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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 264 out of 8,010

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VAERS ID: 1700441 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-15
Onset:2021-09-05
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Chills, Condition aggravated, Conjunctivitis, Cough, Dry eye, Fatigue, Fear, Feeling abnormal, Impaired work ability, Insomnia, Pain, Pain in extremity, Pyrexia, SARS-CoV-2 test negative, SARS-CoV-2 test positive
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (broad), Corneal disorders (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Ocular infections (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (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: COVID 1st Dose - 2/15/2021 - fever, body aches, my arm hurt and I was exhausted. Had those for a week. Had those same symptoms w
Other Medications: Metformin; Losartan; Levothyroxine; Gabapentin; Lipitor; Afixor - anti-depressant; Trulicity; Vasiglar
Current Illness: nothing
Preexisting Conditions: diabetes; high blood pressure; Hypothyroidism
Allergies: Bee stings; Cipro
Diagnostic Lab Data: COVID testing - Urgent Care and two home test
CDC Split Type: vsafe

Write-up: The experience has been deplorable. It has been horrific. I have been through a lot. On the 5th, the first thing I noticed was that I couldn''t taste my "blood Mary" - loss of taste and smell was very first symptom. I started to get a fever - 101. 5 was the highest it went and had some chills with it. Body aches and coughing - but not horrible coughing. I wasn''t tired. I couldn''t sleep. I felt lousy for about three days. I went to Urgent Care -saw Dr. - she spent a good amount of time there with me. They were going to call me if I was COVID positive and email me if it was negative. They did neither. I am high risk and I was scared. I went out and bought a COVID test - it was a digital test and it came up positive. I kind of figured that because I couldn''t smell anything. That was Sunday, I didn''t know what to do. The next morning, the Dept of Health contact me by test and said that I had a positive COVID-19 test. Urgent Care finally called me and I was talking to a girl. She said I was eligible for the antibodies infusion but the appt was for 15 minutes from the when she told me. Hospital was the closest to me and I was registered at 09:05 am and no one was there. Maybe me and one other person (for the infusion) and then while waiting a lot of people started coming in (about 15 total) and they haven''t removed me (I am coughing with COVID) from the room/situation so I told them I was going to me car until they could take me. I didn''t get to go in to start the infusion until four hours after getting in the car. At four o''clock, I finally went back into the waiting room of the ER. I had to announce to the ER waiting room that I had COVID and list my risks and that they wouldn''t help me I didn''t get out of there until 06:00PM. The next day, I woke up with Pink Eye. I had to drive myself down to the ER Room - they gave me an antibiotic of that. My eyes are not pink anymore but they are not quite right yet. I feel like I have kind of dry eyes especially at the end of the day and at night. I have to blink. My job has not even checked on me and they know I am high risk with COVID. I have been gone 10 days. The infusion helped with my COVID symptoms. I took another home COVID test which was negative. I am about 90% recovered. I still can''t smell and taste all the way. If it''s a strong flavor I can taste it - if salty can taste the salt and if sweet can taste the sweet but not necessarily the flavor. I won''t go back to work until Monday. Note: fever, body aches, my arm hurt and I was exhausted. Reacted immediately after COVID 2nd Dose for week also.


VAERS ID: 1700491 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-04
Onset:2021-09-05
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Aggression, Blood glucose decreased, COVID-19, Chills, Delirium, Hypoglycaemia, Mental status changes, SARS-CoV-2 test positive, Screaming
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hostility/aggression (narrow), Cardiomyopathy (broad), Hypoglycaemia (narrow), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Allipurinol, Colchicine, Eliquis, Flomax, Glimepiride, Lisinop
Current Illness: Uknown
Preexisting Conditions: Kidney transplant, AFib, Hemodialysis, HTN, Kidney disease, Mitral valve replacement, Speep apnea,
Allergies: Contrast Dye, Morphine, PCN
Diagnostic Lab Data: 09/05/2021 SARS COV2 COVID 19 PCR (POSITIVE)
CDC Split Type:

Write-up: 09/05/21 The patient presents with AMS. Pt reports to have been at church when he began to feel delirious. Per family, pt was at church when he became combative. Family states pt began yelling and walked out of church. EMS services were called and at arrival they noted pt to be hypoglycemic with a BGL of 49 and given oral glucose. At ED bedside, pt reports to feel better but notes to have been experiencing chills lately. Pt s/p kidney transplant prescribed with prednisone and glimepiride, states to have not administered with Prednisone for the past 3 weeks. Pt denies abdominal pain, nausea, vomiting, fevers, chest pain, shortness of breath, and all other symptoms.


VAERS ID: 1700566 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-09
Onset:2021-09-05
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA #030A21A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA #017B21A / 2 UN / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Atrial fibrillation, Blood pressure decreased, Chest discomfort, Chest pain, Computerised tomogram, Electrocardiogram, Heart rate increased, Myocardial infarction, Pain in extremity
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Dehydration (broad)

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

Write-up: Tightness/pain in chest on several occassions. Pain running down both arms. Blood pressure drop. Heart attack. Elevated Heart rate. Arterial fibrilation. Patients brother has reported the same medical issue shortly after receiving the vaccination.


VAERS ID: 1700623 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Alanine aminotransferase increased, Aspartate aminotransferase increased, Blood alkaline phosphatase increased, Blood bilirubin increased, Blood creatinine normal, Brain natriuretic peptide increased, Colitis, Computerised tomogram abdomen abnormal, Computerised tomogram thorax, Conjunctivitis, Diarrhoea, Gallbladder enlargement, Headache, Multisystem inflammatory syndrome in adults, Myalgia, Neck pain, Periportal oedema, Platelet count normal, Procalcitonin, Pyrexia, Rash, Troponin I increased, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Acute pancreatitis (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Toxic-septic shock conditions (broad), Pseudomembranous colitis (broad), Biliary system related investigations, signs and symptoms (narrow), Gallbladder related disorders (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Eosinophilic pneumonia (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: COVID-19 infection symptom onset early August
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Admitted to the hospital and thought to have probable MIS-A. On 9/15/21: WBC 33, platelet 292, creatinine 0.5, Bilirubin 1.4, ALP 168, ALT 109, AST 137, procalcitonin 4.26 BNP 14100 Troponin I 3.26 CT chest/abdomen/pelvis 9/14/21: circumferential thickening of the wall of the cecum and ascending colon compatible with colitis, peri-portal edema and diffuse gallbladder wall thickening, prominent lymph nodes within the root of the small bowel mesentery and right pericecal space.
CDC Split Type:

Write-up: Fever, myalgia onset on same day as vaccination. Followed by headache, neck pain and few days later rash, conjunctivitis, abdominal pain/diarrhea.


VAERS ID: 1700720 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-28
Onset:2021-09-05
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acne, Dysmenorrhoea, Heavy menstrual bleeding, Menstrual disorder
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Around September 5, 2021, I started to have menstrual cramping outside of the normal cycle. By September 7, 2021 I had started a menstruating and it has progressed since. I should not have had menstruation until September 21, 2021. The cycle is different this time. Thicker and heavier. Acne has progressed during the week of September 12, 2021


VAERS ID: 1700745 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-22
Onset:2021-09-05
   Days after vaccination:167
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039A21A / 2 UN / SYR

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

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: Diabetes mellitus Hypertension Chronic Renal Disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, muscle ache, cough and fatigue.


VAERS ID: 1703986 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-03-20
Onset:2021-09-05
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chills, Cough, Fatigue, Oxygen saturation decreased, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID+ PCR test on 9/15/21
CDC Split Type:

Write-up: COVID breakthrough. Patient recently returned from vacation and began having symptoms for COVID on 9/5/21 such as cough, chills, and fatigue. He presented to the hospital on 9/14/21 with ongoing symptoms and decreased oxygen saturation. He tested positive in the hospital on 9/15/21.. He is currently on 5L of Oxygen.


VAERS ID: 1704028 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-11
Onset:2021-09-05
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 20A21A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Headache, Neck pain, Pain, Respiratory tract congestion, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Arthritis (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
Allergies:
Diagnostic Lab Data: POSITIVE SARS-COV-2 BY PCR 9/15/21
CDC Split Type:

Write-up: This case meets vaccine breakthrough criteria review. Presented to ED with SOB, cough, congestion, body aches, headache, and neck pain for 7-10 days PTA.


VAERS ID: 1704440 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-01
Onset:2021-09-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 1 LA / IM

Administered by: Pharmacy       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: unknown
Current Illness: unknown
Preexisting Conditions: liver transplant hep C portal vein thrombosis HTN GERD thrombocytopenia
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt given first covid vaccine 9/1 and then diagnosed with COVID 9/5, admitted to hospital 9/14


VAERS ID: 1704985 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-09-02
Onset:2021-09-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Fatigue, Feeling abnormal, Hepatic enzyme increased, Muscular weakness, Speech disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Peripheral neuropathy (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Elevated liver enzymes increasing over 130 alt, ast
CDC Split Type:

Write-up: Elevated liver enzymes, speech disturbance, muscle weakness lower extremities, brain fog, fatigue.


VAERS ID: 1704991 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-27
Onset:2021-09-05
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram abnormal, Extra dose administered, Groin pain, Muscle spasms, Peripheral swelling, Pulmonary thrombosis, Thrombosis, Ultrasound scan abnormal
SMQs:, Cardiac failure (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Dystonia (broad), Thrombophlebitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Osteonecrosis (broad), Medication errors (narrow)

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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Verzenio
Current Illness: Metastatic breast cancer
Preexisting Conditions: Metastatic breast cancer, high blood pressure
Allergies:
Diagnostic Lab Data: Ultrasound and CT scan done on 9/8/21 showed a large blood clot in her groin area and 2 smaller clots in each lung.
CDC Split Type:

Write-up: A week and a half after receiving the Pfizer Booster shot, she began experiencing pain in her groin area, swelling of the right leg, and cramping in the leg. Ultrasound and CT scan done at the hospital on 9/8/21 showed a large blood clot in the groin area as well as 2 smaller clots in each lung.


VAERS ID: 1705001 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-01
Onset:2021-09-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ataxia, Blood test, Disturbance in attention, Feeling abnormal, Headache, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vyvanse 40mg 1x Adderrall 10mg 1x Vitamin D Multivitamin
Current Illness: Non
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Unknown. Blood work taken today 9/16. Results should be complete in a week.
CDC Split Type:

Write-up: Pain in arm the following day, lasted 1 day. Current issues come and go: Recurring headache, trouble concentrating, brain in a haze, fatigue. My physician is doing current bloodwork to rule out other possible issues.


VAERS ID: 1705013 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-02
Onset:2021-09-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 2 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Angina pectoris, Cardiac flutter, Palpitations
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Other ischaemic heart disease (narrow)

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

Write-up: Heart pain periodically, definitely fluttering, palpitations-felt like I was going to have a heart attack. Cannot sustain running as usual.


VAERS ID: 1705905 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-15
Onset:2021-09-05
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Atrial flutter, Chest X-ray, Chills, Computerised tomogram thorax, Electrocardiogram, Full blood count, Hypotension, Lung infiltration, Metabolic function test, Nausea, Pyrexia, Respiratory viral panel, SARS-CoV-2 test, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (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: Flecainide,Acyclovir,Candesartan,clonidine Amlodipine Spironolactone
Current Illness: Multiple Myeloma,AL Amyloidosis,HTN,GERD
Preexisting Conditions: Same as 11
Allergies: None
Diagnostic Lab Data: CBC,CMP, Covid screen, Respiratory Virul Screen CXR, Ct of Chest ECG
CDC Split Type:

Write-up: Chills, Fever, Pulmonary Infiltrate , elevated D Dimer and ESR ONE WEEK LATER- Hypotension Aflutter N and vomiting Weakness


VAERS ID: 1705962 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Lethargy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Chills-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fever-Severe


VAERS ID: 1705963 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Lethargy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Chills-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fever-Severe


VAERS ID: 1706440 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Flushing, Hyperhidrosis, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Severe


VAERS ID: 1706540 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Arkansas  
Vaccinated:0000-00-00
Onset:2021-09-05
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 test, Suspected COVID-19, Vaccination failure
SMQs:, Lack of efficacy/effect (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: Comments: Patient had no known allergies. Patient had no medical history and no daily medications.
Allergies:
Diagnostic Lab Data: Test Date: 20210905; Test Name: COVID-19 antigen test; Result Unstructured Data: Positive; Test Date: 20210908; Test Name: COVID-19 antigen test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20210924403

Write-up: SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION; This spontaneous report received from a patient concerned a 57 year old male of unknown race and ethnicity. The patient''s weight was 197 pounds, and height was 64 inches. Patient had no known allergies. Patient had no medical history and no daily medication. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, expiry: unknown) dose was not reported, 1 total administered on 22-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 05-SEP-2021, patient was tested positive for rapid test (suspected covid-19 infection and suspected clinical vaccination failure). Patient was shocked as he had no symptoms. Again on 08-SEP-2021 patient was tested positive for rapid test. Patient mentioned that he had maybe a little bit of cough and slight head ache in the morning. He stated that the symptoms come and go but he did not felt sick to think they indicate anything. He only noticed after he was tested positive. He was able to do all normal activities. Patient stated that he was exposed to his mom. She tested positive on 01-SEP-2021 and the last exposure to her was on 29-AUG-2021. His mother spent the day with him and his family. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the suspected covid-19 infection and suspected clinical vaccination failure was not reported. This report was serious (Other Medically Important Condition). This report was associated with a product quality complaint.; Sender''s Comments: V0: 20210924403- JANSSEN COVID-19 VACCINE Ad26.COV2.S- Suspected clinical vaccination failure . This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS.


