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

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



Case Details (Reverse Sorted by Onset Date)

This is page 263 out of 8,010

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VAERS ID: 1683679 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-27
Onset:2021-09-05
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood glucose increased, Blood test, Computerised tomogram, Dehydration, Vomiting, X-ray
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Dehydration (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: insulin
Current Illness: diabetes
Preexisting Conditions: diabetes
Allergies: none
Diagnostic Lab Data: CT scan, blood work, xray
CDC Split Type:

Write-up: ER visit for weakness, vomiting, elevated blood sugars, dehydration 9/6/2021


VAERS ID: 1683711 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-30
Onset:2021-09-05
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Palpitations
SMQs:, Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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

Write-up: Palpitations and shortness of breath. They''re constant throughout the day. No medication has been used to allievate these symptoms.


VAERS ID: 1683756 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-03
Onset:2021-09-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19 (Prior to vaccination, was the patient diagnosed with COVID-19?:Yes)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101162242

Write-up: Swollen lymphs - neck; This is a spontaneous report from a contactable consumer, the patient. A 28-year-old non-pregnant female patient received BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration on 03Sep2021 at 15:00 (at the age of 28-years-old) as a single dose for COVID-19 immunisation. Medical history included COVID-19. Prior to the vaccination, the patient was diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. Concomitant medications were not reported. The patient previously received ibuprofen (MANUFACTURER UNKNOWN) and experienced drug allergy. On 05Sep2021 at 08:00, the patient experienced swollen lymphs - neck. The event did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Therapeutic measures were not taken as a result of the event. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the event swollen lymphs - neck was unknown at the time of this report. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1683760 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-04
Onset:2021-09-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LEVOTHYROXINE; VIT C; VIT D [ERGOCALCIFEROL]; ZINC
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101168776

Write-up: Fever; Chills; Shakes; Vomiting; Abdominal cramping; Diarrhea; This is a spontaneous report from a contactable healthcare professional, the patient. A 47-year-old non-pregnant female patient received second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FD8448) via an unspecified route of administration in the left arm on 04Sep2021 at 14:00 (at the age of 47-years-old) as a single dose for COVID-19 immunisation. Medical history included hypothyroidism. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. Concomitant medications included levothyroxine (MANUFACTURER UNKNOWN), ascorbic acid (VIT C), ergocalciferol (VIT D), unspecified probiotics and zinc (MANUFACTURER UNKNOWN); all for an unknown indication from an unknown date and unknown if ongoing. The patient previously received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FC3180) via an unspecified route of administration in the left arm on 07Aug2021 at 12:00 (at the age of 47-years-old) as a single dose for COVID-19 immunisation. On 05Sep2021 at 00:00, the patient experienced fever, chills, shakes, vomiting, abdominal cramping and diarrhea. The events did not result in doctors or other healthcare professional office/clinic visit, and emergency room/department or urgent care. Therapeutic measures were not taken as a result of the events. Since the vaccination, the patient had not tested for COVID-19. The clinical outcome of the events fever, chills, shakes, vomiting, abdominal cramping and diarrhea were not recovered at the time of this report. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1683904 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-03
Onset:2021-09-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Electrocardiogram, Heart rate irregular, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiac arrhythmia terms, nonspecific (narrow), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: vit D Melatonin magnesium
Current Illness: none
Preexisting Conditions: arthritis
Allergies: compazine
Diagnostic Lab Data: ekg 9/5/21 numerous blood tests 9/5/21
CDC Split Type:

Write-up: Tacicardia and irregular heartbeat for 3 hours.


VAERS ID: 1684459 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-03
Onset:2021-09-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Feeling hot, Injection site swelling, Nodule
SMQs:, Anaphylactic reaction (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:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 3 days after vaccine I started noticing a swollen arm at the site injection, hot to the touch, redness, and a knot under the skin


VAERS ID: 1684490 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-05-21
Onset:2021-09-05
   Days after vaccination:107
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cerebral thrombosis, Intracranial aneurysm, Pulmonary embolism
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (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: Nuva Ring Exact date in May of vaccination unknown by pt at time of presentation. Stated second injection was in the middle of May 2021.
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bilateral left and right pulmonary artery PE''s, with development of cerebral aneurysm from blood clot to brain per family members update.


VAERS ID: 1684735 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

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

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

Write-up: Patient came to get the Pfizer vaccine, but was given the Moderna vaccine instead.


VAERS ID: 1684844 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 3 - / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sera taking, multivitamin, tramadol
Current Illness:
Preexisting Conditions: Spinal cord injury L-1
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe chills, fever for 4 days. Body aches and nauseas headaches


VAERS ID: 1684864 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-04
Onset:2021-09-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamin blend (daily), rizatriptan and naproxen (onset of migraine)
Current Illness: None
Preexisting Conditions: Migraines
Allergies: Prednisone
Diagnostic Lab Data:
CDC Split Type:

Write-up: day after (Sunday) had fever, chills, sweating, headache, tiredness, and body aches. Fever broke Sunday night. Monday still had slight aches and chill. Tues, Wed & Thurs, still having extreme fatigue and slight chills/sweating.


VAERS ID: 1684893 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-02
Onset:2021-09-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydroxyzine 25mg@hs Atorvastatin 40mg@hs Halogen 10mg@hs Lisinopril 5mg daily Pantoprazole 40mg2xdaily Duloxetine30my daily Fuosemide 40mg daily Cyanocobalamin 1,000mcg monthly Hydrocodone apap5-325 1 3daily
Current Illness: Low b12 Back pain, neck pain Muscle aches
Preexisting Conditions:
Allergies: Penicillin, sulfa, ivp dye
Diagnostic Lab Data: MD gave shot. Prescription of methylprednisol dose pk. Famotidine 4mg Halogen 25 mg 1-2 daily Lab work was done no results yes
CDC Split Type:

Write-up: Rash all body head to toe. In eyes. Throat


VAERS ID: 1685046 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-09-04
Onset:2021-09-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site pain, Insomnia, Migraine
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Migraines and insomnia, soreness at the injection site, still ongoing at this time of reporting


VAERS ID: 1685128 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-24
Onset:2021-09-05
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, COVID-19, Chills, Cough, Fatigue, Headache, Myalgia, Nasal congestion, Rhinorrhoea
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: anastrozole 1mg daily Calcium-Vitamin D 600mg-800 IU BID cyanocobalamin daily losartan 25mg daily multivitamin with minerals qPM omeprazole 20mg daily
Current Illness: None documented
Preexisting Conditions: polyosteoarthitis GERD osteopenia hypertension diverticulosis history of colon cancer history of breast cancer history of renal cell cancer ascending aorta dilation patent foramen ovale thyroid nodule
Allergies: contrast media - gadolinium based - Hives contrast media - iodine based - hives/itching tranexamic acid - itching Vicodin - ineffective pain control
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated. S/S: Headache, muscle aches, cough, fatigue, sore throat, congestion, runny nose, chills


VAERS ID: 1685160 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-02
Onset:2021-09-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 37F21A / 3 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fish oil, prenatal vitamins, vitamin C
Current Illness: bee sting allergy
Preexisting Conditions:
Allergies: bee sting, seafood
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itchy rash in a big circle around the injection side. Never happened on my first two shots before. It''s been 8 days since I had the vaccine. The rash is still showing on my left arm. Treatment: 3000mg Vitamin C, SARNA lotion, and Benadryl


VAERS ID: 1685230 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-16
Onset:2021-09-05
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chills, Pyrexia, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, Hyperthyroid
Allergies: No Known
Diagnostic Lab Data: Covid + 9/5/2021
CDC Split Type:

Write-up: Breakthrough Covid-19 First Dose 2/23/2021 84-year-old male brought in via EMS for generalized weakness and fever, tested positive for COVID in ED. His main concerns are the chills, alternating with fever, and the generalized weakness associated with this symptoms over the last couple of days according to his statement.


