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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 279 out of 8,010

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VAERS ID: 1675133 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Georgia  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Extra dose administered
SMQs:, Medication errors (narrow)

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

Write-up: Patient requested Booster Moderna after Pfizer series, informed Pfizer is available, vaccinator delivered the Moderna vaccine.


VAERS ID: 1675148 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-01
Onset:2021-09-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear pain, Facial pain, Head discomfort, Headache, Pain in jaw
SMQs:, Glaucoma (broad), Osteonecrosis (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: L-Arginine D3 B12 Tylenol
Current Illness: brain aneurysm
Preexisting Conditions: bi-lateral inguinal hernias
Allergies: droperidol flagyl
Diagnostic Lab Data:
CDC Split Type:

Write-up: face / jaw / ear/ head (left hand side) // pain and full feeling


VAERS ID: 1675150 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cold sweat, Dizziness, Hypoacusis, Malaise, Mydriasis, Tinnitus, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Approximately 10 minutes after receiving her first COVID vaccine the patient''s father asked the pharmacist to help his daughter as she stated she wasn''t feeling well. Upon examining the patient, the patient looked as though she was having a possible seizure. She was not responding to any of my verbal cues, her pupils were dilated and her eyes were twitching, and was staring off into the distance. About a minute later, the patient turned towards me and began responding again. She stated that she didn''t remember much other than she could barely hear me and it sounded as though I was talking to her through a tunnel. She reported having ringing in her ears, cold sweats, and feeling faint afterwards. 911 was not called as the father stated he did not need us to call 911 and that he was an EMT and could transport her to the hospital himself. After observing the patient for a few more minutes to assure she was feeling well enough to leave, her father and aunt escorted her out to take her to the Emergency room. Patient denied any history of seizure disorder. It was not confirmed whether or not they went to the emergency room after leaving the pharmacy.


VAERS ID: 1675167 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-18
Onset:2021-09-03
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal discomfort, Chills, Electric shock sensation, Pain, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt c/o GI upset, fever, chills, body aches, lightning bolts to head. Pt appeared in medical with worsening symptoms on this date. No improvement.


VAERS ID: 1675173 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoaesthesia, Muscle tightness, Swelling, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms 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: Lipitor Synthroid Activella Claritin
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillins Surgical tape and liquid adhesives
Diagnostic Lab Data:
CDC Split Type:

Write-up: Numbness and tightness in the upper neck area; slight swelling in neck and face. Symptoms noticed 6 hours after injection and subsided 48 hours later. Took Motrin and Benadryl for relief.


VAERS ID: 1675177 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Dyspnoea, Pruritus, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 12 hours after the vaccine began to feel throat tightening, difficulty breathing, itchiness


VAERS ID: 1675190 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Gait disturbance, Spinal pain
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Arthritis (broad), Hypoglycaemia (broad)

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

Write-up: Shortness of breath, can''t walk up stairs even. Pain in the base of spine.


VAERS ID: 1675192 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Hawaii  
Vaccinated:2021-01-07
Onset:2021-09-03
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / UNK - / -

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

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

Write-up: Symptomatic 9/3/21 and COVID positive 9/4/21 after being fully vaccinated for COVID-19


VAERS ID: 1675201 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram ST segment elevation, Troponin
SMQs:, Myocardial infarction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: No allergies or recent illnesses
Preexisting Conditions: None
Allergies: No allergies
Diagnostic Lab Data: EKG diffuse ST elevation Troponin 23
CDC Split Type:

Write-up: 1 day after vaccination, sternal chest pain , non radiating 0/10-5/10


VAERS ID: 1675205 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, 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? No
Hospitalized? No
Previous Vaccinations: 02/10/2021, Moderna Covid-19 vaccine (2nd dose), age 62, also headache, chills, fatigue
Other Medications: calcium, magnesium, Vitamin D3, NAC, flaxseed oil capsules, turmeric capsules, zinc, milk thistle, B12, biotin.
Current Illness: none
Preexisting Conditions: seasonal allergies (mild to moderate)
Allergies: allergies: sulfa, amoxicillin sensitive to most antibiotics lactose intolerant, sensitive to eggs, scallops, cauliflower, and chick peas
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Headache, body aches, chills, fatigue Treated with Tylenol and lots of sleep, resolved after 48 hours.


VAERS ID: 1675229 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Chest pain, Lymphadenopathy, Paraesthesia, Sleep disorder
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension
Allergies: Sulfa allergy
Diagnostic Lab Data: None yet, giving symptoms 1 more day to see if there?s improvement before going to urgent care
CDC Split Type:

Write-up: Lots of swelling under the left armpit, severe stabbing and throbbing pain under armpit, pins and needles stabbing feeling in chest, severe collar bone pain and tenderness Onset woke me up out of my sleep at 1:30 am and has continued without relief


VAERS ID: 1675240 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Petit mal epilepsy
SMQs:, Systemic lupus erythematosus (broad), Convulsions (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: Levetiracetam ER 500mg Folic Acid 1mg
Current Illness: Epilepsy
Preexisting Conditions: Epilepsy
Allergies: Dilantin 100mg
Diagnostic Lab Data: NK
CDC Split Type:

Write-up: Patient called today to report that since the day he was vaccinated he has experienced absence seizures.