VAERS ID: 1707035 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-09-02
Onset:2021-09-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / UNK LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Peripheral swelling, Tenderness, Vaccination site pain, Vaccination site warmth
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: injection site painful; swollen leg; tender to touch; heat was radiating on the site; This spontaneous case was reported by a consumer and describes the occurrence of PERIPHERAL SWELLING (swollen leg), TENDERNESS (tender to touch), VACCINATION SITE WARMTH (heat was radiating on the site) and VACCINATION SITE PAIN (injection site painful) in a 39-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 020F21A) for COVID-19 vaccination. No Medical History information was reported. On 02-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 05-Sep-2021, the patient experienced PERIPHERAL SWELLING (swollen leg), TENDERNESS (tender to touch) and VACCINATION SITE WARMTH (heat was radiating on the site). On an unknown date, the patient experienced VACCINATION SITE PAIN (injection site painful). The patient was treated with PARACETAMOL (TYLENOL) at a dose of 2 DF. At the time of the report, PERIPHERAL SWELLING (swollen leg), TENDERNESS (tender to touch), VACCINATION SITE WARMTH (heat was radiating on the site) and VACCINATION SITE PAIN (injection site painful) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No concomitant medication was reported. This is alarming since patient is skinny.


VAERS ID: 1707160 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-02
Onset:2021-09-05
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 2 LA / OT

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

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

Write-up: nauseated; having joint pains; This spontaneous case was reported by a consumer and describes the occurrence of NAUSEA (nauseated) and ARTHRALGIA (having joint pains) in a 79-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 037F21A and 032L20A) for COVID-19 vaccination. Concurrent medical conditions included Sulfonamide allergy. On 02-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 18-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 04-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 05-Sep-2021, the patient experienced NAUSEA (nauseated) and ARTHRALGIA (having joint pains). At the time of the report, NAUSEA (nauseated) and ARTHRALGIA (having joint pains) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No Concomitant medications were reported No treatment information was provided. This case was linked to MOD-2021-308441 (Patient Link). Most recent FOLLOW-UP information incorporated above includes: On 08-Sep-2021: follow-up document received and include no new information


VAERS ID: 1707176 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-09-05
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

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

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

Write-up: after his Moderna vaccine which is his third shot since he already got 2 Pfizer doses; achy knees; This spontaneous case was reported by a consumer and describes the occurrence of ARTHRALGIA (achy knees) and INTERCHANGE OF VACCINE PRODUCTS (after his Moderna vaccine which is his third shot since he already got 2 Pfizer doses) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 05-Sep-2021, the patient experienced ARTHRALGIA (achy knees). On an unknown date, the patient experienced INTERCHANGE OF VACCINE PRODUCTS (after his Moderna vaccine which is his third shot since he already got 2 Pfizer doses). At the time of the report, ARTHRALGIA (achy knees) and INTERCHANGE OF VACCINE PRODUCTS (after his Moderna vaccine which is his third shot since he already got 2 Pfizer doses) outcome was unknown. Doses 1 and 2 were Pfizer and 3rd/booster was Moderna No relevant concomitant medications were reported. No treatment information was provided.


VAERS ID: 1707217 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062D21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Hypopnoea, Nausea, Pharyngeal swelling, Rhinorrhoea, Somnolence
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Respiratory failure (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: BUSPIRONE; ATORVASTATIN; METOPROLOL; APIXABAN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Atrial fibrillation; Stroke
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: This spontaneous case was reported by a consumer and describes the occurrence of PHARYNGEAL SWELLING (throat is swelling a bit), HYPOPNEA (shallow breathing), SOMNOLENCE (unusually very sleepy), RHINORRHEA (nose was clogged a few minutes ago and now he feels some nasal drip) and NAUSEA (Slightly nauseated) in a 67-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 062D21A) for COVID-19 vaccination. The patient''s past medical history included Stroke in 2015 and Atrial fibrillation. Concomitant products included BUSPIRONE, ATORVASTATIN, METOPROLOL and APIXABAN for an unknown indication. On 05-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 05-Sep-2021, the patient experienced PHARYNGEAL SWELLING (throat is swelling a bit), HYPOPNEA (shallow breathing), SOMNOLENCE (unusually very sleepy), RHINORRHEA (nose was clogged a few minutes ago and now he feels some nasal drip) and NAUSEA (Slightly nauseated). At the time of the report, PHARYNGEAL SWELLING (throat is swelling a bit), HYPOPNEA (shallow breathing), SOMNOLENCE (unusually very sleepy), RHINORRHEA (nose was clogged a few minutes ago and now he feels some nasal drip) and NAUSEA (Slightly nauseated) was resolving. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No treatment medication use was reported.


VAERS ID: 1707269 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-03-20
Onset:2021-09-05
   Days after vaccination:169
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 1 LA / OT

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: AMLODIPINE; LEVOTHYROXINE; LOSARTAN; GLIPIZIDE; ROSUVASTATIN; ALLOPURINOL; PREDNISONE
Current Illness:
Preexisting Conditions: Comments: No medical history were provided by reporter.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: I felt fatigue / tiredness for one day then it resolved; Administered a third dose of COVID-19 vaccine (PFIZER) instead of flu shot; This spontaneous case was reported by a consumer and describes the occurrence of FATIGUE (I felt fatigue / tiredness for one day then it resolved) and WRONG PRODUCT ADMINISTERED (Administered a third dose of COVID-19 vaccine (PFIZER) instead of flu shot) in a 72-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 048821A and 046A21A) for COVID-19 vaccination. No medical history were provided by reporter. Concomitant products included AMLODIPINE, LEVOTHYROXINE, LOSARTAN, GLIPIZIDE, ROSUVASTATIN, ALLOPURINOL and PREDNISONE for an unknown indication. On 20-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 17-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 05-Sep-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced WRONG PRODUCT ADMINISTERED (Administered a third dose of COVID-19 vaccine (PFIZER) instead of flu shot). On an unknown date, the patient experienced FATIGUE (I felt fatigue / tiredness for one day then it resolved). On 05-Sep-2021, WRONG PRODUCT ADMINISTERED (Administered a third dose of COVID-19 vaccine (PFIZER) instead of flu shot) had resolved. At the time of the report, FATIGUE (I felt fatigue / tiredness for one day then it resolved) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. On 05-SEP-2021 the patient went to a pharmacy for a flu vaccine but was accidentally administered a dose of the Pfizer COVID-19 vaccine. No treatment information were provided.


VAERS ID: 1707333 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-12
Onset:2021-09-05
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Dizziness, Fatigue, Hyperhidrosis, Inappropriate schedule of product administration, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: METOPROLOL; ISOSORBIDE; LISINOPRIL; ASPIRIN 1000; ATORVASTATIN
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210906; Test Name: Fever; Result Unstructured Data: High (fever of 102 F)
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: woke up in a puddle of sweat; dizziness; weakness; Fever; nausea; vomiting; fatigue; less than 25 days for administration of the second dose; This spontaneous case was reported by a consumer and describes the occurrence of DIZZINESS (dizziness), ASTHENIA (weakness), HYPERHIDROSIS (woke up in a puddle of sweat), INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (less than 25 days for administration of the second dose) and PYREXIA (Fever) in an 89-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 004F21A and 040C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concomitant products included METOPROLOL, ISOSORBIDE, LISINOPRIL, ACETYLSALICYLIC ACID (ASPIRIN 1000) and ATORVASTATIN for an unknown indication. On 12-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 05-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 05-Sep-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (less than 25 days for administration of the second dose). On 06-Sep-2021, the patient experienced DIZZINESS (dizziness), ASTHENIA (weakness), PYREXIA (Fever), NAUSEA (nausea), VOMITING (vomiting) and FATIGUE (fatigue). On an unknown date, the patient experienced HYPERHIDROSIS (woke up in a puddle of sweat). The patient was treated with PARACETAMOL (TYLENOL) for Fever, at a dose of 1 dosage form. On 06-Sep-2021, PYREXIA (Fever) had resolved. At the time of the report, DIZZINESS (dizziness), ASTHENIA (weakness), HYPERHIDROSIS (woke up in a puddle of sweat), INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (less than 25 days for administration of the second dose), NAUSEA (nausea), VOMITING (vomiting) and FATIGUE (fatigue) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 06-Sep-2021, Pyrexia: high (High) High (fever of 102 F). Patient also take Water pill as a concomitant medication.


VAERS ID: 1707373 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-01-06
Onset:2021-09-05
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Body temperature, Feeling abnormal, Hallucination, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210907; Test Name: Body temperature; Result Unstructured Data: 102.7 F
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Still dont feel normal; Fever creeping up to 102.7; Fever; Hallucinations; Very weak; Dont feel like myself; This spontaneous case was reported by a consumer and describes the occurrence of HALLUCINATION (Hallucinations) in a 47-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 939906, 032L20A and 037K20A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 06-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 04-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 05-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 05-Sep-2021, the patient experienced HALLUCINATION (Hallucinations) (seriousness criterion medically significant) and ASTHENIA (Very weak). 05-Sep-2021, the patient experienced FEELING ABNORMAL (Dont feel like myself). On 05-Sep-2021 at 5:00 PM, the patient experienced PYREXIA (Fever). On 07-Sep-2021, the patient experienced FEELING ABNORMAL (Still dont feel normal) and PYREXIA (Fever creeping up to 102.7). On 07-Sep-2021, HALLUCINATION (Hallucinations) had resolved. At the time of the report, ASTHENIA (Very weak), FEELING ABNORMAL (Dont feel like myself), FEELING ABNORMAL (Still dont feel normal), PYREXIA (Fever) and PYREXIA (Fever creeping up to 102.7) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 07-Sep-2021, Body temperature: 102.7 (High) 102.7 F. Concomitant medications were not reported . Reported that patient got the booster of Moderna. she experienced hallucinations from it, The patient states she started with a fever on Sunday 05-Sep-2021 about 5 PM, The hallucinations started between 10-12 PM, She was very weak, and she still doesn''t feel normal on 07Sep2021. Company comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. More information has been requested.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. More information has been requested.


VAERS ID: 1707403 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Musculoskeletal discomfort, Musculoskeletal stiffness, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: My arm hurt; stiffness spread up over my shoulder, across my collarbone and up the side of my neck; discomfort spread up over my shoulder, across my collarbone and up the side of my neck; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (My arm hurt), MUSCULOSKELETAL STIFFNESS (stiffness spread up over my shoulder, across my collarbone and up the side of my neck) and MUSCULOSKELETAL DISCOMFORT (discomfort spread up over my shoulder, across my collarbone and up the side of my neck) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 05-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In 2021, the patient experienced MUSCULOSKELETAL STIFFNESS (stiffness spread up over my shoulder, across my collarbone and up the side of my neck) and MUSCULOSKELETAL DISCOMFORT (discomfort spread up over my shoulder, across my collarbone and up the side of my neck). On 05-Sep-2021, the patient experienced PAIN IN EXTREMITY (My arm hurt). At the time of the report, PAIN IN EXTREMITY (My arm hurt) and MUSCULOSKELETAL STIFFNESS (stiffness spread up over my shoulder, across my collarbone and up the side of my neck) outcome was unknown and MUSCULOSKELETAL DISCOMFORT (discomfort spread up over my shoulder, across my collarbone and up the side of my neck) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown.


VAERS ID: 1707421 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-06
Onset:2021-09-05
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 - / OT

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

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

Write-up: Expired vaccine administered beyond 12 hours expiration for punctured vial; Vial was first punctured on 05-Sep-2021 at 11:00 AM and was kept in refrigerator/ was discarded on 06-Sep-2021 after 04:30 PM; This spontaneous case was reported by a pharmacist and describes the occurrence of EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered beyond 12 hours expiration for punctured vial) and PRODUCT STORAGE ERROR (Vial was first punctured on 05-Sep-2021 at 11:00 AM and was kept in refrigerator/ was discarded on 06-Sep-2021 after 04:30 PM) in a 65-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 058E21A) for COVID-19 vaccination. No Medical History information was reported. On 06-Sep-2021 at 4:30 PM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 05-Sep-2021 at 11:00 AM, the patient experienced PRODUCT STORAGE ERROR (Vial was first punctured on 05-Sep-2021 at 11:00 AM and was kept in refrigerator/ was discarded on 06-Sep-2021 after 04:30 PM). On 06-Sep-2021 at 4:30 PM, the patient experienced EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered beyond 12 hours expiration for punctured vial). On 06-Sep-2021, PRODUCT STORAGE ERROR (Vial was first punctured on 05-Sep-2021 at 11:00 AM and was kept in refrigerator/ was discarded on 06-Sep-2021 after 04:30 PM) had resolved. On 06-Sep-2021 at 4:30 PM, EXPIRED PRODUCT ADMINISTERED (Expired vaccine administered beyond 12 hours expiration for punctured vial) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were provided. No Treatment information was provided. The vial was initially stored in the refrigerator on 31-Aug-2021. The vaccine was administered at room temperature. The vial did not undergo any previous temperature excursions. The reporter stated that the total amount of time the vial was exposed to room temperature range 46? to 77? F was from 06-Sep-2021 9:00 AM. This case was linked to MOD-2021-311383 (Patient Link).