VAERS ID: 1685235 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-04
Onset:2021-09-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Extra dose administered, Injected limb mobility decreased, Lymphadenopathy, Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: cymbalta, levora, metformin, elmiron, crestor, synthroid, nexium, losartan, bystolic
Current Illness: none
Preexisting Conditions: type 2 diabetes, hashimotos disease
Allergies: red food coloring
Diagnostic Lab Data:
CDC Split Type:

Write-up: all the lymph nodes on the left side of my body swelled. could raise left arm or turn neck to left for several days


VAERS ID: 1685333 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-03
Onset:2021-09-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear swelling, Pharyngeal swelling, Pyrexia, Swelling, Tenderness, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Side that I received the vaccine on, side of neck blew up like a balloon. From my ear to the middle of my throat. Too drink of orange juice and it burned like crazy on that side. Very painful to touch. Went down in 5 hours after applying cold wash cloth constantly. Anything heavier hurt. Slight fever


VAERS ID: 1685413 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-03
Onset:2021-09-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Red, blotchy, itchy rash by injection site


VAERS ID: 1685420 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: North Dakota  
Vaccinated:2021-09-02
Onset:2021-09-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: General physical health deterioration
SMQs:

Life Threatening? Yes
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: nonenone
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: My health has been deteriating daily. I am now at the point where I can only function very slowly for a few minuets and have to rest.


VAERS ID: 1685516 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-17
Onset:2021-09-05
   Days after vaccination:141
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 RA / IM

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

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

Write-up: Individual with symptoms of SOB, body aches, and runny nose on 9/5/21. Tested covid positive on 9/7/21. Advised to isolate from family in separate rooms until 9/15/21 and to callback when done. Also, advised to callback if DOH contacts him.


VAERS ID: 1685525 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-04
Onset:2021-09-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Echocardiogram abnormal, Ejection fraction abnormal, Electrocardiogram abnormal, Magnetic resonance imaging heart, Myalgia, Myocarditis, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: NKDA
Diagnostic Lab Data: Hospital admission (9/6/21), EKG with typical pericarditis findings (9/6/21) echocardiogram with preserved ejection fraction (9/6/21), cardiac MRI with results pending at discharge (9/8/21), troponin of 42.02 (9/7/21)
CDC Split Type:

Write-up: The patient presented with myalgias and chest pain. He was found to have myopericarditis.


VAERS ID: 1685811 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast swelling, Dermatitis acneiform, Fatigue, Pruritus, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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: Moderna
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Prednisone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash and itching. Fever of 101. Swelling in armpits and breasts. Severe Fatigue


VAERS ID: 1685987 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 05321A / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injected limb mobility decreased, Injection site hypoaesthesia, Injection site pain, Injection site paraesthesia, Musculoskeletal pain, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Pt reports the evening she got home she started to feel numbness tingling and pain in the injection arm. She states she was unable to move her arm entirely so she put it in a sling. Now she is having pain radiating into her shoulder blade.


VAERS ID: 1686202 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-03
Onset:2021-09-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / IM

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

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

Write-up: Pt stated they woke up, got out of bed then lost consciousness for approximately 30min.


VAERS ID: 1686248 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-08-31
Onset:2021-09-05
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: I missed my period the month following receiving the vaccination. I am not pregnant and was not trying to get pregnant.


VAERS ID: 1686430 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Pt had a seizure for about 2 to 3 minutes following administration


VAERS ID: 1686596 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-02-27
Onset:2021-09-05
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Apixaban, glipizide, potassium citrate
Current Illness:
Preexisting Conditions: History of type 2 diabetes mellitus and cardiac arrhythmia with pacemaker
Allergies: Levofloxacin, sulfa
Diagnostic Lab Data: COVID status positive on 9/5/21.
CDC Split Type:

Write-up: Patient received Pfizer COVID vaccine out of state on 2/6/21 and 2/27/21. On 9/5/21, patient admitted to our facility for acute hypoxic respiratory failure due to COVID pneumonia. As of 9/9/21, patient is in CCU sedated on BiPAP.


VAERS ID: 1686728 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fear of injection, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: Patient vomited after 2 minutes of giving second dose of Pfizer Covid vaccine. His parents said he vomited in the past because he was afraid of needle and vaccine. Patient was responsive and answered the questions of pharmacist such as first name, last name, date of birth correctly. His chest raised up and down normally. Patient was sitting down and monitored by pharmacist for about 1 hour before he went home. He was laughing with siblings when he was sitting down for monitoring. Patient was completely fine when he left with his family. Pharmacist called up the parents to follow up about 5 to 6 hours after incident, and the parent said the patient was completely fine.


VAERS ID: 1688859 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-01
Onset:2021-09-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Arthralgia, Joint swelling, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: trandate and pariet
Current Illness: nil
Preexisting Conditions: HTN RSD
Allergies: HCTZ - rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: swelling in the right knee, swelling and arthalgias


VAERS ID: 1688900 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Around 3:30pm on Sunday 9/5 patient fainted after receiving covid vaccine. According to the pharmacist on duty that day it took some time for the patient to wake up. 911 was called and paramedic checked on her. She eventually walked out on her on her own with her mom.


VAERS ID: 1688915 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-07
Onset:2021-09-05
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: PCR + for Covid 9/8/2021
CDC Split Type:

Write-up: Client was vaccinated with Moderna vaccine for Covid on 4/7 and 5/7/2021. Covid symptoms started 9/5 (fever, nasal congestion, cough, headache). Tested + with PCR on 9/8 for Covid. Reported as a case of breakthrough Covid disease in fully vaccinated person.


VAERS ID: 1688939 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-17
Onset:2021-09-05
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: atorvastatin. clopidogrel, colchicine, ezetimibe, losartan...
Current Illness: N/A
Preexisting Conditions: CAD, Hx Stroke, CABG, Essential Hypertension, diabetes mel...
Allergies: Allopurinol
Diagnostic Lab Data: SARS-COV-2 (COVID-19) by NAA, Micro
CDC Split Type:

Write-up: Patient tested positive, otherwise asymptomatic.


VAERS ID: 1688969 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-05-27
Onset:2021-09-05
   Days after vaccination:101
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW 0170 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW 0185 / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 pneumonia, Dyspnoea, Productive cough, Sputum discoloured
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: sxs of Shortness of breath and productive cough with green phlegm started on 9/05/2021. ADmitted to Hospital on 9/6/2021 and diagnosed with COVID pneumonis


VAERS ID: 1689039 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-08-30
Onset:2021-09-05
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA 7484, FC 318 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Testicular pain, Ultrasound scan, Urine analysis
SMQs:, Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pantoprazole, melatonin
Current Illness: Acid reflux, GERD
Preexisting Conditions: Migraine headaches, back and knee pain, sleep issues, acid reflux
Allergies: None
Diagnostic Lab Data: Urinalysis, blood draw, and ultrasound
CDC Split Type:

Write-up: Severe right testicular pain without inflammation


VAERS ID: 1689122 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-06
Onset:2021-09-05
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 antibody 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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: ESRD, DM Type Two, HTN, BPH
Allergies:
Diagnostic Lab Data: + COVID serology test
CDC Split Type:

Write-up: Breakthrough infection


VAERS ID: 1689225 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Hyperhidrosis, Nausea, Pallor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Prior to vaccination patient stated that she had no known allergies and she may or may not be pregnant. Couple minutes after administration pharmacy associate asked her how she was feeling, she said she was fine. At around 8 minutes after administration she started gasping for air and sweating profusely. She looked pale and nauseous. No swelling of the face or lips were seen. Patient was not speaking English, so her husband was translating for her. I asked her if she had trouble breathing. She nodded yes. We called 911. He breathing was getting worse, so I administered Epipen. Several minutes after administration she slowly started to feel better. Her breathing improved. By the time EMS arrived, her condition improved significantly and she was reluctant to go with them but ended up going anyway.


