2021-11-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Headache, Pyrexia, SARS-CoV-2 test negative, Viral test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: Covid-19 test Viral test
CDC Split Type: vsafe

Write-up: I have very high fever that runs from 101.01 to 103.7 with a severe headache. This has lasted 4 to 5 day now. The fever does not go away but does get lower. I went to the doctor about this. They tested for Covid-19 test, negative result. They are running more viral test to make sure that it is not the flu. But I don''t know that result of the test at this moment.


VAERS ID: 1853759 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8028 / 3 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Abdominal discomfort, Axillary pain, Chills, Dizziness, Extra dose administered, Headache, Influenza like illness, Injection site pain, Lymphadenopathy, Nasal congestion, Neck pain, Pain, Pain in extremity, Peripheral coldness, Pyrexia, Restless legs syndrome, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Similar reaction to Pfizer COVID-19 vaccine dose #2 (administered 2/16/2021, lot number EN6200)
Other Medications: None
Current Illness: None
Preexisting Conditions: Chronic sinusitis (mild), seasonal allergies
Allergies: None known
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The side effects began with a low-grade fever and general achiness all over the body. This progressed to a high fever (~103.5 degrees F) with chills and extreme achiness. The fever was controlled with over-the-counter medication, but continued to spike up with the same intensity over the following 48-72 hours when left untreated. The injection site, including the left arm and armpit, were sore and achy over the next 96 hours. Some swelling in the lymph nodes occurred during the affected period, particularly in the left armpit and under the left-side jaw. There was achiness and soreness through the limbs, accompanied by a "restless legs"-type feeling occasionally in the legs. Headache was present on-and-off for 96 hours after the effects onset, with concentrated pain in the neck and brow area. Some vomiting and digestive upset occurred only in the first 24 hours after the injection. Other minor side effects include a cold feeling in the left side hand and fingertips, mild dizziness, and mild nasal congestion. Overall, the side effects were intense, but were generally flu-like and presented no discernable threat to safety or wellbeing.


VAERS ID: 1853776 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-11-03
Onset:2021-11-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067C21A / UNK AR / IM

Administered by: Other       Purchased by: ?
Symptoms: Contusion, Erythema, Haemorrhage, Immediate post-injection reaction, Pruritus, Skin warm, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin, calcium, folic acid, omegas, vitamin C, ? generic ambient (can''t recall if I took 2.5 mg the night before the injection.)
Current Illness: None.
Preexisting Conditions: None.
Allergies: None.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Immediate bleeding at time of injection with local swelling. Approximately 55 hours later I noted extensive bruising, redness extending down the arm nearly to the elbow with slight heat, itch and swelling--hive-like. Bleed and bruising continues one week later--some yellow/green, some blue, purple. Area of redness is smaller.


VAERS ID: 1853797 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Dyspnoea, Fatigue, Influenza, Injection site erythema, Injection site swelling, Nasopharyngitis, Pain
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad)

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

Write-up: very swollen, large softball size red around shot, chills, next day cold symptoms, 3nd day cough and short of breath, 4th day aches, flu symptoms, feels like I have covid AGAIN!! took advil, 2nd day cough medicine, 3rd day flue medicine, drank lots of liquid...symptoms still prevalent and very tired at end of 5th day . I have called Dr office, they do not think it is related to shot. I told them I have had covid, they said it was fine to get the shot 3 months after...it obviously was not. My Dr cannot see me until DECEMBER


VAERS ID: 1853843 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-04-09
Onset:2021-11-05
   Days after vaccination:210
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / UNK - / -

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

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

Write-up: covid + ON 11/8/21


VAERS ID: 1853868 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-30
Onset:2021-11-05
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Headache, Nausea, Neck pain, Photophobia, Scan brain
SMQs:, Acute pancreatitis (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Arthritis (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: Thyroid; Asthma; Sumatriptan
Current Illness: COPD; HYPOTHYROIDISM
Preexisting Conditions: COPD; HYPOTHYROIDISM
Allergies: Mushrooms
Diagnostic Lab Data: Brain Scan, Blood test.
CDC Split Type: vsafe

Write-up: Excruciating Headaches, Light sensitivity, Pain in upper neck, nausea.


VAERS ID: 1853884 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Condition aggravated, Fatigue, Feeling abnormal, Head discomfort, Headache, Pain, Pyrexia, Ventricular extrasystoles
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ventricular tachyarrhythmias (narrow), Dementia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sythroid, zoloft
Current Illness: n/a
Preexisting Conditions: PCOS, pituitary gland tumor, PVCs, low thyroid, low blood pressure
Allergies: Sulfa, foods - but unknown (happens randomly - usually when wood or seafood is involved)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within hours, a dull headache, which grew to usual side effects (fever, fatigue, headache, achy). However, 4-5 days later I still have a strong headache / pressure in head, and noticed fatigue and brain fog. Also noticing more PVCs than normal.