VAERS ID: 1707430 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: New York  
Vaccinated:2020-12-01
Onset:2021-09-05
   Days after vaccination:278
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Drug ineffective, Illness
SMQs:, Lack of efficacy/effect (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: Test Name: COVID-19; Test Result: Positive; Result Unstructured Data: positive.
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: This spontaneous case was reported by a consumer and describes the occurrence of DRUG INEFFECTIVE (Father got Moderna, and he has coronavirus), ILLNESS (Had it for a couple days and he is very sick.) and COVID-19 (Covid positive) in a male patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In December 2020, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In January 2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 05-Sep-2021, the patient experienced DRUG INEFFECTIVE (Father got Moderna, and he has coronavirus). On an unknown date, the patient experienced ILLNESS (Had it for a couple days and he is very sick.) and COVID-19 (Covid positive). At the time of the report, DRUG INEFFECTIVE (Father got Moderna, and he has coronavirus), ILLNESS (Had it for a couple days and he is very sick.) and COVID-19 (Covid positive) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, COVID-19: positive (Positive) positive. No relevant concomitant medications were reported. No treatment information was reported. Most recent FOLLOW-UP information incorporated above includes: On 08-Sep-2021: Follow-up received on 08-SEP-2021 contains significant information: Event Covid positive; Sender''s Comments: This report refers to a case of Drug ineffective for mRNA-1273, lot # unknown with adverse events. Very limited information regarding this event has been provided at this time. Further information regarding temporal association is necessary. Further information has been requested. For the event COVID-19, based on the mechanism of action of mRNA-1273 causal association between the event of COVID-19 infection and mRNA-1273 is assessed as not applicable.


VAERS ID: 1707482 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-08-08
Onset:2021-09-05
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042B21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test
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: Test Date: 20210905; Test Name: Covid-19 test; Test Result: Positive ; Result Unstructured Data: Positive
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: tested positive for covid-19 after first dose; This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 (tested positive for covid-19 after first dose) in a 58-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 042B21A) for COVID-19 vaccination. No Medical History information was reported. On 08-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 05-Sep-2021, the patient experienced COVID-19 (tested positive for covid-19 after first dose). At the time of the report, COVID-19 (tested positive for covid-19 after first dose) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 05-Sep-2021, SARS-CoV-2 test: positive (Positive) Positive. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were reported by reporter Treatment information was not provided by reporter


VAERS ID: 1708037 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025C / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, 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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Systemic: Headache-Medium


VAERS ID: 1708042 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: Patient fainted after the COVID vaccine and was unresponsive for approximately 5 seconds. He awoke and could breath but stayed on floor until EMT arrived. The EMT took BL and vitals and took patient to the local ER. The pharmacist on duty the following day followed up with nicolas and he stated he was fine.


VAERS ID: 1708386 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-01
Onset:2021-09-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003B21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009021A / 3 LA / 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? 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: tested positive for COVID-19 on 9/5/21


VAERS ID: 1708533 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-01-23
Onset:2021-09-05
   Days after vaccination:225
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 2 RA / -

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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: hospitalization


VAERS ID: 1708573 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-04
Onset:2021-09-05
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9265 / 1 AR / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 AR / SYR

Administered by: Public       Purchased by: ?
Symptoms: Pyrexia, Respiratory distress
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Allopurinol 100 mg Tab 100 mg 1 tab(s), PO (oral), qDay Amiodarone 200 mg Tab 400 mg 2 tab(s), PO (oral), bid Aspirin 81 mg Chew 81 mg 1 tab(s), PO (oral), qDay Atorvastatin 40 mg Tab 80 mg 2 tab(s), PO (oral), at bedtime Calcium Carbon
Current Illness: Type 2 Diabetes, prostate cancer, multiple myeloma, atrial fibrilation, chronic diastolic heart failure, end stage renal disease on dialysis, stroke, hypertension, hypothyroid, left ventrical hypertrophy
Preexisting Conditions: Type 2 Diabetes, prostate cancer, multiple myeloma, atrial fibrilation, chronic diastolic heart failure, end stage renal disease on dialysis, stroke, hypertension, hypothyroid, left ventrical hypertrophy
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: The patient has multiple health issues, so exact time of onset and symptoms are hard to diagnose, but patient presents with respiratory distress, fever (may be due to sepsis)


VAERS ID: 1708589 (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: 2021-09-17
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: COVID-19, SARS-CoV-2 test positive, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, albuterol, mylanta, augmentin, amlodipine, aspirin, lidocaine patch
Current Illness:
Preexisting Conditions: CAD, essential HTN, arthritis, skin cancer, COPD, lung cancer, hypercholesteremia, PSA elevation
Allergies:
Diagnostic Lab Data: Swabbed positive for covid on 9/5/2021
CDC Split Type:

Write-up: vomitting


VAERS ID: 1708855 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-03
Onset:2021-09-05
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 FULLY VACCINATED AND TESTED POSITIVE FOR COVID 9/5/2021 AND ADMITTED TO HOSPITAL 9/5/2021


VAERS ID: 1708870 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-01-07
Onset:2021-09-05
   Days after vaccination:241
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 FULLY VACCINATED TESTED POSTIVE FOR COVID 9/5/2021 AND ADMITTED TO THE HOSPITAL.


VAERS ID: 1708896 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-07
Onset:2021-09-05
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / UNK LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Dyspnoea, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lasix, Insulin glargine, Eliquis, clopidogrel
Current Illness: Uknown
Preexisting Conditions: diabetes, chronic kidney disease, hyperlipidemia, hypertension, CHF
Allergies: hydralazine, cipro
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient admitted 9/5 for cough, congestion and shortness of breath. Patient discharged on 9/10.


VAERS ID: 1708978 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-06-13
Onset:2021-09-05
   Days after vaccination:84
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood test abnormal, Chest X-ray normal, Cough, Diarrhoea, Headache, Mononucleosis heterophile test negative, Oropharyngeal pain, Pain, SARS-CoV-2 test negative, Streptococcus test negative
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: None
Preexisting Conditions: Colitis
Allergies: Codeine Gluten Dairy
Diagnostic Lab Data: Covid-19 test - negative Mono test - negative Flu test - negative Strep test - negative Chest X-ray - clear Blood test
CDC Split Type: vsafe

Write-up: Headache Sore throat Cough Body aches Diarrhea


VAERS ID: 1708979 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-09-03
Onset:2021-09-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Hypersensitivity, Nausea, Palpitations
SMQs:, Acute pancreatitis (broad), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily vitamin
Current Illness: None
Preexisting Conditions: MTHFR-double variant C677T
Allergies: Penicillin codeine tamiflu ibuprofen eggs
Diagnostic Lab Data:
CDC Split Type:

Write-up: I had typical initially nausea chills exhaustion but then woke up early sun 2am with heart palpitations, I get this allergic reaction to codeine. It didn?t seem as intense as the response I get from codeine but it lasted a few hours. I was going to see clinic when opened but it stopped about 5 am.


VAERS ID: 1709170 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-08-13
Onset:2021-09-05
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood thyroid stimulating hormone decreased, Cardiac stress test, Chest discomfort, Condition aggravated, Dizziness, Echocardiogram, Electrocardiogram abnormal, Eructation, Heart rate irregular, Laboratory test, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Cardiac arrhythmia terms, nonspecific (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LEVOTHYROXINE 0.15 MG BENAZAPRIL 20MG VITAMIN A C D E AND ZINC . MAGNESIUM 250MG ELDERBERRY 3800 MG . PEPCID AC
Current Illness: NONE
Preexisting Conditions: HYPOTHYROIDISM
Allergies:
Diagnostic Lab Data: ECHO MONITOR AND STRESS TEST . RESULTS NOT IN . ALSO LABWORK TSH CAM BACK GELOW NORMAL RANGE. TSH HASN''T BEEN LOW IN 20
CDC Split Type:

Write-up: NAUSEA LIGHTHEADED . CHEST PRESSURE. CONSTANT BELCHING. SAW PRIMARY PHYSICIAN ON 9/13/21 . EKG SHOWED ABNORMAL HEARBEAT . WA REFERED TO CARDIOLOGIST . SAW CARDIOLOGIST ON 9/14/21 REQUESTED LAB AND TEST


VAERS ID: 1709645 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066021 / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Hyperhidrosis, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall 20mg bid, multi vitamin, vitamin c, b-12 complex, vitamin d, biotin, baby aspirin
Current Illness: None
Preexisting Conditions: None
Allergies: Anaphylactic pine nut allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, severe muscle aches, chills, sweats, nausea


VAERS ID: 1709851 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-01
Onset:2021-09-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Amenorrhoea, Fatigue, Immunodeficiency
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: 4/1/2021, missed period. 3 days late.
Other Medications: N/A
Current Illness: None.
Preexisting Conditions: N/A
Allergies: None.
Diagnostic Lab Data: Missed period!
CDC Split Type:

Write-up: I had my 1st shot on 4/1/2021 & I missed my period by about 3 days, but I didn?t think anything of it. I had my 2nd shot on 4/22/2021, and I was tired, had a sore arm and mild temp just like with my 2nd shot, and I just figured it was normal. On 9/1/2021, I had my 3rd booster shot. I have PCOS, but my periods are normal. I am overweight. I also have high blood pressure. I did feel tired after the 3rd COVID shot, no temperature that time, but the 5th came, and I didn?t have my period. I?m not pregnant. I have not had sex for over a year now. I didn?t think about my period til I checked my calendar, and noticed that my period is now 12 days late!


VAERS ID: 1710056 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-30
Onset:2021-09-05
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Galactostasis, Lymphadenopathy, Maternal exposure during breast feeding
SMQs:, Functional lactation disorders (narrow), Neonatal exposures via breast milk (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: swollen/sore lymph node in left armpit, breastfeeding at time and clogged ducts occurred on the same left side with the lymph node


VAERS ID: 1711006 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-09-03
Onset:2021-09-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Aphonia, Nasopharyngitis
SMQs:

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

Write-up: No voice; Felt like I was catching a cold; This spontaneous case was reported by a consumer and describes the occurrence of NASOPHARYNGITIS (Felt like I was catching a cold) and APHONIA (No voice) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 03-Sep-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 05-Sep-2021, the patient experienced NASOPHARYNGITIS (Felt like I was catching a cold). On 07-Sep-2021, the patient experienced APHONIA (No voice). At the time of the report, NASOPHARYNGITIS (Felt like I was catching a cold) and APHONIA (No voice) outcome was unknown. Concomitant medications were not provided. Treatment medication was not provided. Patient thought the third dose was booster and got vaccinated was told that third dose are for immunosuppressed.


VAERS ID: 1711016 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-08-08
Onset:2021-09-05
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Illness, Injected limb mobility decreased, Joint warmth, Lymphadenopathy, Musculoskeletal stiffness, Periarthritis, Product administered at inappropriate site, Pyrexia, Vaccination site pain
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Drug abuse and dependence (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: sickness; capsulitis; fever; tiredness; injection was "higher" than it should have been, was not in the deltoid; shoulder feels hot; jolt of pain into her shoulder; pain and hot burning at the injection site; lymph nodes in my arm are swollen; arm feels stiff; hard time moving my arm up or forward,cannot put on my shirt by myself,can''t put on deodorant by myself,cannot lift my arm; This spontaneous case was reported by a consumer and describes the occurrence of JOINT WARMTH (shoulder feels hot), ILLNESS (sickness), MUSCULOSKELETAL STIFFNESS (arm feels stiff), INJECTED LIMB MOBILITY DECREASED (hard time moving my arm up or forward,cannot put on my shirt by myself,can''t put on deodorant by myself,cannot lift my arm) and PERIARTHRITIS (capsulitis) in a 36-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 052E21A and 026D21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 08-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 05-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 05-Sep-2021, the patient experienced JOINT WARMTH (shoulder feels hot), MUSCULOSKELETAL STIFFNESS (arm feels stiff), INJECTED LIMB MOBILITY DECREASED (hard time moving my arm up or forward,cannot put on my shirt by myself,can''t put on deodorant by myself,cannot lift my arm), VACCINATION SITE PAIN (pain and hot burning at the injection site), LYMPHADENOPATHY (lymph nodes in my arm are swollen) and ARTHRALGIA (jolt of pain into her shoulder). On an unknown date, the patient experienced ILLNESS (sickness), PERIARTHRITIS (capsulitis), PYREXIA (fever), FATIGUE (tiredness) and PRODUCT ADMINISTERED AT INAPPROPRIATE SITE (injection was "higher" than it should have been, was not in the deltoid). At the time of the report, JOINT WARMTH (shoulder feels hot), ILLNESS (sickness), MUSCULOSKELETAL STIFFNESS (arm feels stiff), INJECTED LIMB MOBILITY DECREASED (hard time moving my arm up or forward,cannot put on my shirt by myself,can''t put on deodorant by myself,cannot lift my arm), PERIARTHRITIS (capsulitis), VACCINATION SITE PAIN (pain and hot burning at the injection site), LYMPHADENOPATHY (lymph nodes in my arm are swollen), PYREXIA (fever), FATIGUE (tiredness), ARTHRALGIA (jolt of pain into her shoulder) and PRODUCT ADMINISTERED AT INAPPROPRIATE SITE (injection was "higher" than it should have been, was not in the deltoid) outcome was unknown. The patient treatment medication included Tylenol and advil, also using ice for shoulder pain. Also prescribed steroid for 5 days but she had not taken yet. This case was linked to MOD-2021-311116 (Patient Link).