VAERS ID: 1689271 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-04
Onset:2021-09-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

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

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

Write-up: rash and hives in the arm of shot, chest, and legs for a few hours, benadryl was taken twice before it went away


VAERS ID: 1689281 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-02
Onset:2021-09-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: None
Allergies: Not to my knowledge
Diagnostic Lab Data: None
CDC Split Type: vsafe

Write-up: I''m a general contractor I went out of town to visit a friend and lost my voice. I went to the hospital and they prescribed me prednisone and sent me on my way. Went home a 1.5 days later and it got worse and completely lost my voice. I went to the hospital and the Dr. prescribed me Flonase, antibiotics and more prednisone.


VAERS ID: 1689286 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-12
Onset:2021-09-05
   Days after vaccination:177
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / 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: Hospitalization on 9/5/2021 due to COVID19. Reported per Janssen COVID vaccine EUA.


VAERS ID: 1689414 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-03-24
Onset:2021-09-05
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anaemia, Chills, Fatigue, Full blood count, Headache, Laboratory test abnormal, Lymphadenopathy, Thrombocytopenia
SMQs:, Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (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: None
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NKDA
Diagnostic Lab Data: CBC / Anemia labs 09/09/2021
CDC Split Type:

Write-up: Fatigue, Chills, Headache, Lymphadenopathy, Thrombocytopenia, Anemia


VAERS ID: 1689451 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-31
Onset:2021-09-05
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 2 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 3 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Pyrexia, Respiratory viral panel, SARS-CoV-2 test negative
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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Full COVID and respiratory panel ran and all came back negative.
CDC Split Type:

Write-up: Patient presented to facility after having severe reaction to booster. Patient states the day after her booster, she developed a low grade fever. however her symptoms worsened over the next week. patient came to ED two times before getting admitted on 9/5/21.


VAERS ID: 1689502 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / UNK LA / OT

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

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

Write-up: Rash from ankles to neck. Still have rash 6 days after 2nd shot.


VAERS ID: 1689537 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Muscle spasms, Neck pain, Status migrainosus
SMQs:, Dystonia (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Topiramate 50mg daily, Fluoxetine 30mg daily, Eletriptan 20mg prn migraine
Current Illness: None
Preexisting Conditions: Well-controlled migraine headaches
Allergies: Amoxicillin - hives; extensive food allergies per documentation (exact details unknown)
Diagnostic Lab Data:
CDC Split Type:

Write-up: Prolonged uncontrolled status migrainosus, not controlled with triptan or even IV medications in the hospital; severe and painful muscle spasms in neck/shoulder area.


VAERS ID: 1689607 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-02
Onset:2021-09-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse drug reaction, Dermatitis, Dermatitis contact, Discomfort, Erythema, Pain, Rash, Rash pruritic, Sensitive skin, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 50 mg five (5) tablets once daily, Prenatal Formula four (4) gummies once daily, Stool Softener 100 mg one (1) capsule once daily, Simethicone 250mg one to two (1-2) soft gels PRN, Benadryl 25 mg one to two capsules (1-2) PRN. H
Current Illness: Five weeks postpartum at the time of receiving the second dose of the Pfizer-BioNTech COVID-19 Vaccine and had just recovered from a facial rash and swelling following the first dose of the Pfizer-BioNTech COVID-19 Vaccine.
Preexisting Conditions: Skin conditions: Eczema, Psoriasis, Contact Dermatitis, rashes/hives, Hyperhidrosis, Polymorphous Light Eruption (PLME), Digestive disorder: Gastroesophageal Reflux Disease (GERD), Mental health disorders: Obsessive Compulsive Disorder (OCD), Generalized Anxiety Disorder and Depression
Allergies: Valtrex, Diazolidinyl urea, Imidazolinyl urea, epoxy resin, poison ivy, yellow jacket stings and other insect bites
Diagnostic Lab Data: None - just the recent exams
CDC Split Type:

Write-up: On Sunday, 9/5/21, I began developing itchy rash/hives on my face, elbow creases, forearms, underarms and groin. The affected areas became more red, inflamed and itchy over the next couple days and the rashes spread to my neck, upper extremities (biceps, forearms, wrists and palms), trunk (sides and under breasts), groin, inner thighs and intergluteal cleft. On Tuesday, 9/7/21, I was seen at a local urgent care facility to be evaluated and treated for my rashes/hives. The provider diagnosed my condition as contact dermatitis, prescribed me Methylprednisolone 4 mg Dospak and recommended that I make an appointment with my dermatologist. She also encouraged me to report my reaction to VAERS since the rashes/hives occurred after receiving the COVID-19 vaccine. During the visit, I mentioned being seen by my primary care doctor on Saturday, 8/21/21 after experiencing a severe facial rash/hives earlier that week since it occurred after the first dose of the COVID-19 vaccine (received on Thursday, 8/12/21). I did not piece the events together until my urgent care visit. It seemed like the facial rash appeared more delayed following the first dose of the vaccine. I experienced more severe itching, inflammation and pain/discomfort over the next couple days. On Thursday, 9/9/21, I visited my dermatologist who examined me and said the rashes/hives appear to be a drug reaction and/or dermal hypersensitivity (possibly related to the COVID-19 vaccine). The doctor advised me to continue the Methylprednisolone Dospak, take Zyrtec 10 mg one (1) capsule once a day in the morning and Benadryl 25 mg one to two (1-2) capsules once a day in the evening and stop all unnecessary medications and supplements (e.g., no Ibuprofen, Tylenol, Colace, prenatal vitamins). She also prescribed Triamcinolone 0.1% Ointment 454 gm (apply to affected areas 2-3x a day for up to three weeks) and recommended applying Vaseline to the sensitive areas where ointment cannot be applied (face, underarms and groin area). I''m still experiencing severe itching, inflammation and redness today and haven''t had much relief with the medications or treatments.


VAERS ID: 1689637 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dysphagia, Glossodynia, Hypoaesthesia oral, Rash erythematous, Swollen tongue, Tongue eruption
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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: Zyrtec
Current Illness:
Preexisting Conditions:
Allergies: Sulfa and penecillin. Possible polysorbate 80??
Diagnostic Lab Data:
CDC Split Type:

Write-up: Selling and numbness of tongue. Red rash/ sore under tongue. Unable to swallow properly.


VAERS ID: 1689682 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: New York  
Vaccinated:2021-08-24
Onset:2021-09-05
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Angiogram, Bacterial test, Bell's palsy, Chest X-ray, Computerised tomogram head, Electrocardiogram, Full blood count, Metabolic function test, Prothrombin time
SMQs:, Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Obesity, tobacco use
Allergies: None
Diagnostic Lab Data: 9/5/2021: CT head, CTA head and neck, CBC, CMP, Lyme, PTT, PT, EKG, chest x-ray (all related to ED encounter)
CDC Split Type:

Write-up: Left sided bells palsy


VAERS ID: 1691405 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New Mexico  
Vaccinated:0000-00-00
Onset:2021-09-05
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Feeling abnormal, Hypokinesia, Insomnia, Muscle fatigue, Muscular weakness, Neuralgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypotonic-hyporesponsive episode (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: ROSUVASTATIN
Current Illness: Abstains from alcohol; Cholesterol; Cigarette smoker (10 cigarettes/day)
Preexisting Conditions: Comments: The patient had no drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210918471

Write-up: FEELS HORRIBLE; CANNOT USE ARM; UNABLE TO SLEEP; MUSCLE FATIGUE; SHOOTING NERVE PAIN IN THE INJECTION SITE, INTO THE BACK, UP TO THE NECK AND DOWN THE ARM; MUSCLE WEAKNESS; This spontaneous report received from a patient concerned a 63 year old female. The patient''s weight was 120 pounds, and height was 68 inches. The patient''s concurrent conditions included: cholesterol, cigarette smoker 10 cigarettes/day, and non alcohol user, and other pre-existing medical conditions included: The patient had no drug abuse or illicit drug usage. The patient experienced did not wear off for 2 weeks after receiving it at the dentist''s office when treated with articaine hydrochloride/epinephrine bitartrate. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular, batch number: 203A21A, expiry: UNKNOWN) dose was not reported, administered on 26-AUG-2021 13:15 for prophylactic vaccination. Concomitant medications included rosuvastatin for cholesterol. On 05-SEP-2021, the patient experienced shooting nerve pain in the injection site, into the back, up to the neck and down the arm. On 05-SEP-2021, the patient experienced muscle fatigue. On 05-SEP-2021, the patient experienced muscle weakness. On 06-SEP-2021, the patient experienced unable to sleep. On 09-SEP-2021, the patient experienced cannot use arm. On an unspecified date, the patient experienced feels horrible. Treatment medications (dates unspecified) included: ibuprofen, diphenhydramine hydrochloride, and paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from shooting nerve pain in the injection site, into the back, up to the neck and down the arm, muscle weakness, unable to sleep, muscle fatigue, and cannot use arm, and the outcome of feels horrible was not reported. This report was non-serious.