VAERS ID: 1853956 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-28
Onset:2021-11-05
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Electrocardiogram normal, Fatigue, Gastrooesophageal reflux disease, Headache, Rash, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific dysfunction (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: after first 2 shots headache and fatigue for 1-2 days. After booster shot had headache and fatigue day 1-5, then on day 8 get red bumps/rash on face, acid reflux symptoms that resolved with Pepcid. Day 10 rash was on bilateral palms as well as face (palms only, not whole hand), this is ongoing. Was prescribed prednisone on day 10, I''m writing this on day 12.


VAERS ID: 1853958 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 2 RA / IM

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

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

Write-up: Systemic: Numbness (specify: facial area, extremities)-Medium, Systemic: Tingling (specify: facial area, extemities)-Medium, Additional Details: Patient experienced numbness and tingling to the lower extermity on the right arm upto her elbow after receiving the covid19 2nd vaccine. She said the numbness went away the same day in the evening and the tingling went away in the late afternoon on 11/6/21 (saturday). she has recovered from her tingling and numbness.


VAERS ID: 1853960 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Extra dose administered, Fatigue, Injection site discolouration, Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth, Interchange of vaccine products, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: redness and swelling at injection site with influenza vaccines.
Other Medications: elavil, apple cider vinegar pill, vitamin c, calcium carbonate, vitamin D3, yasmin (ocp), elderberry tablet, magnesium oxide, multivitamin, zoloft.
Current Illness: none known
Preexisting Conditions: anxiety, depression.
Allergies: none known
Diagnostic Lab Data:
CDC Split Type:

Write-up: pfizer vaccine as booster dose to J&J vaccine 8 months prior. had flu shot in same location about 5 weeks prior. h/o prior reactions to flu shot with "red hard lump" but this flu shot, did not have that. about 1 day after vaccine, had typically chills, fever, fatigue lasting less than 24 hours. Then about 2-3 days after vaccine- had redness/ purple discoloration of the left arm near the injection site. 6 days post vaccine still has light pink and light purple discoloration in a patch distribution. itchy at times. Was raised and more painful and hot yesterday. not hot today.


VAERS ID: 1853970 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FH8030 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Dysphagia, Injection site pain, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (narrow)

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

Write-up: Site: Pain at Injection Site-Mild, Systemic: Allergic: Anaphylaxis-Medium, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Mild


VAERS ID: 1853986 (history)  
Form: Version 2.0  
Age: 5.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FK5127 PFR / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure decreased, Heart rate decreased, Pyrexia, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), COVID-19 (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: Cough, her doctor thought the cough was caused by post nasal drip due to allergies
Preexisting Conditions: None
Allergies: Seasonal allergies to pollen
Diagnostic Lab Data: They gave her a full panel swab and everything came back negative. They said her lungs sounded totally clear, her heart rate and BP went down while at the hospital as well.
CDC Split Type:

Write-up: The morning following the vaccine, the patient developed a fever of 101.2, but noon that day it got up to 103.5. I treated her with ibuprofen and a bath. After her nap that afternoon she woke up around 5:30 with a 104.2 fever. I took her to the ER and they treated her with ibuprofen. Her temp went down to 99.8 and they discharged us and said to follow up with her doc if it got worse.


VAERS ID: 1853993 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 11621 / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 11,621 / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, lisinopril ,synthroid venlafaxine ,amlodipine ,montelukast sodium Flovent , zydeco,aubertol
Current Illness:
Preexisting Conditions: Asthma,high blood pressure
Allergies: Aspirin, Levaquinn
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness ,itching ,sore ,skin hard and bumpy arm swollen and hot


VAERS ID: 1854008 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamins Grape seed extract Turmeric Over-the-counter enzymes
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data: CAT scan in ER- results normal
CDC Split Type:

Write-up: Fever ache for one day. Ice-pick headache lasting almost 2 weeks with need of prescription medicine


VAERS ID: 1854009 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-30
Onset:2021-11-05
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypomenorrhoea, Intermenstrual bleeding
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin, 150 mg daily, lexapro 10 mg daily
Current Illness: none
Preexisting Conditions: depression, anxiety
Allergies: penicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: My first menstrual period following the vaccine was 10/4 and it was normal. My second period was almost nonexistent- some spotting for approximately two days.


VAERS ID: 1854116 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-11-04
Onset:2021-11-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 071F2A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Nausea, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

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

Write-up: Patient presented to the ER at Hospital with nausea, vomiting, and tremors that developed 12 hours after vaccination. Was treated with Zofran and released.


VAERS ID: 1854128 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-11-03
Onset:2021-11-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2593 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Myalgia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Aches and pain of muscles and joints. severe vomiting.


VAERS ID: 1854184 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-11-05
Onset:2021-11-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Emotional distress, Feeling cold, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (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: moderna covid vaccine
Other Medications: Excedrin, estrogen tablets
Current Illness: none
Preexisting Conditions: no
Allergies: percocet
Diagnostic Lab Data: none
CDC Split Type:

Write-up: That evening I got really cold, shaking and emotional. It lasted about 4 hours.


VAERS ID: 1854255 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-10
Onset:2021-11-05
   Days after vaccination:299
Submitted: 0000-00-00
Entered: 2021-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK4176 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 11/6 SARS/COV-2, Positive
CDC Split Type:

Write-up: Breakthrough COVID


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