VAERS ID: 1711075 (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: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 - / OT

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

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

Write-up: 15 year old patient administered 1st Moderna dose; This spontaneous case was reported by a pharmacist and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE in a 15-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 053E21A) for COVID-19 vaccination. No Medical History information was reported. On 05-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 05-Sep-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (1st Moderna dose). On 05-Sep-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (1st Moderna dose) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Relevant concomitant medications were not reported. The treatment information was not provided.


VAERS ID: 1711089 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-03
Onset:2021-09-05
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Fatigue, Hypoaesthesia, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: the tingling numbness in her left hand got worse; tingling numbness moved into her left leg; the tingling numbness moved into her left arm and moved into her whole left side; numbness in her left hand; felt totally wiped out; pain in her left hand; tingling in her left hand; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (pain in her left hand), PARAESTHESIA (tingling in her left hand), HYPOAESTHESIA (the tingling numbness in her left hand got worse), HYPOAESTHESIA (tingling numbness moved into her left leg) and HYPOAESTHESIA (the tingling numbness moved into her left arm and moved into her whole left side) in a 39-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 052CorE21A and 088D21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 03-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 05-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 05-Sep-2021, the patient experienced PAIN IN EXTREMITY (pain in her left hand) and PARAESTHESIA (tingling in her left hand). On 06-Sep-2021, the patient experienced FATIGUE (felt totally wiped out). On 07-Sep-2021, the patient experienced HYPOAESTHESIA (numbness in her left hand). On 08-Sep-2021, the patient experienced HYPOAESTHESIA (the tingling numbness in her left hand got worse), HYPOAESTHESIA (tingling numbness moved into her left leg) and HYPOAESTHESIA (the tingling numbness moved into her left arm and moved into her whole left side). At the time of the report, PAIN IN EXTREMITY (pain in her left hand), PARAESTHESIA (tingling in her left hand), HYPOAESTHESIA (the tingling numbness in her left hand got worse), HYPOAESTHESIA (tingling numbness moved into her left leg), HYPOAESTHESIA (the tingling numbness moved into her left arm and moved into her whole left side), HYPOAESTHESIA (numbness in her left hand) and FATIGUE (felt totally wiped out) outcome was unknown. Patient had reported that she tested negative twice then but felt all the symptoms and felt the worst in the house as other in the house were Covid positive and sick. Patient also reported that on 06-SEP-2021 she felt worse with the vaccine than she did in July of 2020. On Tuesday she got better but had numbness in her hand that got worse and radiate to her left arm, then left leg and to the whole left side of body. Concomitant product use was not provided by the reporter. Treatment information was not provided by the reporter.


VAERS ID: 1711209 (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: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Anaphylactic reaction, Confusional state, Nausea, Seizure
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: nausea; very confused; seizure in her bed; Anaphylactic allergic reaction; This spontaneous case was reported by a consumer and describes the occurrence of SEIZURE (seizure in her bed), CONFUSIONAL STATE (very confused), NAUSEA (nausea) and ANAPHYLACTIC REACTION (Anaphylactic allergic reaction) in a 52-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 058E21A) for COVID-19 vaccination. No Medical History information was reported. On 04-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 05-Sep-2021, the patient experienced SEIZURE (seizure in her bed) (seriousness criteria hospitalization and medically significant) and ANAPHYLACTIC REACTION (Anaphylactic allergic reaction) (seriousness criteria hospitalization and medically significant). On 06-Sep-2021, the patient experienced CONFUSIONAL STATE (very confused) (seriousness criterion hospitalization). On an unknown date, the patient experienced NAUSEA (nausea) (seriousness criterion hospitalization). The patient was hospitalized from 05-Sep-2021 to 07-Sep-2021 due to ANAPHYLACTIC REACTION, CONFUSIONAL STATE, NAUSEA and SEIZURE. At the time of the report, SEIZURE (seizure in her bed), CONFUSIONAL STATE (very confused), NAUSEA (nausea) and ANAPHYLACTIC REACTION (Anaphylactic allergic reaction) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications were reported. On Sunday, 05-Sep-2021, at 7 PM, patient experienced a seizure in her bed. She was taken to ER. The patient woke up after 24 hours in confused state and gradually became aware of her surroundings She was treated with anti seizure medications and fluids. She was discharged 48 hours later with seizure medications. Company Comment: This case concerns a 52-year-old, female patient with no relevant medical history , who experienced the expected event of Anaphylactic reaction, also experienced seizures, confusional state and nausea. The event occurred the next day after the first dose of mRNA-1273. The rechallenge was not applicable since only information about the first dose was disclosed. The reporter assessed the events as possible. The event is consistent with the current understanding of the mechanism of action of the vaccine. The benefit-risk relationship of mRNA-1273 is not affected by this report. Most recent FOLLOW-UP information incorporated above includes: On 13-Sep-2021: Follow up received on 13-sep-2021 includes dose description, events, vaccine facility information.; Sender''s Comments: This case concerns a 52-year-old, female patient with no relevant medical history , who experienced the expected event of Anaphylactic reaction, also experienced seizures, confusional state and nausea. The event occurred the next day after the first dose of mRNA-1273. The rechallenge was not applicable since only information about the first dose was disclosed. The reporter assessed the events as possible. The event is consistent with the current understanding of the mechanism of action of the vaccine. The benefit-risk relationship of mRNA-1273 is not affected by this report.


VAERS ID: 1711764 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-09-03
Onset:2021-09-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure measurement, Depression, Post-traumatic stress disorder, Suicidal ideation
SMQs:, Suicide/self-injury (narrow), Depression (excl suicide and self injury) (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: VITAMIN B12 [CYANOCOBALAMIN]; FOLIC ACID; FLUVOXAMINE; BUSPIRONE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Blood pressure high; Concussion; Endometriosis; Fibromyalgia; Migraine; Post-traumatic stress disorder (Complex post-traumatic stress disorder); Premenstrual dysphoric disorder; Type 2 diabetes mellitus
Allergies:
Diagnostic Lab Data: Test Name: blood pressure; Result Unstructured Data: Test Result:High
CDC Split Type: USPFIZER INC202101154764

Write-up: suicidal thougths; Severe depression; tgen my c-ptsd got so severe; This is a spontaneous report from a Non-contactable consumer (patient). A 34-year-old non-pregnant female patient received BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Lot number: unknown) via an unspecified route of administration (Age at time of vaccination: 34) on 03Sep2021, 03.45 PM in left arm as dose 1, single dose for COVID-19 immunisation. Patient medical history reported as C-pstd, migraines, concussions, fibromyalgia, pmdd, endometriosis, diabetes type 2, high blood pressure from an unknown start and stop dates. Patient''s known allergies were too many to list. Concomitant medication reported as Vitamin B12, folic acid, fluvoxamine, buisperone. No other vaccine administered within four weeks. COVID prior vaccination was reported as no and COVID test post vaccination reported as no. On 05Sep2021 03:30 AM, patient experienced Severe depression and suicidal thoughts increase and tgen c-ptsd got so severe. On unspecified date patient underwent lab test and procedure included Blood pressure measurement: high. Treatment was not taken. The clinical outcome of all events were unknown. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1711778 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-06
Onset:2021-09-05
   Days after vaccination:152
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7533 / 2 RA / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Fruit allergy (kiwi fruit); Hashimoto''s thyroiditis; Penicillin allergy (mycin/micin types of antibiotics)
Allergies:
Diagnostic Lab Data: Test Date: 20210902; Test Name: SARS-COV-2 NAA/Nasal Swab; Test Result: Positive
CDC Split Type: USPFIZER INC202101161238

Write-up: COVID-19 positive; COVID-19 positive/symptoms: nasal congestion, fatigue, loss of taste and smell.; This is a spontaneous report from a contactable consumer. A 53-years-old non pregnant female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Solution for injection; Lot number: EP7533, Expiry date was not reported), intramuscular, administered in Arm Right on 06Apr2021 15:30 (at the age of 53-years-old) as dose 2, single for covid-19 immunisation (Pharmacy or Drug Store). Medical history included hashimoto thyroiditis from an unknown date and unknown if ongoing and known allergies: penicillin, mycin/micin types of antibiotics, kiwi fruit. The patient''s concomitant medications were not reported. Prior vaccination, the patient had not received any other vaccine within 4 weeks. The patient had been covid tested post vaccination. The patient previously received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot number: EP6055, Expiry date was not reported), intramuscular, administered in arm right on 16Mar2021 13:00 as dose 1 for covid-19 immunisation. The patient had breakthrough COVID-19 positive case with these symptoms: nasal congestion, fatigue, loss of taste and smell. The patient tested positive. Symptoms began on Monday 30Aug2021 with congestion and then progressed with fatigue and loss of taste and smell on 31Aug2021. Took a nasal swab test on Thursday 02Sep2021 and learned positive result on Sunday 05Sep2021. The event resulted in doctor or other healthcare professional office/clinic visit. The patient did not receive treatment for the adverse event. The patient underwent lab tests and procedures which included sars-cov-2 test/ nasal Swab: positive on 02Sep2021. The outcome of event was recovering. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1711814 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-29
Onset:2021-09-05
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Feeling abnormal, SARS-CoV-2 test
SMQs:, Dementia (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: Test Date: 20210906; Test Name: SARS-CoV-2 test; Result Unstructured Data: Test Result:tested positive
CDC Split Type: USPFIZER INC202101163731

Write-up: they are now testing positive for COVID 19; her daughter began to feel bad yesterday; This is a spontaneous report from a contactable consumer (patient''s mother) for the patient (daughter). A female patient of an unspecified age received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection), dose 1 via an unspecified route of administration on 29Aug2021 (Batch/Lot number was not reported) as DOSE 1, SINGLE for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The reporter states that her daughter got her first dose of the vaccine on 29Aug2021. She states that they have not been exposed to anyone with COVID 19 and that they are now testing positive for COVID 19. She states that it has been 8-9 days and she tested positive on Saturday and her daughter tested positive today (06Sep2021). She would like to know if this is because of the vaccine and that they really don''t have the virus? She makes an example of when people get the flu shot and then get sick with the flu. She states that it''s the same because the vaccine is COVID that they put in their body. She states that her daughter began to feel bad yesterday (05Sep2021). The reporter would like to know if she can still get her second dose of the vaccine now since she has tested positive after the first dose. She also states that this vaccine is the virus so that is why she is testing positive right? She states that the vaccine puts the virus in your body. The patient underwent lab tests and procedures which included sars-cov-2 test: tested positive on 06Sep2021. The outcome of both the events was unknown. The lot number for the vaccine, BNT162B2, was not provided and will be requested during follow up.


VAERS ID: 1711815 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-04
Onset:2021-09-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test
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: Test Date: 20210905; Test Name: Rapid Test; Test Result: Positive ; Comments: tested positive today for the rapid test
CDC Split Type: USPFIZER INC202101163928

Write-up: tested positive today for the rapid test; This is a spontaneous report from a Pfizer sponsored program. A Non-contactable consumer reported for a patient (reporter''s wife) reported that: A female patient of unspecified age received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Batch/Lot Number: not reported), via an unspecified route of administration on 04Sep2021 as dose 1, single for covid-19 immunization. Patient had no known allergies and no relevant medical history. The patient concomitant medications were not reported. The caller wanted to know that if his wife take 2nd dose since his wife got covid-19 vaccine yesterday and she tested positive today (i.e. 05Sep2021) for the rapid test. The outcome of the event was unknown. No follow-up attempts are possible. No further information is expected.