VAERS ID: 1692304 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-04
Onset:2021-09-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Ear discomfort, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure abnormal (BP); Hemoglobin A1C increased (High a1c); High cholesterol
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101161570

Write-up: Blurred vision; Clogging of both ears; This is a spontaneous report from a contactable consumer, the patient. A 56-year-old male patient received BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 04Sep2021 at 13:30 (at the age of 56-years-old) as a single dose for COVID-19 immunisation. Medical history included high a1c, blood pressure (BP) and high cholesterol. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the COVID vaccine. Concomitant medications were not reported. On 05Sep2021 at 13:30, the patient experienced blurred vision and clogging of both ears 24-48 hours after the shot. The adverse events did not result in a visit to the doctor or other healthcare professional office/clinic visit and emergency room/department or urgent care. Since the vaccination, the patient had not been tested for COVID-19. Therapeutic measures were not taken as a result of the reported events. The clinical outcome of the events blurred vision and clogging of both ears was not resolved at the time of this report.


VAERS ID: 1692354 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-04
Onset:2021-09-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101170494

Write-up: Fever; Chills; Muscle aches; Tired; This is a spontaneous report from a contactable consumer, the patient. A 13-year-old male patient received second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the right arm on 04Sep2021 at 16:00 (at the age of 13-years-old) as a single dose for COVID-19 immunisation. The patient had no medical history. The patient had no known allergies. The patient did not receive any other vaccines within four weeks prior to the COVID-19 vaccine. The patient did not receive any concomitant medications. The patient previously received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on an unknown date in Aug2021 at 16:00 (at the age of 13-years-old) as a single dose for COVID-19 immunisation. On 05Sep2021 at 00:00, the patient experienced fever, chills, muscle aches and tired. The events resulted in doctor or other healthcare professional office/clinic visit. Since the vaccination, the patient had not been tested for COVID-19. Therapeutic measures were not taken as a result of the events. The clinical outcome of the events fever, chills, muscle aches, and tired were recovered on an unknown date in Sep2021. The lot number for BNT162b2, was not provided and will be requested during follow up.


VAERS ID: 1692355 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-09-01
Onset:2021-09-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3102 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Anosmia
SMQs:, Taste and smell disorders (narrow), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101170664

Write-up: Loss of taste and smell; Loss of taste and smell; This is a spontaneous report from a non-contactable consumer, the patient. A 28-year-old male patient received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FC3102) via an unspecified route of administration in the left arm on 01Sep2021 at 20:45 (at the age of 28-years-old) as a single dose for COVID-19 immunisation. The patient had no medical history and no known allergies. Prior to vaccination, it was unknown whether the patient was diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. Concomitant medications were reported as not applicable. On 05Sep2021 at 00:00, the patient experienced loss of taste and smell. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Since the vaccination, the patient had not been tested for COVID-19. Therapeutic measures were not taken as a result of the events. The clinical outcome of the events loss of taste and smell was not resolved at the time of this report. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1692445 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Electrocardiogram normal, Fatigue, Palpitations, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NKDA
Diagnostic Lab Data: EKG NORMAL 9/11/21
CDC Split Type:

Write-up: HEART RACING, FEVER, CHILLS, FATIGUE


VAERS ID: 1692915 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Unknown  
Location: New York  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / UNK UN / IM

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

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

Write-up: Patient felt numbness in their hands and legs. Patient was monitored for 1 hour. Patient was evaluated by EMS. Patient signed an RMA.


VAERS ID: 1692944 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-01
Onset:2021-09-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cough, Headache, Influenza like illness, Insomnia, Malaise, Nausea, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Berberine, Vi C and D, fish oil, multi vitamin, zinc
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: First 3 days, I had a headache and trouble sleeping. This turned into flu like symptoms for 4 days. I?m still experiencing flu-like symptoms (congestion, cough, malaise, nausea, headache).


VAERS ID: 1692971 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-04
Onset:2021-09-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: tramadol, cephalosporin antibiotics, gluten, milk
Diagnostic Lab Data: I was hospitalized and placed on anti-seizure medication. (9-5-2021 thru 9-7-2021)
CDC Split Type:

Write-up: 24 hour later, I had seizures. (9-5-2021)


VAERS ID: 1693060 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 RA / IM

Administered by: Pharmacy       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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: no
Allergies: none
Diagnostic Lab Data: patient has had no adverse event
CDC Split Type:

Write-up: moderna was given to patient under 18 years of age


VAERS ID: 1693142 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-28
Onset:2021-09-05
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Shingles


VAERS ID: 1693163 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-03-11
Onset:2021-09-05
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

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

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

Write-up: None stated.


VAERS ID: 1693315 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-01
Onset:2021-09-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Asthma, Condition aggravated
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

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

Write-up: Asthma flare began a couple of hours following the injection. Her Asthma is very mild and she has not experienced a flare in several years.


VAERS ID: 1693503 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-01
Onset:2021-09-05
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 - / SYR

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Dizziness, Fatigue, Feeling abnormal, Pain, Pyrexia, Rash pruritic, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Bupropion
Current Illness:
Preexisting Conditions: Depression, anxiety,
Allergies: Hair dye, jewelry
Diagnostic Lab Data: Covid test. Negative. 9/8/21
CDC Split Type:

Write-up: Fatigue, weakness, all over ach, fevered rash about 6in in diameter that itched, fever, dizziness, felt out of it for a day


VAERS ID: 1693508 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-29
Onset:2021-09-05
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F2HA / 1 RA / SC

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

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

Write-up: Hair loss and pain in arm.


VAERS ID: 1693785 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-28
Onset:2021-09-05
   Days after vaccination:100
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH BW0179 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Neuromuscular pain
SMQs:, Peripheral neuropathy (broad)

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

Write-up: Severe neuromuscular pain in right side of uterus, hip and legs


VAERS ID: 1693857 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-18
Onset:2021-09-05
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chest pain, Dizziness, Dyspnoea, Gait disturbance, Hypotension, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol (PROVENTIL HFA) 108 (90 BASE) MCG/ACT HFA inhaler allopurinol (ZYLOPRIM) 100 MG tablet gabapentin (NEURONTIN) 100 MG capsule loperamide (IMODIUM) 2 MG capsule vitamin D3 (CHOLECALCIFEROL) 5000 UNIT CAPS capsule
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 test positive on 9/5/2021
CDC Split Type:

Write-up: Patient presented on 9/5/2021 to the emergency department with weakness and inability to ambulate. She was previously admitted from 9/2/2021 to 9/3/2021 for lightheadedness, hypotension, chest pain and shortness of breath. She was found to be COVID-19 positive and was admitted for further management. She was treated with dexamethasone, remdesivir, and supplemental oxygen. She was able to be weaned off oxygen prior to discharge. Patient was discharged to home on 9/10/2021.


VAERS ID: 1694098 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-01-01
Onset:2021-09-05
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Positive COVID19 PCR on 9/5/2021


VAERS ID: 1694140 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-03
Onset:2021-09-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Disorientation, Disturbance in attention, Dizziness, Fatigue, Feeling abnormal, Gait disturbance
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (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: vitiligo
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizzyness, lightheaded, sense of instability and balance issues, disoriented, difficulty to focus or concentrate. Feeling of swaying while sitting or standing still, fatigue.