VAERS ID: 1711840 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-05
Onset:2021-09-05
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 2 - / OT

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test, Vaccination failure
SMQs:, Lack of efficacy/effect (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: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data: Test Date: 20210905; Test Name: COVID test; Test Result: Positive.
CDC Split Type: USPFIZER INC202101169107

Write-up: Patient tested positive for COVID on 05Sep2021; Patient tested positive for COVID on 05Sep2021; This is a spontaneous report from a contactable other healthcare professional. A 12-year-old female patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: solution for injection, Lot Number: EW0175) via intramuscular on 15May2021 (12-year-old at the time of vaccination) as dose 1, single, and second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Lot Number: EW0175) via intramuscular on 05Jun2021 (12-year-old at the time of vaccination) as dose 2, single for covid-19 immunization. Medical history included the patient was infected with COVID 19 in December 2020 and unknown if ongoing. The patient''s concomitant medications were not reported. The patient was fully vaccinated. The patient had covid prior to vaccination. The patient was tested since vaccination. On 05Sep2021, the patient was tested positive for COVID. The patient underwent lab tests and procedures which included COVID test positive on 05Sep2021. The outcome of the events were recovering. No follow-up attempts are possible. No further information is expected. Based on plausible dose- event relationship post-vaccination the causal role of BNT162B2 vaccine cannot be excluded for the reported events The impact of this report on the benefit/risk profile of the product is evaluated as part of procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, as appropriate


VAERS ID: 1711848 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-03-30
Onset:2021-09-05
   Days after vaccination:159
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6995 / 2 RA / OT

Administered by: Work       Purchased by: ?
Symptoms: COVID-19, Headache, Polymerase chain reaction, Sneezing, Vaccination failure
SMQs:, Anaphylactic reaction (broad), Lack of efficacy/effect (narrow), Hypersensitivity (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? No
Previous Vaccinations:
Other Medications: LEVOXYL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Egg allergy (Egg white); Food allergy (Wheat); Food allergy (Corn); Hashimoto''s disease (Hashimoto Disease (thyroid)); Milk allergy; Soy allergy
Allergies:
Diagnostic Lab Data: Test Date: 20210905; Test Name: PCR; Test Result: Positive ; Comments: Nasal Swab
CDC Split Type: USPFIZER INC202101169354

Write-up: Tested positive with PCR test; Tested positive with PCR test; sneezing; slight headache; This is a spontaneous report from a contactable consumer (patient). A 48-years-old female patient received bnt162b2 (BNT162B2, Solution for injection, Lot Number: EP6995) via intramuscular, administered in Arm Right on 30Mar2021 at 14:00 (at the age of 48-year-old) as dose 2, single and dose 1, bnt162b2 (BNT162B2, Solution for injection, Lot Number:EL3247) via intramuscular, administered in Arm Right on 09Mar2021 at 14:45 (at the age of 47-year-old) as dose 1, single for COVID-19 immunisation. The patient''s medical history included Hashimoto Disease (thyroid) and the patient was allergic to dairy, wheat, egg white, soy, corn. Concomitant medication included levothyroxine sodium (LEVOXYL) taken for an unspecified indication. Prior to vaccination the patient was not diagnosed with COVID-19. Patient stated that he tested positive with PCR test taken on 05Sep2021,no symptoms other than some sneezing, slight headache evening of 05Sep. Since the vaccination in 2021, the patient been tested for COVID-19. The patient underwent lab tests and procedures which included polymerase chain reaction: positive on 05Sep2021(Nasal Swab). The outcome of the event events was recovered on unknown date in Sep2021. Follow-Up (10Sep2021): Follow-up attempts are completed. No further information is expected.


VAERS ID: 1711903 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-02
Onset:2021-09-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Musculoskeletal discomfort, Musculoskeletal stiffness, Neck pain
SMQs:, Rhabdomyolysis/myopathy (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101176843

Write-up: developed a still neck with pain, barely can turn head left or right, and its really tensed up; developed a still neck with pain, barely can turn head left or right, and its really tensed up; developed a still neck with pain, barely can turn head left or right, and its really tensed up; This is a spontaneous report received from a contactable consumer or other non hcp. A 54-years-old female patient received 1st dose of bnt162b2 (COMIRNATY,Batch/Lot number was not reported), via an unspecified route of administration on 02Sep2021,at the age of 54 years old, as Dose 1,single for covid-19 immunization.The patient medical history and concomitant medications were not reported.The patient experienced she developed a still neck with pain, barely can turn head left or right, and its really tensed up on 05Sep2021.Therapeutic measures were taken as a result of developed a still neck with pain, barely can turn head left or right, and its really tensed up.Patient has been taking extra strength tylenol but its barely helped. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1711940 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-09-04
Onset:2021-09-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / UNK LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ESCITALOPRAM OXALATE; FLUTICASONE PROPIONATE; DULOXETINE; ASPIRIN [ACETYLSALICYLIC ACID]; ATORVASTATIN; CLONAZEPAM; MELATONIN; INFLIXIMAB DYYB; NEBIVOLOL; TRAZODONE; MULTIVITAMINS [VITAMINS NOS]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anxiety; Crohn''s disease (Chron''s Disease); Depression; Palpitation (One chamber of hear beating out of rhythm with the others); Shingles
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101182790

Write-up: I have had shingles before (10 years ago) and recognized it. Since then it is slowly spreading in a circle around the outside of my underarm on both arms; I started having a burning sensation in the underarm area of my left arm; I had a rash area develop in the underarm of my left arm.; This is a spontaneous report from a contactable consumer (patient) or other HCP. A 50-year-old male patient received bnt162b2 (BNT162B2, solution for injection, Lot Number: FA7485) dose number unknown via an unspecified route of administration, administered in the left arm on 04Sep2021 17:45 (at the age of 50 years old) as dose number unknown, single for COVID-19 immunisation. Medical history included crohn''s disease, anxiety, depression, palpitations (one chamber of heart beating out of rhythm with the others), shingles had shingles before (10 years ago). Patient had no known allergies. Concomitant medication(s) included escitalopram oxalate; fluticasone propionate; duloxetine; aspirin (acetylsalicylic acid), atorvastatin; clonazepam; melatonin; infliximab dyyb; nebivolol; trazodone and multivitamins start date and stop date was unknown. No other vaccines were given 4 weeks. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination the patient had not been tested COVID-19. On 05Sep2021 16:00 the patient experienced I have had shingles before (10 years ago) and recognized it, since then it is slowly spreading in a circle around the outside of my underarm on both arms, I started having a burning sensation in the underarm area of my left arm, I had a rash area develop in the underarm of my left arm. Therapeutic measures were taken as a result of I have had shingles before (10 years ago) and recognized it, since then it is slowly spreading in a circle around the outside of my underarm on both arms, I started having a burning sensation in the underarm area of my left arm, I had a rash area develop in the underarm of my left arm and included treatment with prescriptions for valacyclovir and gabapentin. All the events results physician office visit. The clinical outcome of the events was reported as not recovered. Follow-up attempts are completed. No further information is expected.


VAERS ID: 1712069 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101198094

Write-up: Still getting off and on chills; Easily fatigued; Arm is still sore; This is a spontaneous report from a contactable consumer, the patient. A 55-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 05Sep2021 at 16:00 (at the age of 55-years-old) as a single dose for COVID-19 immunisation. The patient did not have any medical history. The patient had no known allergies. Prior to vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccine 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 15Aug2021 at 12:00 (at the age of 55-years-old) as a single dose for COVID-19 immunisation. On 05Sep2021 at 18:00, the patient experienced off and on chills, easily fatigued and his arm was sore. Reportedly, it was then 7 days later he was still getting off and on chills. He was easily fatigued. His arm was still sore. The events 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 reported events. Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events chills, fatigue and arm was still sore was not recovered at the time of this report. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1712116 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-01
Onset:2021-09-05
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH CW0164 / 1 - / -

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: USPFIZER INC202101207217

Write-up: This is a spontaneous report from a contactable consumer (patient). A 28-year-old male patient received the first dose of BNT162B2 (Pfizer-BioNTech COVID-19 mRNA vaccine, solution for injection, batch/lot# CW0164), at the vaccination age of 28, via an unspecified route of administration, on an unspecified date, Aug 2021, single dose, at workplace clinic, for COVID-19 immunisation. Medical history and concomitant medication not reported. The patient had not received any other vaccine within 4 weeks. Prior to vaccination and post vaccination, patient was not diagnosed with COVID-19. The patient was not tested for COVID-19. On Sep 5, 2021, patient experienced hives on different areas of my body (legs, back, thighs) at various times (urticaria), loss of balance while standing and walking (balance disorder), difficulty standing in one place or walking in a straight line (dysstasia), difficulty standing in one place or walking in a straight line (gait disturbance). Patient treated with Cadista as a result of events with outcome of recovering.


VAERS ID: 1712124 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-25
Onset:2021-09-05
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Heart rate abnormal, Hypoaesthesia, Palpitations, Pruritus, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad), 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:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data: Test Date: 20210910; Test Name: Nasal Swab; Test Result: Negative
CDC Split Type: USPFIZER INC202101211587

Write-up: Bruises on the legs; Itching all over body; Numbness on hands, arms, legs, and toes; Heartbeat Palpitations; Heartbeat Palpitations; This is a spontaneous report from a contactable consumer, the patient. A 20-year-old non-pregnant female patient received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FD8448) via an unspecified route of administration in the left arm on 25Aug2021 at 12:30 (at the age of 20-years-old) as a single dose for COVID-19 immunisation. The patient did not have any medical history. 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. The patient did not receive any concomitant medications. On 05Sep2021, the patient had bruises on the legs, numbness on hands, arms, legs and toes, itching all over body and heartbeat palpitations. The events resulted in doctor or other healthcare professional office/clinic visit. Therapeutic measures were taken as a result of the events and included treatment with methylprednisolone (MANUFACTURER UNKNOWN). Since the vaccination, the patient had been tested for COVID-19. On 10Sep2021, the patient underwent COVID-19 test via nasal swab and the result was negative. The clinical outcome of the events bruises on the legs, numbness on hands, arms, legs and toes, itching all over body and heartbeat palpitations were resolving at the time of this report.


VAERS ID: 1714093 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-26
Onset:2021-09-05
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Decreased appetite, Dehydration, Dyspnoea, Productive cough, SARS-CoV-2 test positive, Troponin increased, Vaccine breakthrough infection, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Infective pneumonia (broad), Dehydration (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, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ALPRAZolam (XANAX) 0.25 MG tablet TAKE ONE TABLET BY MOUTH THREE TIMES DAILY AS NEEDED FOR ANXIETY amLODIPine (NORVASC) 10 MG tablet Take 10 mg by mouth daily. Information, Historical chlorhexidine (PERIDEX) 0.12 % MT Solution Rinse m
Current Illness:
Preexisting Conditions: Anxiety ? Cancer ? Cholelithiasis ? Diabetes mellitus ? Gout ? History of skin cancer ? Hypertension ? Lower back pain ? Nephrolithiasis ? Osteoarthritis
Allergies: Penicillins
Diagnostic Lab Data: SARS-COV02, NAA, Detected: 09/05/21.
CDC Split Type:

Write-up: Patient required hospitalization due to breakthrough infection. Patient received J&J vaccine on 03/26/21. Patient was hospitalized from 09/05/21 - 09/18/21. Below is copied from discharge summary: History of Present Illness: 93 y.o. male with Hx of HTN, DM, CAD s/p CABGx4, jaw cancer presents c/o worsening SOB and wheezing since this morning. Pt reports associated productive cough, dehydration and no appetite. Denies fevers, N/V or abd pain. PSHx Bypass graft. Vaccinated against COVID with J&J vaccine. Denies chest pain. Troponins are significantly elevated. The history is provided by the patient. No language interpreter was used. Shortness of Breath Severity: Moderate Onset quality: Gradual Duration: 1 day Timing: Constant Progression: Unchanged Chronicity: New Associated symptoms: cough and wheezing Associated symptoms: no abdominal pain, no chest pain, no fever, no headaches, no neck pain, no sore throat and no vomiting


VAERS ID: 1714254 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O17EZ1A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bed rest, Chest pain, Chills, Dyspnoea, Electrocardiogram, Pyrexia, Syncope, Tachycardia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Soy
Diagnostic Lab Data: Ekg, waiting on cardiologist appointment for further tests
CDC Split Type:

Write-up: Fever, chills, chest pain, shortness of breath, tachycardia, fainted once morning after vaccine. It?s been 2 weeks and still have chest pain, tachycardia, and shortness of breath. Had ekg, prescribed propranolol and anti inflammatory and bed rest.


VAERS ID: 1714489 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-08-09
Onset:2021-09-05
   Days after vaccination:27
Submitted: 0000-00-00
Entered: 2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angina pectoris, Asthenia, Chest X-ray normal, Chest pain, Discomfort, Electrocardiogram normal, Fatigue, Initial insomnia, Muscle spasms
SMQs:, Dementia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Other ischaemic heart disease (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: Amitriptylin 10 mg, Vitamin D, Omega 3
Current Illness: None
Preexisting Conditions: No
Allergies: None
Diagnostic Lab Data: I went to Urgent care on 9/5/21. The nurse practitioner conducted chest X-ray and another test (I believed called EKG) that measured my heart pulse. No issue was detected. I followed up with Dr. on 9/7/21. She reviewed the results taken on 9/5/21 and she believed I should be fine. However, as a precaution, she ordered me a treadmill test which I have not done yet.
CDC Split Type:

Write-up: On August 23, exactly 2 weeks after my first dose, I felt slight cramp in my heart continuously through the day for one to two days. I also felt light upper chest pain along as well. The discomfort was minor and did not affect my daily routine. I never had this kind of cramp and pain before so I knew it was from the vaccine. I was back to normal after one to two days. I never Then on early AM of 9/5/21 while trying to fall asleep, I suffered heartache that lasted a while, probably several minutes (I did not check the clock to see how long it lasted). I never had this problem. I thought that I was going to have a heart attack. Fortunately, it went away and I was able to sleep later. I felt tired and weak all day on 9/5/21. I felt better the next day and is fine so far.


VAERS ID: 1714899 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-04
Onset:2021-09-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, Dostinex, MVI-Flintstone, Zyrtec, Vitamin D, Collagen, Baby ASA
Current Illness: Sinuses
Preexisting Conditions: Hypothyroidism, hypopitiuitarism, Osteoarthritis, Spinal Stenosis, Endometriosis, Menopause. Bell''s Palsy 20 years ago as a result of a traumatic stressful life event.
Allergies: Seasonal allergies only
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient states that the morning after she was vaccinated she woke up with numbness and tingling on the left side of her face. This numbness and tingling was above the baseline of the regular level of numbness and tingling she has on the left side of her face due to Bell''s Palsy from 20 years ago. She indicates that the original occurrence of Bell''s Palsy was not the result of a previous vaccination but of a traumatic stressful event. She has been under the care of a neurologist since that time. The new numbness and tingling on the left side of her face lasted for a day and by the next day she had returned to her previous level of sensation on the left side of her face. Patient notified her physician of her reaction to the vaccination and they suggested she call the Health Department to see if she should have the second Pfizer vaccination. RN encouraged patient to call physician to discuss whether a second dose of the Pfizer vaccine should be given due to the physician''s greater knowledge of the patients complex medical history. Patient verbalized understanding and said that she would follow up with her physician to discuss.


VAERS ID: 1714927 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-01
Onset:2021-09-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Arthralgia, Blood test normal, Burning sensation, Myalgia, Pain, Pain in extremity, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Propranolol 20mg 2x per day
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: On 9/9/21 I went to the emergency department and blood work was done. It was clear.
CDC Split Type:

Write-up: My spine felt like it was burning. I would move a muscle such as my hand or my foot or even my abdominals and they would respond with a searing/shooting pain. The joints in my body were burning which I''ve never experienced before. It hurt to close my hand to grip a pencil. After a few days of this my entire body felt as if it was burning or tingling with pain. The friction of my clothes against my skin caused physical pain.


VAERS ID: 1715054 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: California  
Vaccinated:2021-05-23
Onset:2021-09-05
   Days after vaccination:105
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Cough, Oropharyngeal pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: cough sore throat fever


VAERS ID: 1715224 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-04
Onset:2021-09-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Paroxetine 5 mg (1/2 of 10 mg) daily
Current Illness:
Preexisting Conditions:
Allergies: None Known
Diagnostic Lab Data: Received pelvic ultrasound on September 15th after 10 days of intermittent bleeding. Waiting for results.
CDC Split Type:

Write-up: Intermittent vaginal bleeding. Onset 9/5/2021 (morning after receiving vaccine) and is still continuing.


VAERS ID: 1715351 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-01
Onset:2021-09-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Condition aggravated, Dizziness, Insomnia, Nausea, Oropharyngeal pain, Pain in extremity, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Seroquel, Paxil, mirtazipine, ezetimibe, Ativan, budesonide and formetoterol fumarate dihydrate inhaler. Vit d, b vitamins, vitamin c.
Current Illness: None
Preexisting Conditions: Asthma. Anxiety. Depression.
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I felt dizzy for a few hours after the vaccine and felt like I might pass out. Shaking for about an hour. Anxiety for a few days. Nausea off and on for two days. Trouble sleeping the night of vaccine. Sore throat for two days. Sore arm for 3 days.


VAERS ID: 1715454 (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: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Cold sweat, Disorientation, Headache, Loss of consciousness, Nausea, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (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: Lisinopril, Pantoprazole, Fenofibrate
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data: The doctor checked me and did bloodwork but don''t know results yet.
CDC Split Type:

Write-up: Had the shot and after about five minutes started to feel queasy. Then started to have a cold sweat and passed out. The pharmacy guy thought it was a seizure and I was out for around four minutes. I came out of it and was disoriented and was very weak and had a headache. Went back home and rested the rest of the day. Couldn''t get in to see Doctor until about a week later and she felt I may not of had a full seizure.


VAERS ID: 1715657 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-09-04
Onset:2021-09-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN B43A21A / 1 LA / IM

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

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

Write-up: Long Standing Tinnitus to left ear. Suddenly increased in intensity next day. Remains significantly louder.


VAERS ID: 1716105 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Anthrax vaccine, shoulder soreness, ~ age 35
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Significant soreness and some swelling in left deltoid, maximizing on Sept 7th, and mostly resolved by evening of Sept 9th.


VAERS ID: 1716114 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-17
Onset:2021-09-05
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017EZIA / 2 RA / SYR

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

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

Write-up: Early period (10 days early) and frequent spotting in month following vaccine.


VAERS ID: 1716330 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-01-25
Onset:2021-09-05
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EJ1686 / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EL9263 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Cough, Dyspnoea, Hypoxia, Lung opacity, SARS-CoV-2 test positive, Wheelchair user
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen, allopurinol, labetalol, levothyroxine, milk of magnesia, prednisone, simvastatin, tamsulosin, tramadol
Current Illness:
Preexisting Conditions: Known history of CAD with history of MI, history of complete heart block status post pacemaker implant, hypertension, hyperlipidemia, BPH, hypothyroidism, gout, obstructive sleep apnea, osteoarthritis, polymyalgia rheumatica, history of prostate cancer, history of CVA in the remote past, history of left femur fracture status post surgery, osteopenia, skin cancer.
Allergies: None
Diagnostic Lab Data: 9/5/21 COVID 19: Positive 9/15/21 Chest xray: Bilateral pulmonary opacities likely representing COVID-19 pneumonia. 9/15/21 CTA chest: Findings compatible with COVID pneumonia.
CDC Split Type:

Write-up: Has been vaccinated against COVID-19, but on 9/5/21 he tested positive for COVID 19 at the nursing home and since then he has shortness of breath and cough has gotten worse and he was apparently saturating only 88% on room air and therefore, was sent to the emergency room at DMH where workup showed him to have a bilateral COVID pneumonia on the CT of the chest without any PE. The patient was started on Decadron, Rocephin, Zithromax and then the hospitalist service was called for admission. Please note, the patient has no history of CHF or COPD but is requiring currently 2 L of oxygen and is saturating 93%. A stat ABG has been ordered and the patient will be need to be admitted as an inpatient to our COVID unit. As per the nursing home papers he is a DNR. When I saw the patient he denies any headache, dizziness, chest pain, or shortness of breath. Does say that he has occasional cough but not bringing up any sputum. No nausea, vomiting, or diarrhea. No history of any epistaxis, hemoptysis, hematemesis, melena, hematochezia, hematuria.Was not a candidate for any remdesivir. He was treated with the Decadron, but patient already on steroids at home. He has hypoxia has resolved. He is back to normal himself. Up and active to his capacity. Normally at the assisted living facility he goes to the facility dining room in a wheelchair. He uses wheelchair to go to the bathroom. Here physical therapy is working with him and he seems to be doing stable from the discharge standpoint here. Today patient is afebrile. Has no shortness of breath cough Lungs clear Heart regular rhythm Extremity no edema scar from bilateral knee arthroplasty Physical therapy working with patient and patient''s seem to be strong overall stable. Skin turgor is good. Discharged on 9/20/21


VAERS ID: 1716353 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-03
Onset:2021-09-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: 2 days after my 2nd shot, I started ?spotting?. My period was not due for another 2 1/2 weeks. My cycle is extremely regular, every 28 days for over 10 years now. I have never spotted in between periods. I spotted off and on from 9/5-9/20 then my period started fully. It was originally due on 9/20. So I spotted for 2 1/2 weeks which I have never done before. It is also heavier and more clotted than usual. I?m not sure yet if this will be a normal period from here out or not. I came across an article online about this happening to other women after their vaccine and it all made sense. I felt like it was important to share this.


VAERS ID: 1716787 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-08-16
Onset:2021-09-05
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066D21A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthyroid, Vitamin C, Vitamin D3
Current Illness: None.
Preexisting Conditions: Hypothyroidism
Allergies: Sulfa, Pencillin, Morphine.
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2weeks after receiving the COVID vaccine I broke out with shingles on my right lower abdomen and back


VAERS ID: 1716908 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-07
Onset:2021-09-05
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Hepatic pain, Hot flush, Hyperhidrosis, Myalgia, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament 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: syntroid 125 mcg
Current Illness: none
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Muscle aches on legs and lower bag that will not resolve even after 2 weeks. Also hot flash and sweating and pain in Liver.


VAERS ID: 1718082 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-06
Onset:2021-09-05
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling
SMQs:

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

Write-up: it itches like crazy; the area is a little bit swollen; red around the injection site. Today it is still real red around the injection site, is worse than it was to begin with, and the redness is drifting away from injection site to the under side of her arm; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE PRURITUS (it itches like crazy), VACCINATION SITE ERYTHEMA (red around the injection site. Today it is still real red around the injection site, is worse than it was to begin with, and the redness is drifting away from injection site to the under side of her arm) and VACCINATION SITE SWELLING (the area is a little bit swollen) in an 80-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 06-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 03-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 05-Sep-2021, the patient experienced VACCINATION SITE ERYTHEMA (red around the injection site. Today it is still real red around the injection site, is worse than it was to begin with, and the redness is drifting away from injection site to the under side of her arm). On 10-Sep-2021, the patient experienced VACCINATION SITE PRURITUS (it itches like crazy) and VACCINATION SITE SWELLING (the area is a little bit swollen). At the time of the report, VACCINATION SITE PRURITUS (it itches like crazy) and VACCINATION SITE SWELLING (the area is a little bit swollen) outcome was unknown and VACCINATION SITE ERYTHEMA (red around the injection site. Today it is still real red around the injection site, is worse than it was to begin with, and the redness is drifting away from injection site to the under side of her arm) had not resolved. No Concomitant and Treatment medications were reported.


VAERS ID: 1718293 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye pain, Injection site pruritus, Vaccination site mass, Vaccination site swelling
SMQs:, Glaucoma (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZOLOFT
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anxiety depression (Depression and anxiety); COVID-19 (If Covid Prior vaccination: Yes); Food allergy (known allergies: Penicillin, black beans, agave, everything bagel seasoning); Penicillin allergy (known allergies: Penicillin, black beans, agave, everything bagel seasoning)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101171774

Write-up: Painful eyes; golf ball sized lump under injection site with swelling and itchiness; golf ball sized lump under injection site with swelling and itchiness; golf ball sized lump under injection site with swelling and itchiness; This is a spontaneous report from a contactable consumer (patient). A 23-year-old female non-pregnant patient received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Formulation: Solution for injection, Lot number and expiration date was not reported), via an unspecified route of administration in left arm on 05Sep2021 14:30 as dose 1, single for COVID-19 immunization (at the age of 23-year-old, non-pregnant). The most recent COVID-19 vaccine was administered at Pharmacy or Drug Store. Medical history included depression and anxiety, known allergies to Penicillin, black beans, agave, everything bagel seasoning and patient had covid prior vaccination from an unknown date and unknown if ongoing. Covid was not tested post vaccination. Concomitant medication(s) (within 2 weeks of vaccination) included sertraline hydrochloride (ZOLOFT). The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient experienced painful eyes, golf ball sized lump under injection site with swelling and itchiness on 05Sep2021 15:45. Reported seriousness for the events was non-serious. The patient did not receive treatment for the event. The outcome of the events was not recovered. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1718971 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-02-11
Onset:2021-09-05
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9262 / UNK - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest pain, Cough, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen (TYLENOL) 325 MG CAPS desogestrel-ethinyl estradiol (KARIVA) 0.15-0.02/0.01 MG (21/5) desvenlafaxine (PRISTIQ) 50 MG 24 hr tablet Ibuprofen 200 MG CAPS ondansetron (ZOFRAN ODT) 4 MG disintegrating tablet promethazine (PHENERGA
Current Illness: 8/5/2021 1. Person under investigation for COVID-19 (COVID negative) 2. Acute nonintractable headache, unspecified headache type 3. Nasal congestion
Preexisting Conditions: Endocrine Insulin resistance PCOS (polycystic ovarian syndrome) Musculoskeletal and Integument Acne vulgaris Acanthosis
Allergies: NKA
Diagnostic Lab Data: COVID PCR +
CDC Split Type:

Write-up: Subjective Patient is a 23-year-old obese female who received the Pfizer vaccine in March of this year but tested positive for Covid 1 week ago she comes in today very anxious breathing about 30 times a minute stating that she cannot catch her breath but her oxygen saturation was 100%. She received the Regeneron infusion yesterday-states she was feeling worse today she also complains of some chest pain with her breathing. States she has had cough which has been dry she denies fever in the last 24 hours-she rates her pain a 6/10 Review of Systems Constitutional: Negative for chills, fatigue and fever. HENT: Negative for congestion, tinnitus and trouble swallowing. Eyes: Negative for photophobia, discharge and redness. Respiratory: Positive for cough and shortness of breath. Cardiovascular: Positive for chest pain. Negative for palpitations. Gastrointestinal: Negative for abdominal pain, diarrhea, nausea and vomiting. Genitourinary: Negative for dysuria, frequency and urgency. Musculoskeletal: Negative for back pain, joint swelling and myalgias. Skin: Negative for rash. Neurological: Negative for dizziness and headaches. Psychiatric/Behavioral: Negative for confusion. The patient is nervous/anxious. All other systems reviewed and are negative.