VAERS ID: 1694194 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-19
Onset:2021-09-05
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Product dose omission issue
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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: Erythromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Second vaccine dose not given. Admitted to hospital; given remdesivir, on oxygen, on dexamethasone


VAERS ID: 1694312 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-05-25
Onset:2021-09-05
   Days after vaccination:103
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / UNK - / -

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

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

Write-up: Covid positive..household contact


VAERS ID: 1694351 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-01-20
Onset:2021-09-05
   Days after vaccination:228
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / UNK - / -

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

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

Write-up: Covid positive contact unknown


VAERS ID: 1694422 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-02
Onset:2021-09-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: flat red fixed drug rash to chest / armpits


VAERS ID: 1694460 (history)  
Form: Version 2.0  
Age: 88.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-02
Onset:2021-09-05
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028A21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Laboratory test abnormal, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol, Norvasc, Lutein. toprol, nitroglycerin, prilosec, zocor, carafate
Current Illness:
Preexisting Conditions: CAD, HTN, AAA, Lung cancer, prostate cancer, COPD, Thrombocytopenia
Allergies:
Diagnostic Lab Data: Swabbed positive on admission 9.5.2021
CDC Split Type:

Write-up: Vomitting,


VAERS ID: 1694493 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-02
Onset:2021-09-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH SD8448 / 2 LA / IM

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

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

Write-up: My period started on 09-05-2021, even though I was taking Junel. There was no reason why period started. It has finally started to taper off since yesterday.


VAERS ID: 1694494 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2020-12-31
Onset:2021-09-05
   Days after vaccination:248
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Senior Living       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: COVID-19 Test on 9/6/21
CDC Split Type:

Write-up: Employee tested positive for COVID-19 on 9/6/21


VAERS ID: 1694506 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-17
Onset:2021-09-05
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 807772730 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Decreased appetite, 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: CHRONIC CONDITIONS INCLUDE DEMENTIA, HTN, ATAXIA, CKD
Allergies:
Diagnostic Lab Data: POSITIVE SARS-COV-2 BY PCR
CDC Split Type:

Write-up: This case meets vaccine breakthrough criteria . SXS LACK OF APPETITE


VAERS ID: 1694589 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-22
Onset:2021-09-05
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / UNK - / -

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

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

Write-up: positive covid test and symptoms


VAERS ID: 1694641 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: California  
Vaccinated:2021-01-07
Onset:2021-09-05
   Days after vaccination:241
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Agitation, Altered state of consciousness, COVID-19, Insomnia, SARS-CoV-2 test positive
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 09/05/2021, COVID-19 (NAA), Positive
CDC Split Type:

Write-up: Patient is fully vaccinated for COVID-19, one dose documented 01/07/2021, date of other isn''t documented. 78 YO F with PMHx dementia, chronic anemia, GERD, hypothyroidism, depression sent to the ED from nursing facility for ALOC. She was seen at this hospital yesterday for 2 days of insomnia, increased agitation, at which time her work-up was unremarkable. She was D/C back to nursing facility and then returned today for persistent AMS. She was Dx with COVID in the ED and will be admitted to COVID medical floor since she is medically stable...On 9/7 I called patients'' relative, who is the POA, informed him of the patient''s poor prognosis, and he agreed to switch the patient to comfort care.


VAERS ID: 1694652 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-19
Onset:2021-09-05
   Days after vaccination:229
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Lethargy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. came in with medical history of Myocardial infarction, dyslipidemia, dimentia; Presented with worsening weakness, lethargy, and low grade fever; Pt is on Remdesivir, cefepime, dexamechasone; aspirin; pantoprazole; Inpatient


VAERS ID: 1695048 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: New York  
Vaccinated:2021-01-13
Onset:2021-09-05
   Days after vaccination:235
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

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

Write-up: VAERS completed because of being Tested positive for COVID-19 infection 14 or more days after being fully vaccinated. 1st dose12/22/20 2nd dose01/13/21 Diagnosed covid positive:09/07/21 Symptom onset:09/05/21 Exposure:Travel Symptoms:cough, fatigue, sore throat, runny nose, HA.


VAERS ID: 1695065 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-04
Onset:2021-09-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Fatigue, Lip pruritus, Pharyngeal swelling, Pruritus, Urticaria, X-ray
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
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: Humalog insulin , Albuterol, Symbicort, Flovent,
Current Illness: Type one diabetic asthma bronchitis acid reflex disease geard
Preexisting Conditions: Type one diabetic acid reflux disease guard asthma bronchitis
Allergies: Allergic to pork allergic to beef allergic to chicken Allergic to lisinopril allergic to NovoLog insulin allergic to sulfur eight allergic to codeine
Diagnostic Lab Data: hospital Blood work, X-ray , iv medicine
CDC Split Type: 06081

Write-up: Itchy lips , swollen throat, itchy feet , hives on face , itchy body all over , Fatigue,


VAERS ID: 1695232 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-04
Onset:2021-09-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 2 LA / SYR

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? Yes
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: IV contrast, sunscreen
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Numbness and tingling to the hand and arm of vaccinated arm, 2nd dose COVID vaccination, numbness and tingling has lasted 10 days so far with no improvement.


VAERS ID: 1695252 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamictal , clondine
Current Illness: none
Preexisting Conditions: none
Allergies: no none allergies to food, or medications/ any other products
Diagnostic Lab Data: none
CDC Split Type:

Write-up: patients has stated that dizziness has started approx 1 hours after receiving the short and had had low level dizziness ever since. Never really went away.


VAERS ID: 1696093 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-26
Onset:2021-09-05
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Herpes zoster, Induration, Inflammation, Lymphadenopathy, Mass
SMQs:, Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Minivelle Patch, .10 mg, Rousuvastatin 5 mg/day, Aspirin 81 mg. , COQ-10 200 mg, Calcium 1200 mg, Vit D 5000 iu, Fish Oil 2400 mg, Antioxidant, Zinc 50 mg, Multivitamin, Folic Acid 400 mcg, Krill Oil 500 mg, B Complex, Selenium 200 mcg.
Current Illness: None
Preexisting Conditions: none
Allergies: None
Diagnostic Lab Data: I described the doctors I went to in Item 18.
CDC Split Type:

Write-up: I''ve had many adverse reactions. I''ll list them in order: 8-28-21 - Swollen lymphnodes under left arm. 9-5-21 - Got shingles on the right side of my upper chest. I did a tele med call over the computer because I realized I had shingles on a weekend. On day two of getting shingles, I went on Valtrex for that. 9-8-21 - Inflamed, hard lumps on both sides of chin. After googling it I found this is a reaction to the Juvederm fillers that I had back on 6-22-21, three months ago. I went to my PCP on 9-13-21 for an exam and then left there and went right to my dermatologist, the one that injected the fillers three months ago. Dr., the dermatologist, injected steroids into the areas of the large lumps (about 8 injections in total). Then today, he called in a RX for Linisiopril 10 mg. 1/day in am. I am so upset that this all is happening to me and I''ve only had the first dose. I didn''t want to get the vaccine in the first place, since I''ve already had Covid twice, but my adult children kept pushing me to do it. What the heck is going on with me???? My face looks disfigured due to these large, hard lumps.