VAERS ID: 1719218 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-01
Onset:2021-09-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 066021A / UNK - / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Blood pressure increased, Dizziness, Dizziness postural, Fibrin D dimer normal, Full blood count normal, Headache, Influenza like illness, Vestibular disorder
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hypertension (narrow), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pegasys, baby aspirin, evamist, progesterone, calcium, magnesium
Current Illness: Polycythemia Vera, Osteoporosis
Preexisting Conditions: Polycythemia Vera, Osteoporosis
Allergies: penicillan
Diagnostic Lab Data: I met with my internist on 9/13. I went to a vestibular PT on 9/13 who said I don''t have vertigo (didn''t respond to Epley), but I have vestibular occular disfunction. He gave me exercises for the dizziness that he said would make me worse before I get better. I am not better yet. I monitor my BP twice a day. The Omron device reports hypertension stage the majority of the time. My internist ordered D-Dimer and CBC blood tests. All normal. I am going for an ECG today.
CDC Split Type:

Write-up: I had the usual flu like symptoms on day 2. I took tylenol and they went away the next day. On day 4, I woke up in the middle of the night dizzy while rolling over in bed. From Day 5 - 20 (today), I have daily headache in the back of my head, positional dizzyness, and elevated blood pressure. The room isn''t spinning, I just feel unstable and dizzy when my head is down or with quick movements. I normally have normal to low blood pressure. I met with my internist on 9/13. I went to a vestibular PT on 9/13 who said I don''t have vertigo (didn''t respond to Epley), but I have vestibular occular disfunction. He gave me exercises for the dizziness that he said would make me worse before I get better. I am not better yet. I take motrin daily for the headache. I monitor my BP twice a day. My internist ordered D-Dimer and CBC blood tests. All normal. I am going to ECG today. THIS IS A NIGHTMARE.


VAERS ID: 1719829 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-03
Onset:2021-09-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Antinuclear antibody positive, Erythema, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Systemic lupus erythematosus (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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Xyzal, singulair, metformin, dymista, Mirena
Current Illness:
Preexisting Conditions: Pcos
Allergies: Cefdinir
Diagnostic Lab Data: Inflammation panel: negative except for positive ANA which I?ve had in the past Allergy testing: only positive to dust mites and ragweed. Getting titers pulled for antibodies.
CDC Split Type:

Write-up: Between 36 and 48 hours I started to develop welt-like hives, redness, and severe itching all over my body. Lasted over two weeks.


VAERS ID: 1720312 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypotonia, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was sitting in waiting area after receiving the vaccination. After about 10 mins after receiving the shot, she passed out for a few seconds and slumped gently from the chair onto the floor to lay down. She was given some water and a candy bar as she composed herself on the floor and after a few minutes was able to get up on her own and leave with her boyfriend.


VAERS ID: 1721610 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-08-14
Onset:2021-09-05
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, SARS-CoV-2 test
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: Test Name: COVID-19 test; Test Result: Positive ; Result Unstructured Data: Positive
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Got Covid 19; This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 (Got Covid 19) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) for COVID-19 vaccination. No Medical History information was reported. On 14-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 05-Sep-2021, the patient experienced COVID-19 (Got Covid 19). At the time of the report, COVID-19 (Got Covid 19) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: positive (Positive) Positive. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were reported. Treatment medications were not provided by the reporter. It was reported that patient had Covid 19 after on 09/21 and Covid 19 results were positive and then again on 09/05 patient second dosage was schedule for 09/11. Patient still COVID Positive as of today. Reporter did not allow further contact


VAERS ID: 1721739 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-03-08
Onset:2021-09-05
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Pain
SMQs:

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

Write-up: Constant pain after 3rd shot; Suffering with bad headache after 3rd shot; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (Constant pain after 3rd shot) and HEADACHE (Suffering with bad headache after 3rd shot) in a 73-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 004F21A and 010M20A) for COVID-19 vaccination. Concurrent medical conditions included Angioma. Concomitant products included PARACETAMOL (ACETAMINOPHEN), TRAMADOL and CYCLOBENZAPRINE HYDROCHLORIDE (FLEXERIL [CYCLOBENZAPRINE HYDROCHLORIDE]) for Angioma. On 08-Mar-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 05-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 05-Sep-2021, the patient experienced PAIN (Constant pain after 3rd shot) and HEADACHE (Suffering with bad headache after 3rd shot). At the time of the report, PAIN (Constant pain after 3rd shot) outcome was unknown and HEADACHE (Suffering with bad headache after 3rd shot) had resolved. Patient experienced headache and constant pain it was so bad that she visited the emergency room on Sunday,12-SEP-2021. They gave her a Migraine cocktail by IV. She believes that there was Muscle relaxer and Benadryl in the cocktail. They released her to follow up with her doctor. re-challenge is positive This case was linked to MOD-2021-318514, MOD-2021-318486 (Patient Link).; Sender''s Comments: This case concerns a 73 year-old, female subject with a history of Angioma for which she takes Acetaminophen, Tramadol, and Flexeril who experienced the expected event of headache and unexpected event of pain. The events occurred occurred on the same day after the third dose of Spikevax. The rechallenge was positive as the subject experienced headache after the first, second and reoccurred on third dose. The event is consistent with the current understanding of the mechanism of action of the study medication. The medical history of Angioma for which she takes Acetaminophen, Tramadol, and Flexeril remains a confounder. The benefit-risk relationship of Spikevax is not affected by this report. Events were assesed as non-serious as emergency room visits that do not result in admission to the hospital would not qualify for hospitalazation and the events doesn?t seem to be serious by medical judgement and from a clinical or regulatory standpoint.


VAERS ID: 1721746 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-07
Onset:2021-09-05
   Days after vaccination:241
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Discomfort, Myalgia, Vaccination site swelling, Vaccination site warmth
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (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: INSULIN; FOLIC ACID; CALCIUM; MELOXICAM
Current Illness: Diabetes
Preexisting Conditions: Medical History/Concurrent Conditions: Thyroidectomy (thyroid removed)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: experienced body aches and discomfort for a whole day, more severe than after the second dose, and they had to lay down.; Left arm was hot; had to much swelling on their left arm, it was very hot, lasting 2-3 days; Body aches; This spontaneous case was reported by a consumer and describes the occurrence of DISCOMFORT (experienced body aches and discomfort for a whole day, more severe than after the second dose, and they had to lay down.), VACCINATION SITE WARMTH (Left arm was hot), VACCINATION SITE SWELLING (had to much swelling on their left arm, it was very hot, lasting 2-3 days) and MYALGIA (Body aches) in a 75-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 037F21A, 029K20A and 039K20A) for COVID-19 vaccination. The patient''s past medical history included Thyroidectomy (thyroid removed). Concurrent medical conditions included Diabetes. Concomitant products included INSULIN, FOLIC ACID, CALCIUM and MELOXICAM for an unknown indication. On 07-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 04-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 04-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 05-Sep-2021, the patient experienced DISCOMFORT (experienced body aches and discomfort for a whole day, more severe than after the second dose, and they had to lay down.), VACCINATION SITE WARMTH (Left arm was hot), VACCINATION SITE SWELLING (had to much swelling on their left arm, it was very hot, lasting 2-3 days) and MYALGIA (Body aches). The patient was treated with ACETAMINOPHEN for Adverse event, at a dose of UNK UNK, q4h. At the time of the report, DISCOMFORT (experienced body aches and discomfort for a whole day, more severe than after the second dose, and they had to lay down.), VACCINATION SITE WARMTH (Left arm was hot), VACCINATION SITE SWELLING (had to much swelling on their left arm, it was very hot, lasting 2-3 days) and MYALGIA (Body aches) outcome was unknown. Concomitant medications included medication to replace thyroid. Treatment for the events included ice. This case was linked to MOD-2021-318648, MOD-2021-318654, MOD-2021-318659 (Patient Link).


VAERS ID: 1722585 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-05
Onset:2021-09-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dizziness, Fatigue, Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: Dizzy, rapid heartbeat, tired, chills.


VAERS ID: 1723029 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-18
Onset:2021-09-05
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Cough, Dyspnoea, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (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? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Presented to ED with shortness of breath, myalgia, non productive cough Received decadron, asprin, singulair, oxygen, out of window for remdesivir Discharged under stable condition.


VAERS ID: 1723225 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-03
Onset:2021-09-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Arthralgia, Intermenstrual bleeding, Migraine, Pain
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: lump size of a tennis ball on arm, weakness in arm - both lasted for months
Other Medications: doxazosin, progesterone, armour thyroid, nadalol, amlodipine besylate
Current Illness: n/a
Preexisting Conditions: high blood pressure, poly cystic ovarian syndrome
Allergies: n/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: menstrual spotting that lasted for 4 days; migraine that lasted for 3 days; extreme body/joint aches that lasted for 2 days; stomach pain that lasted for 8 days


VAERS ID: 1723863 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-04
Onset:2021-09-05
   Days after vaccination:185
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Diarrhoea, Incontinence, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: he developed diarrhea 10 days ago and has since complained of $g10 watery stools a day. He reports frequent incontinence. Diarrhea seems to be worst at night when he lays down. Weakness - Generalized, Vomiting, and Diarrhea


VAERS ID: 1723865 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-07
Onset:2021-09-05
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8729 / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Extra dose administered, Hypoxia, Oxygen saturation decreased, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Medication errors (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? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: presents with worsening dyspnea and hypoxia. He has been triple vaccinated for COVID-19, and was on a vacation. On 09/05/2021 he started developing symptoms of rhinorrhea and he and his wife both tested positive for COVID-19, same-day. He has had overall increasing dyspnea over the past 9 days and was able to measure his oxygen saturation which had been fluctuating between 88 and 93%


VAERS ID: 1725357 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-08-31
Onset:2021-09-05
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Autoimmune disorder, Axillary pain, Eye movement disorder, Fatigue, Fear of injection, Feeling abnormal, Neck pain, Palpitations, Uveitis, Vaccination complication, Vaccination site pain, Vaccination site reaction
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Cardiomyopathy (broad), Ocular infections (broad), Ocular motility disorders (narrow), Arthritis (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VITAMINS NOS; CORTISOL [CORTISONE ACETATE]
Current Illness: Anxiety; Breathing difficult
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Patient has uveitis or inflammation of eye only in left eye; not being able to calm my eyes down from the flare caused by the vaccine; My fear is getting the second shot; Had a few heart palpitations which comes and goes; Pain that went down her sides as if the pain was right underneath her chest cavity that radiated up to her neck and shoulder; And not herself; A COVID arm; Pain that went down her sides as if the pain was right underneath her chest cavity that radiated up to her neck and shoulder; There is still some soreness and tenderness under the armpit; Sore arm; Was very very tired and not herself; She felt bad for two days; Her autoimmune disorder flared up/full blown autoimmune response; This spontaneous case was reported by a nurse and describes the occurrence of AUTOIMMUNE DISORDER (Her autoimmune disorder flared up/full blown autoimmune response) and UVEITIS (Patient has uveitis or inflammation of eye only in left eye) in a 41-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 053E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Anxiety and Breathing difficult. Concomitant products included CORTISONE ACETATE (CORTISOL [CORTISONE ACETATE]) for Anxiety and Breathing difficult, VITAMINS NOS for an unknown indication. On 31-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 05-Sep-2021, the patient experienced AUTOIMMUNE DISORDER (Her autoimmune disorder flared up/full blown autoimmune response) (seriousness criterion medically significant). On an unknown date, the patient experienced UVEITIS (Patient has uveitis or inflammation of eye only in left eye) (seriousness criterion medically significant), EYE MOVEMENT DISORDER (not being able to calm my eyes down from the flare caused by the vaccine), FEAR OF INJECTION (My fear is getting the second shot), PALPITATIONS (Had a few heart palpitations which comes and goes), NECK PAIN (Pain that went down her sides as if the pain was right underneath her chest cavity that radiated up to her neck and shoulder), FEELING ABNORMAL (And not herself), VACCINATION SITE REACTION (A COVID arm), ARTHRALGIA (Pain that went down her sides as if the pain was right underneath her chest cavity that radiated up to her neck and shoulder), AXILLARY PAIN (There is still some soreness and tenderness under the armpit), VACCINATION SITE PAIN (Sore arm), FATIGUE (Was very very tired and not herself) and VACCINATION COMPLICATION (She felt bad for two days). The patient was treated with DIFLUPREDNATE (DUREZOL) for Adverse event, at a dose of UNK UNK, bid. At the time of the report, AUTOIMMUNE DISORDER (Her autoimmune disorder flared up/full blown autoimmune response), UVEITIS (Patient has uveitis or inflammation of eye only in left eye), PALPITATIONS (Had a few heart palpitations which comes and goes), NECK PAIN (Pain that went down her sides as if the pain was right underneath her chest cavity that radiated up to her neck and shoulder), ARTHRALGIA (Pain that went down her sides as if the pain was right underneath her chest cavity that radiated up to her neck and shoulder), AXILLARY PAIN (There is still some soreness and tenderness under the armpit) and FATIGUE (Was very very tired and not herself) had not resolved, EYE MOVEMENT DISORDER (not being able to calm my eyes down from the flare caused by the vaccine), FEAR OF INJECTION (My fear is getting the second shot), FEELING ABNORMAL (And not herself), VACCINATION SITE PAIN (Sore arm) and VACCINATION COMPLICATION (She felt bad for two days) outcome was unknown and VACCINATION SITE REACTION (A COVID arm) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Patient states that if treating with eye drops also if disease get uncontrolled she may have lost her eyesight and there is a possibility that every flare she will have to go on oral steroids. She doesn''t want to do that because of IBD. The symptoms are still there and patient expecting symptoms get resolve in mid October or last November. Before taking vaccination patient experienced anxiety and shortness of breath. Patient is frequently visiting her ophthalmologist for the side effects and going to see ophthalmologist again. Company Comment: This case concerns a 41-year-old, female patient with no relevant medical history, who experienced the expected event of Autoimmune Disorder and Uveitis. The event Autoimmune Disorder occurred 6 days after the first dose of mRNA-1273 (Moderna COVID-19 Vaccine) and the event uveitis occurred after an unknown number of days after the first dose of the vaccine. The rechallenge was not applicable since only information about the first dose was disclosed. The event is consistent with the current understanding of the mechanism of action of the vaccine. The benefit-risk relationship of mRNA-1273 (Moderna COVID-19 Vaccine) is not affected by this report. Most recent FOLLOW-UP information incorporated above includes: On 17-Sep-2021: Follow- up received on 17-Sep-2021. Added events; Sender''s Comments: This case concerns a 41-year-old, female patient with no relevant medical history, who experienced the expected event of Autoimmune Disorder and Uveitis. The event Autoimmune Disorder occurred 6 days after the first dose of mRNA-1273 (Moderna COVID-19 Vaccine) and the event uveitis occurred after an unknown number of days after the first dose of the vaccine. The rechallenge was not applicable since only information about the first dose was disclosed. The event is consistent with the current understanding of the mechanism of action of the vaccine. The benefit-risk relationship of mRNA-1273 (Moderna COVID-19 Vaccine) is not affected by this report.