VAERS ID: 1696260 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-23
Onset:2021-09-05
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Anticoagulant therapy, Arthralgia, Asthenia, Atrial fibrillation, Balance disorder, Beta haemolytic streptococcal infection, Blood lactic acid, C-reactive protein increased, COVID-19, COVID-19 pneumonia, Cardiac telemetry, Computerised tomogram head normal, Condition aggravated, Dyspnoea, Fall, Fibrin D dimer increased, Heart rate increased, Hypoxia, Inflammatory marker test, International normalised ratio increased, Joint swelling, Lactic acidosis, Nitrite urine absent, Procalcitonin increased, Productive cough, Pyrexia, SARS-CoV-2 test positive, Sepsis, Staphylococcus test positive, Tracheal aspirate culture, Troponin, Urine analysis normal, Urine leukocyte esterase, White blood cell count increased
SMQs:, Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Lactic acidosis (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acarbose (PRECOSE) 25 MG tablet alfuzosin (UROXATRAL) 10 MG 24 hr tablet atorvastatin (LIPITOR) 20 MG tablet cefTRIAXone (ROCEPHIN) 2 g/20mL injection clindamycin (CLEOCIN) 150 MG capsule digoxin (LANOXIN) 125 MCG tablet dilTIAZem (CARDIZEM
Current Illness: Pain and swelling of knee; mobility issues
Preexisting Conditions: Benign prostatic hyperplasia, unspecified whether lower urinary tract symptoms present Type 2 diabetes mellitus without complication, without long-term current use of insulin (HCC) Chronic atrial fibrillation (HCC) Mixed hyperlipidemia Essential hypertension Tobacco dependence Chronic venous insufficiency Coronary artery disease involving native coronary artery of native heart without angina pectoris Obstructive sleep apnea on CPAP Primary osteoarthritis involving multiple joints Hx of colonic polyp Fungal nail infection Abnormal digital rectal exam PAD (peripheral artery disease) (HCC) Platelets decreased (HCC) Pain and swelling of knee, right Pneumonia due to COVID-19 virus Bacteremia due to group B Streptococcus Uncontrolled type 2 diabetes mellitus (HCC) Gram-positive cocci bacteremia Atrial fibrillation with rapid ventricular response (HCC) Atrial fibrillation with rapid ventricular response (HCC)
Allergies: Amoxicillin [Penicillins] Rash Ampicillin Other
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized; COVID-19 positive (9.5.21); fully vaccinated Admission Date: 9/4/2021 Discharge Date: 09/13/2021 ASSESSMENT / PLAN: 1. COVID-19 pneumonia, Tylenol p.r.n. fever, oxygen as per protocol, IV remdesivir, Decadron, bronchodilators, zinc, thiamine, undo with full inflammatory markers 2. Atrial fibrillation monitor telemetry, continue metoprolol, and Coumadin for anticoagulation. INR is therapeutic at 2.3 3. Possible sepsis likely from COVID-19 lactic acidosis resolved, procalcitonin elevated, CRP also elevated, urinalysis negative nitrite and esterase , continue ceftriaxone and Zithromax for possible superimposed bacterial pneumonia 4. DVT prophylaxis patient therapeutic on Coumadin. Pharmacy to dose Coumadin HISTORY OF PRESENT ILLNESS: PT is a 76 y.o. male with history of chronic knee pain who had initially come to the emergency room for evaluation of the he lost balance while coming out of his truck and fell backwards. He claims he did not hit his head and he did not lose consciousness but reported worsening right knee pain. He also reports occasional cough which sometimes is productive none mild shortness of breath, he does not use oxygen at home. He denies chest pain reports fever denies nausea vomiting abdominal pain or diarrhea. Denies dysuria hematuria no leg pain or swelling In the emergency room maximum temperature was 38.5? centigrade, patient was hypoxic with oxygen saturation of 87 and was subsequently placed on 2 L nasal cannula, troponin less than 6, lactic acid was 2.3 but trended downwards, procalcitonin 1.64, WBC count of 11.65 2 CT scan of the head was unremarkable CTA of the chest no evidence of PE shows mild COVID-19 pneumonia PRESENTING PROBLEM: Weakness [R53.1] Atrial fibrillation with RVR (HCC) [I48.91] Fever, unspecified fever cause [R50.9] Sepsis, due to unspecified organism, unspecified whether acute organ dysfunction present (HCC) [A41.9] Pneumonia due to 2019 novel coronavirus [U07.1, J12.82] COVID-19 virus infection [U07.1] HOSPITAL COURSE: Admitted to the hospital with COVID pneumonia, treated with steroids, remdesivir, supplemental oxygen, empirical antibiotic coverage. Blood culture grew Streptococcus agalactiae, initially source was thought to be the right knee, it was initially swollen and painful following a fall that the patient experienced prior to coming to the hospital. Orthopedics were consulted, aspirate negative for Streptococcus agalactiae. Treatment with Rocephin 2 g daily that the ID consultant recommended be continued for 2 weeks, it started on the 7th, it will be continued until the 20th on outpatient basis. Oxygen was weaned down to room air fairly early during the course of hospitalization The patient is on Coumadin for history of atrial fibrillation, initially INR was supratherapeutic, over the last 3 days before today INR has been subtherapeutic therefore a CT angiography of chest to rule out PE given the fact that the D-dimer was more elevated was done, negative for PE but more inflammatory changes of COVID found. For the AFib RVR in addition to his Lopressor 100 mg twice a day I added Cardizem initially IV and subsequently orally, I added digoxin up to 125 mcg daily but previous to that loading of 2 consecutive days 500 mcg IV daily done. Since heart rate was still elevated I increased the Lopressor to 150 mg by mouth twice a day. I explained to the patient that this is more than likely consistent with AFib RVR resulting directly from the presence of COVID pneumonia therefore I am anticipating that in the future these medications will need to be scaled back so I encouraged him to follow-up with his primary care physician to do that. Need for continuous hospitalization up to this point was 1. COVID pneumonia isolation, 2. Need for IV antibiotic, 3. Ongoing AFib RVR with rates above 100 requiring active medication adjustment and intravenous medication and close monitoring.


VAERS ID: 1696270 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-30
Onset:2021-09-05
   Days after vaccination:128
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 2 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet aspirin 81 MG enteric coated tablet benzonatate (TESSALON) 100 MG capsule donepezil (ARICEPT) 10 MG tablet escitalopram (LEXAPRO) 20 MG tablet lactulose (CONSTULOSE) 20 GM/30ML SOLN melatonin 3 MG table
Current Illness: NA
Preexisting Conditions: HTN (hypertension) Alcohol dependence with withdrawal (HCC) Urinary retention Anemia COVID-19 Chronic liver disease Dementia with behavioral disturbance (HCC) Cerebral vascular disease
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized; COVID-19 positive (9.5.21); fully vaccinated Admission Date: 9/5/2021 Discharge Date: 9/8/2021 DISCHARGE DIAGNOSES: 1. COVID-19 infection 2. Urinary retention 3. History of multiple strokes 4. Dementia with behavioral disturbance 5. Chronic liver disease 6. Anemia 7. Benign essential hypertension DETAILS OF HOSPITAL STAY: HOSPITAL COURSE: Patient is a 69-year-old male who was brought to the ED after testing positive for COVID-19 at his long-term care facility. Due to his positive COVID test, he was unable to status facility, so was sent to the emergency department for further evaluation. He was hemodynamically stable in the emergency department with normal labs, but due to placement issues, he was admitted to the hospitalist service for further care. Upon admission, the patient was monitored on the general medical floor. We discussed regenerate on therapy with his guardian, but never heard back from the guardian as to whether or not she wished to pursue this, so it was never given. He remained hemodynamically stable, with normal labs throughout his inpatient stay. He is to be discharged for continued isolation until he can return to his local skilled nursing facility.