VAERS ID: 1725510 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-02
Onset:2021-09-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood blister, Rash, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ACIPHEX; METOPROLOL
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Arthritis; COVID-19 (prior to vaccination); Drug allergy; Endometriosis; Food allergy; Latex allergy; Lupus erythematosus; Polycystic ovarian syndrome
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101181065

Write-up: broke out in a rash under the chest, stomach and back; blistering areas that bled; red rash under the skin that spread; This is a spontaneous report from a contactable consumer (patient). A 53-year-old non-pregnant female patient received BNT162b2 (PFIZER-BIONTECH COVID-19 VACCINE; lot number: FA7485), administered in the left arm on 02Sep2021 at 15:30 (at the age of 53-years-old) at dose number unknown, single for COVID-19 immunisation. Medical history included patient was allergic to multiple meds and foods, latex; polycystic ovarian syndrome (PCOS); endometriosis; arthritis and lupus; prior to vaccination the patient was diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. Concomitant medications included rabeprazole sodium (ACIPHEX) and metoprolol, both reported as other medications the patient received within 2 weeks of vaccination. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. On the 3rd day, on 05Sep2021, patient broke out in a rash under the chest, stomach and back; blistering areas that bled and a red rash under the skin that spread. Ended up in urgent care with prednisone and a steroid cream (which patient ended up having another reaction too). On day 7, the patient still had the rash after 3 days of meds. The events were reported as non-serious. The adverse event resulted in doctor or other healthcare professional office/clinic visit and in emergency room/department or urgent care. A treatment was received for the adverse event and included steroid. The patient had not recovered from the events.


VAERS ID: 1726497 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-01
Onset:2021-09-05
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anticoagulant therapy, Atrial fibrillation, Blood cholesterol normal, Carotid artery thrombosis, Computerised tomogram, Dysarthria, Electrocardiogram, Facial paralysis, Laboratory test, Magnetic resonance imaging, Pain in extremity, Pulmonary thrombosis, Transient ischaemic attack
SMQs:, Supraventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hearing impairment (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol 325mg, Norvasc 5mg, Aspirin 81mg, Calcium 600+D 600-400mg unit tabs, Toprol XL 25mg, Paxil 10mg
Current Illness: None
Preexisting Conditions: Diverticulitis and high blood pressure
Allergies: None
Diagnostic Lab Data: 2 CT scans, MRI, EKG and lab work done on 9/10/21 and 9/11/21
CDC Split Type:

Write-up: Patient suffered a mini stroke on 9/5/21. Slurred speech, pain in arm, drooping face. Vocalized the event to family on 9/9/21 and then went to the ER and was admitted to the hospital on 9/9/21. Hospital diagnosed patient with a pulmonary blood clot, some clotting in the carotid and atrial fibrillation. Patient was released from the hospital on 9/12/21 with a blood thinner and cholesterol medicine. Cholesterol levels are normal, however. Patient ordered to follow up with PCP and cardiologist within one week, the pulmonologist within 3 weeks and the neurologist within 2 months.


VAERS ID: 1726716 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-08-16
Onset:2021-09-05
   Days after vaccination:20
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Computerised tomogram normal, Feeling abnormal, Head discomfort, Insomnia, Panic attack
SMQs:, Dementia (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Began feeling fuzziness/discomfort in my head on 9/5/21. This was not a headache or a migraine. This feeling lasted 5 days on and off and caused me to have trouble sleeping for fear of not waking up. On 9/9/21 the feeling in my head worsened as I tried to fall asleep. I got out of bed and told my girlfriend I needed to go to the ER. Almost immediately the feeling in my head became so severe that I thought I was going to die at any moment and went into a full-blown panic attack. At the ER I had 3 more panic attacks. I had a CT scan and bloodwork completed and they showed nothing was wrong. It is now 9/23/21 and for the past 2 weeks, I have continued to have the same feeling in my head followed by panic attacks ranging in severity from mild to quite severe. I have been prescribed Atarax and Xanax to help with anxiety and panic attacks. My entire life I have never had any mental health issues and am a very relaxed person. There has been no major life events or stressors in my life to cause the anxiety and panic attacks. The only thing that has changed in my life is receiving the Pfizer vaccine leading me to believe it is the cause of the head discomfort leading to panic attacks.


VAERS ID: 1726889 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-04
Onset:2021-09-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Decreased appetite, Extra dose administered, Fatigue, Food intolerance, Fungal infection, Influenza like illness, Pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Arthritis (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Valsartan; Estradiol; Flaxseed oil; Levothyroxine; Valcyclovir; Diclofenac, Pravastatin; Medimmune; amlodipine; metoprolol; tumeric, Lutein eye vitamins; Zyrtec
Current Illness: none
Preexisting Conditions: Sclerderma
Allergies: none
Diagnostic Lab Data: none
CDC Split Type: vsafe

Write-up: After getting the 3rd dose, within a couple of hours, I had flu like symptoms, no appetite, tired and achy. This lasted for a few days. Then I started getting itching on my scalp and under my breast. My joints started hurting everywhere followed by extreme fatigue and no appeitite. The itching worsen especially on my scalp. I did go see my doctor. The doctor says it looks like yeast and I was prescribed medication for my scalp and a cream to apply under my breast. I now notice that I can not tolerate food with yeast, for example, wine, beer, baked goods, and breads.


VAERS ID: 1727118 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-30
Onset:2021-09-05
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 058E21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Injection site pruritus, Injection site rash, Injection site warmth, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypersensitivity (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: Balcoltra- birth control IBS solution- prebiotic supplement
Current Illness: none
Preexisting Conditions: Atrial Septal Defect Pelvic kidney
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Six days following the vaccine, I noticed a rash appear near the injection site. The rash started our spotty but became solid. The rash lastly about four days. It was extremely itchy and warm to the touch. I also felt nauseous while the rash was present. When the rash went away, I experienced chest pain for a few days.


VAERS ID: 1727263 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-08
Onset:2021-09-05
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Computerised tomogram head, Guillain-Barre syndrome, Hypoaesthesia, Lumbar puncture, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: lumbar puncture with CSF analysis CT head non-contrast
CDC Split Type:

Write-up: The patient presented with weakness and numbness of lower extremities, consistent with Guillain Barre syndrome


VAERS ID: 1727265 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-14
Onset:2021-09-05
   Days after vaccination:83
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 16888

Write-up: Hospitalization 9/5-9/11 for COVID. Treated with dexamethasone 6 mg IV daily and Remdesivir


VAERS ID: 1727302 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-19
Onset:2021-09-05
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19 pneumonia, Mental status changes
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 16888

Write-up: Patient hospitalized 9/5/21-9/8/21 for COVID Pneumonia/AMS, Treated with dexamethasone IV and Remdesivir.


VAERS ID: 1727393 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-03-24
Onset:2021-09-05
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Brain scan abnormal, Cerebral atrophy, Cerebral ischaemia, Cerebral small vessel ischaemic disease, Cerebrovascular accident, Computerised tomogram head abnormal, Condition aggravated, Magnetic resonance imaging head abnormal, Mastoid effusion, Mastoiditis
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen (TYLENOL ARTHRITIS EXT RELIEF PO) albuterol (PROVENTIL) (5 MG/ML) 0.5% nebulizer solution aspirin (LOW DOSE) 81 mg chewable tablet budesonide (PULMICORT) 0.5 MG/2ML nebulizer solution calcium-vitamin D (OS-CAL CALCIUM + D3) 50
Current Illness: Cardiac and Vasculature Abdominal aortic aneurysm (AAA) 3.0 cm to 5.5 cm in diameter in male Bilateral carotid artery stenosis Essential hypertension Hyperlipidemia Right bundle branch block (RBBB) determined by electrocardiography ENT Mastoiditis of both sides EYE Lens replaced Moderate or severe vision impairment, both eyes Gastrointestinal and Abdominal Dysphagia GERD (gastroesophageal reflux disease) Genitourinary and Reproductive CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min Hyperplasia of prostate without lower urinary tract symptoms Lesion of left native kidney Hematology and Neoplasia Anemia Mental Health Depression Musculoskeletal and Injuries Avascular necrosis of left femoral head Chronic bilateral low back pain without sciatica Lesion of lumbar spine Neuro Cerebral artery occlusion with cerebral infarction Cognitive deficits as late effect of cerebrovascular disease CVA (cerebral vascular accident) Idiopathic peripheral neuropathy Seizures Pulmonary and Pneumonias Abnormal chest x-ray Chronic obstructive pulmonary disease Symptoms and Signs Debility Forgetfulness
Preexisting Conditions: Cardiac and Vasculature Abdominal aortic aneurysm (AAA) 3.0 cm to 5.5 cm in diameter in male Bilateral carotid artery stenosis Essential hypertension Hyperlipidemia Right bundle branch block (RBBB) determined by electrocardiography ENT Mastoiditis of both sides EYE Lens replaced Moderate or severe vision impairment, both eyes Gastrointestinal and Abdominal Dysphagia GERD (gastroesophageal reflux disease) Genitourinary and Reproductive CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min Hyperplasia of prostate without lower urinary tract symptoms Lesion of left native kidney Hematology and Neoplasia Anemia Mental Health Depression Musculoskeletal and Injuries Avascular necrosis of left femoral head Chronic bilateral low back pain without sciatica Lesion of lumbar spine Neuro Cerebral artery occlusion with cerebral infarction Cognitive deficits as late effect of cerebrovascular disease CVA (cerebral vascular accident) Idiopathic peripheral neuropathy Seizures Pulmonary and Pneumonias Abnormal chest x-ray Chronic obstructive pulmonary disease Symptoms and Signs Debility Forgetfulness
Allergies: NKDA
Diagnostic Lab Data: CT brain 1. Moderate atrophic and small vessel ischemic changes of the brain without CT evidence of an acute intracranial process. 2. Bilateral mastoid effusions or mastoiditis. MRI brain 1. Acute stroke of the left posterior parafalcine region. 2. Multiple areas of hypodensity on susceptibility weighted imaging in the cerebellum likely representing hemosiderin deposition from prior microvascular hemorrhage. 3. Bilateral mastoid air cell effusions. 4. Chronic microvascular ischemic changes.
CDC Split Type:

Write-up: Patient had vaccine in March 2021, had acute CVA in September 2021. It is my medical opinion that this is not related to the Janssen COVID-19 vaccine because the stroke is remote from the vaccine administration, and in a patent with previous history of strokes, hypertension, and diabetes.


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https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=264&PERPAGE=100&ESORT=ONSET-DATE&REVERSESORT=ON&VAX=COVID19&DIED=No

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