VAERS ID: 1696284 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-03
Onset:2021-09-05
   Days after vaccination:186
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 2 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Blood culture, COVID-19, Culture urine, Diarrhoea, Insomnia, Leukocytosis, Malaise, Metastases to lymph nodes, Nausea, Neuroendocrine carcinoma, Pyrexia, Retroperitoneal mass, SARS-CoV-2 test positive, Sepsis, Transitional cell carcinoma, Urinary tract infection, Urine analysis abnormal, White blood cell count
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), 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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Haematological malignant tumours (narrow), Non-haematological malignant tumours (narrow), Infective pneumonia (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 MG CAPS aspirin 81 MG enteric coated tablet atorvastatin (LIPITOR) 80 MG tablet diphenhydrAMINE (SOMINEX) 25 MG tablet ezetimibe (ZETIA) 10 MG tablet Glucosamine-Chondroitin (MOVE FREE PO) Melatonin 10 MG CAPS MU
Current Illness: COVID-19 positive 9.5.21 ED visit 9.5.21 Metro Health - fever, chills & vomiting, since Thursday, chemo infusion on Thursday - COVID positive
Preexisting Conditions: Hyperlipidemia LDL goal <100 CAD (coronary artery disease) OSA (obstructive sleep apnea) Lumbar radicular pain Impaired fasting glucose Bladder cancer (HCC) Stage 3b chronic kidney disease Hypertension Abdominal wall hernia Erectile dysfunction Anemia Iron deficiency anemia COVID-19 Sepsis (HCC)
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized; COVID-19 positive (9.5.21); fully vaccinated Admission Date: 9/6/2021 Discharge Date: 09/08/2021 Patient''s Discharge Disposition: Home in stable condition. DISCHARGE DIAGNOSES: 1. Sepsis, UTI 2. Non-neutropenic fevers 3. Covid-19 positive 4. AKI 5. Metastatic neuroendocrine carcinoma of Retroperitoneal Mass with pelvic lymph mets 6. Metastatic invasive urothelial carcinoma 7. HTN 8. HLD 9. Insomnia Hospital course: This is a 69 yo male with a history of neuroendocrine carcinoma of pelvis mass diagnosed 7/8/21 and on active treatment with VP16/cisplatin. He completed cycle 2 on 9/2/21. He also has a history of urothelial carcinoma s/p RURBT 3/22/19 and cystoprostatectomy 11/2020, CAD, OSA, HLD. He had presented to Metro ED on 9/5/21 with a fever, nausea and malaise. Work-up was started with blood cultures, IV antibiotics but the patient eventually left AMA due to bed shortage from Metro. Then on 9/6/21 he presented to SH BWH ED. He had Leukocytosis and fevers. His COVID PCR from 9/5 was positive. The patient was admitted for sepsis, likely from COVID-19. UA appeared positive and urine culture is still pending. Patient was started on Zosyn. ID was consulted for evaluation. The patient did not meet criteria for monoclonal antibodies for Covid. His fevers improved and his blood cultures are negative at 48hrs. Per discussion with ID patient is okay to discharge home today, and with zosyn has been treated for UTI, although cultures will be followed-up outpatient. The patient had diarrhea but it improved prior to cdiff sample could be collected. He had a mild AKI on admission which has improve with IVF. The patient''s WBC normalized and his vitals are stable. He is discharging home in stable condition. He will follow-up in the office on 9/16 with labs and Doctor. Nurse coordinator to f/u on urine culture after discharge.


VAERS ID: 1696302 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-02-25
Onset:2021-09-05
   Days after vaccination:192
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, COVID-19 pneumonia, Chronic obstructive pulmonary disease, Computerised tomogram thorax abnormal, Condition aggravated, Cough, Dyspnoea, Fatigue, Hyponatraemia, Hypoxia, Laboratory test abnormal, Lung disorder, Patient isolation, Respiratory distress, Respiratory symptom, SARS-CoV-2 test positive, Spinal stenosis
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hyponatraemia/SIADH (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet ALBUTEROL 108 (90 Base) MCG/ACT inhaler atorvastatin (LIPITOR) 40 MG tablet azithromycin (ZITHROMAX) 250 MG tablet budesonide/formoterol (SYMBICORT) 160-4.5 MCG/ACT inhaler cholecalciferol (VITAMIN D) 5
Current Illness: Seen in the office 8.17.21 - Dyspnea (COPD and spinal stenosis) Respiratory symptoms and distress 9.4.21/9.5.21 COVID-19 positive 9.5.21
Preexisting Conditions: Bronchiectasis without complication (HCC) Spinal stenosis of lumbar region with neurogenic claudication COPD, very severe (HCC) Rosacea Age-related osteoporosis with current pathological fracture with routine healing Personal history of colonic polyps GERD (gastroesophageal reflux disease) Hyperlipidemia, unspecified hyperlipidemia type Positive PPD, treated Early dry stage nonexudative age-related macular degeneration of both eyes Posterior vitreous detachment of right eye History of Pulmonary Mycobacterium avium-intracellulare infection (HCC) Keratoconjunctivitis sicca (HCC) Filamentary keratitis of right eye Valvular insufficiency Pseudomonas aeruginosa colonization S/p Left Lower Lobe Lobectomy, ''62. Goals of care, counseling/discussion Essential hypertension Opioid use DNR (do not resuscitate) Iron deficiency anemia Macular degeneration IBS (irritable bowel syndrome) Pneumonia due to COVID-19 virus
Allergies: Sulfa Drugs Rash, Throat swelling Amoxicillin Diarrhea Seasonal Sneezing Tape Adhesive Rash, Other
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized; COVID-19 positive (9.5.21); fully vaccinated Admission Date: 9/5/2021 Discharge Date: 09/10/2021 DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Pneumonia due to COVID-19 virus [U07.1, J12.82] HOSPITAL COURSE: Patient is an 82 yo female with PMH of severe COPD, bronchiectasis, PE who was hospitalized on 9/5 with COVID19 pneumonia. Onset of her symptoms were on 9/2. Patient had been vaccinated with Moderna earlier this year. Laboratory workup revealing for hyponatremia of 128 and positive COVID19 test. Hypoxic with ambulation in ED. CT Thorax showed post operative changes secondary to left lower lobectomy and extensive chronic lung changes with no notable acute process. She was started on Decadron and Remdesivir and continued on home bronchodilators. We held home neb treatments secondary to COVID19 status. Her breathing and cough improved. PT/OT recommend Home with Home Care. She was weaned to room air. Clinically stable for discharge on 9/8 but felt fatigued so monitored for 1 more night. On 9/10 - pt felt strong, back to baseline and ready to discharge home. She is discharged home in stable condition. We discussed the following: - completion of Decadron for 4 more days (total of 10 days), THEN resuming home dose Prednisone - self quarantine through 9/1 - patient was recommended to monitor their oxygen levels at home with pulse oximeter and contact his PCP or call 911 if oxygen levels drop below 92%. Patient will need close follow up with PCP with additional outpatient testing/labs. - Patient was provided COVID discharge instructions and to self monitor for any signs/symptoms of blood clots. We reviewed COVID self-isolation instructions.


VAERS ID: 1696423 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-15
Onset:2021-09-05
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / 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:
CDC Split Type:

Write-up: PATIENT HAD PFIZER COVID VACCINE Dose 1 date: 01/15/2021, Dose 2 date: 02/05/2021, AND TESTED POSITIVE TO COVID.


VAERS ID: 1696519 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-03-11
Onset:2021-09-05
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole 20 mg, Rosuvastatin 20 mg, minimum amount of magnesium and potassium, vitamin D3
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa, adhesive, nickel
Diagnostic Lab Data: Covid test 09/09/2021- positive
CDC Split Type: vsafe

Write-up: My husband was not feeling well and since we have been out of town we decided to get a Covid test. We both came out positive. My treatment was a monoclonal infusion on 09/09/2021.


VAERS ID: 1696647 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-04
Onset:2021-09-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Blood creatinine normal, Brain natriuretic peptide normal, Chest pain, Echocardiogram normal, Ejection fraction, Electrocardiogram normal, Headache, Magnetic resonance imaging heart, Magnetic resonance imaging normal, Myalgia, Troponin I, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: pantoprazole
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data: ECG normal on 9/6/21 and 9/7/21. Echo 9/7/21: LVEF 60-65%, normal echo. No LV wall motion abnormalities. Cardiac MRI 9/7/21: LVEF 59%, no wall motion abnormalities. + Late gadolinium uptake (scar) 4% in mid-lateral and apical lateral segments. Normal RV, no valve disease. High sensitivity Trop I peak 1920 ng/L. BNP 28 pg/mL. Cr 0.8 mg/dL, WBC 8.1.
CDC Split Type:

Write-up: Chest Pain, myalgias, headache. Received ibuprofen for headache. Discharged home on metoprolol succinate 25 mg/day (new).


VAERS ID: 1696715 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dyspnoea, Pallor, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Moderna 1st dose caused Diarrhea and light headedness
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was ashy and was feeling short of breath. He had chills and was shaking uncontrolably.


VAERS ID: 1696772 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-22
Onset:2021-09-05
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Anaemia, Blood gases, COVID-19, Chest X-ray, Full blood count, Mental status changes, Metabolic function test, SARS-CoV-2 test positive, Sepsis, Transfusion, Urine analysis
SMQs:, Haematopoietic erythropenia (broad), Interstitial lung disease (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol, apixaban, buspirone, fluticasone, lasix,insulin, levemir,isosorbide, metoprolol, nitroglycerine, omeprazole, potassium, prevastatin, sertaline, tamulosin
Current Illness:
Preexisting Conditions: Anemia, COPD, chronic kidney disease stage 3, HTN, hyperlipidemia, diabetes
Allergies: codeine
Diagnostic Lab Data: ABGs, CBC, Metabolic panel, Covid test, UA, blood transfusion, CXR
CDC Split Type:

Write-up: Altered mental status, acute respiratory distress, COVID 19 positive, sepsis, anemia


VAERS ID: 1696777 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-06
Onset:2021-09-05
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Dyspnoea, Fatigue, Nasal congestion, Rhinorrhoea, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Chronic Lung Disease (asthma/emphysema/COPD), Diabetes Mellitus, Chronic Renal disease, Hypertension/High Blood Pressure
Allergies:
Diagnostic Lab Data: 09/06/2021 PCR+ COVID-19 test at Medical Center
CDC Split Type:

Write-up: Breakthrough COVID-19 case with symptom onset 9/5/2021: New loss of taste or smell, Runny nose/Congestion, Cough (new onset or worsening of chronic cough), Shortness of breath or difficulty breathing, Fatigue or tiredness. Hospitalized for 1 day 9/5/2021-9/6/2021


VAERS ID: 1696802 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-04
Onset:2021-09-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Nausea, Pain, Pyrexia, Wrong product administered
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol hfa, alprazoloam , atorvasatin , cyanocobalamine injection , olanzapine . mirtazpine , montelukast
Current Illness: COPD . CHF
Preexisting Conditions: COPD , CHF
Allergies: NA
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: PATIENT CAME TO GET FLU SHOT AND INSTEAD GOT Covid19(pfizer) . PATIENT CLAIMS TO EXPERIENCES DIFFICULTY IN BREATHING , BODY ACHES , NAUSEA , FEVER FOR 2 DAYS


VAERS ID: 1696804 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-23
Onset:2021-09-05
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cardiac function test, Chest X-ray, Dyspnoea, Electrocardiogram, Full blood count, Metabolic function test, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine, glipizide, pravastatin, flomax, tramadol
Current Illness:
Preexisting Conditions: DM type 2, HTN, neuropathy, hyperlipidemia
Allergies: NKDA
Diagnostic Lab Data: CBC, CMP, CXR, Cardiac profile, COVID, EKG
CDC Split Type:

Write-up: SOB, COVID 19 positive


VAERS ID: 1696817 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-19
Onset:2021-09-05
   Days after vaccination:17
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Appendicectomy, Appendicitis, Computerised tomogram abdomen abnormal, Differential white blood cell count normal, Full blood count normal, Laparoscopic surgery, Metabolic function test normal, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: abemaciclib, aspirin, pantoprazole, tamoxifen
Current Illness: none
Preexisting Conditions: GERD; breast cancer
Allergies: none
Diagnostic Lab Data: 9/9/2021 abdominal CT - acute appendicitis 9/8/2021 CBC with differential - normal; CMP - normal 9/9/20201 CBC with differential - normal; CMP - normal
CDC Split Type:

Write-up: Developed abdominal pain and vomiting on 9/4/2021; ultimately found to have acute appendicitis by CT scan, underwent laprascopic appendectomy


VAERS ID: 1696872 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-09
Onset:2021-09-05
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 UN / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cardiac function test, Chest X-ray, Electrocardiogram, Fatigue, Full blood count, Metabolic function test, 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: allopurinol, calcium, fosrenol, levothyroxine, lisinopril
Current Illness:
Preexisting Conditions: ESRD, dialysis, anemia, CVA, DM Gout, hyperlipidemia, MI, PVD, Atrial fib
Allergies: NKDA
Diagnostic Lab Data: CBC, CMP, CXR, Cardiac Profile, EKG
CDC Split Type:

Write-up: Fatigue, Fever, positive COVID antibiotics given, fluids given


VAERS ID: 1697171 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-03
Onset:2021-09-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Vaccine dose given on 9/3/21. Noticed an itchy rash on back and abdomen when i woke up 9/5/21. on 9/6/21 i then noticed it spread to the rest of my body. It did not get any better after a week and was only spreading more. Went to the doctor on 9/10/21 and was prescribed medicine to treat the rash.


VAERS ID: 1697174 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Administration site warmth, Injection site erythema, Injection site pruritus
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient called on 9/14 and reported and said her arm started itching on Sunday right below administration site. Redness at admin site, hot to touch. No other symptoms. Getting more severe as of the date of this report. More itching, redness is spreading.


VAERS ID: 1697389 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-26
Onset:2021-09-05
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH CW0164 / 1 RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Balance disorder, Dysstasia, Gait disturbance, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: About a week after receiving my first shot, I have had hives populate on different areas of my body (legs, thighs, back, stomach) at various times of the day and at different intervals between outbreaks. Each outbreak lasts about 20 minutes before going away on its own. This has been going on for about a week and a half. I have also had a loss of balance at times when walking or standing still and have had a hard time focusing on where my next step will be level. I have stumbled while walking but have not fallen over. This feels like someone is trying to push me over has been going on for about a week. I do not feel dizzy. I was prescribed Cadista by my doctor to try and help the loss of balance.


VAERS ID: 1697929 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-09-03
Onset:2021-09-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site rash, Injection site warmth, Rash erythematous, Rash macular, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Most shots (flu shot, tetnas, etc), the site of the shot is firm and hot for a few days.
Other Medications: Adderall, Prozac, benadryl, Allegra, Omeprazole
Current Illness: N/A
Preexisting Conditions:
Allergies: Nuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: Large red, hot, firm blotch around injection site. Size and shape varied at times and lasted about a week. After 3 days of having the red blotch/rash, it started to itch severely on and off for 3-4 days. The reddness slowly went away, but I sill have itching there a few times a day.


VAERS ID: 1699876 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-04
Onset:2021-09-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Dyspnoea, Heart rate increased, Pericarditis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Pericarditis characterized by chest tightness, difficulty breathing, rapid heart rate, and severe chest pain.


VAERS ID: 1700121 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-03-29
Onset:2021-09-05
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 RA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Dyspnoea, Fatigue, Headache, Hyperhidrosis, Night sweats, Pain, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: 2020 flu shot, swollen lymph node on my neck.
Other Medications: COQ10, amlodipine, aspirin, allegra, hydrochlorzide, praluent,
Current Illness:
Preexisting Conditions: hypertension, heart disease
Allergies: sulfa, various cholesterol medicines
Diagnostic Lab Data: Covid 19 positive
CDC Split Type: vsafe

Write-up: I had a really bad headache on Monday morning, I had a fever 100.5, I went to Urgent care. I knew that morning when I ate a banana I could not taste that I had covid. I had body aches, loss of taste and smell. I was drenched and sweat at night. I was also congested and a little short of breath I was able to get in have the monoclonal antibodies, I''m on my 10th day and I haven''t had a fever for 24 hours and I''m still very fatigued and loss of taste and smell have not returned.


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