VAERS ID: 1675248 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dermatitis, Rash, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Gabapentin, Claritin, baby aspirin, Omeprazole, Kisqali, Faslodex
Current Illness: Metastatic breast cancer - currently no cancer uptake
Preexisting Conditions: None
Allergies: Sulfa, Cortisone, Keflex, all steroids, gadolineum
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Dermatitus. Very itchy /bBumps on both arms, upper chest, and forehead


VAERS ID: 1675260 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-30
Onset:2021-09-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH NOT SURE / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chest discomfort, Dyspnoea, Electrocardiogram normal, Full blood count normal, Metabolic function test normal, Painful respiration, Troponin normal
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Labs normal (CBC, CMP, Troponin), ECG normal.
CDC Split Type:

Write-up: Pt developed arthralgia diffusely, as well as chest discomfort and SOB, pain with inspiration.


VAERS ID: 1675263 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-08-24
Onset:2021-09-03
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Injection site rash, Injection site warmth, Nausea, Rash vesicular, SARS-CoV-2 test negative, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: none
Allergies: azithromycin (throat swelling) , keflex (henoch-schonlein purpura)
Diagnostic Lab Data: Covid-19 pcr test 9/3 -negative result
CDC Split Type:

Write-up: Had chills with no fever 9/1-3, nausea 9/1 -3 and 1 vomiting event 9/3 (5am). Warm, blistered rash appeared on left arm at site of vaccination on 9/3 12:30pm (Covid Arm)


VAERS ID: 1675266 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angioedema, Dizziness, Erythema of eyelid, Eyelid oedema, Injection site paraesthesia, Lip oedema, Lip swelling, Obesity, Oedema peripheral, Paraesthesia oral, Swelling face
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Outpatient Medications Marked as Taking for the 9/3/21 encounter (Office Visit) with CRNP Medication Sig Dispense Refill ? allopurinoL (ZYLOPRIM) 300 MG tablet TAKE 1 TABLET BY MOUTH EVERY DAY IN THE MORNING ? aspirin 81 MG tablet Take 81
Current Illness: Illnesses: Active Ambulatory Problems Diagnosis Date Noted ? Acute venous embolism and thrombosis of deep vessels of proximal lower extremity [I82.4Y9] 10/28/2016 ? History of pulmonary embolism 10/28/2016 ? Chronic gouty arthritis 11/15/2016 ? Heart transplant status 11/15/2016 ? Morbid obesity 11/15/2016 ? Protein C deficiency 11/15/2016 ? Sarcoidosis 11/15/2016 ? Coronary artery disease involving transplanted heart with angina pectoris 11/15/2016 ? Type 2 diabetes mellitus with retinopathy, with long-term current use of insulin 05/01/2018 ? Back ache 07/09/2019 ? Gout, unspecified 07/09/2019 ? Abnormal cervical Papanicolaou smear 03/08/2019 ? Abnormal uterine bleeding 04/11/2012 ? ACS (acute coronary syndrome) 01/12/2016 ? Hospital discharge follow-up 04/01/2015 ? Anemia 04/01/2015 ? Body aches 07/27/2016 ? Chest pain 11/07/2016 ? Chronic kidney disease, unspecified 10/15/2012 ? CMV (cytomegalovirus infection) not present 06/10/2015 ? CMV infection 05/02/2016 ? Conjunctivitis 02/25/2016 ? Cough 04/11/2016 ? Coronary arteriosclerosis in native artery 07/18/2016 ? Deep vein thrombosis, upper right extremity 09/26/2012 ? Endometritis 08/12/2014 ? Environmental allergies 02/25/2016 ? Exposure to viral disease 06/10/2015 ? Fatigue 07/27/2016 ? History of CMV 06/10/2015 ? History of myocardial infarction 11/07/2016 ? Insomnia 03/15/2016 ? Inadequate sleep hygiene 06/02/2016 ? HTN (hypertension) 11/30/2010 ? HLD (hyperlipidemia) 11/30/2010 ? Long-term use of immunosuppressant medication 04/01/2015 ? Nausea 08/27/2012 ? Obstructive sleep apnea syndrome 03/15/2016 ? Occluded coronary artery stent 12/03/2016 ? Pericardial effusion 01/10/2012 ? Periodic limb movement disorder 03/15/2016 ? Presence of IVC filter 04/01/2015 ? Antiplatelet or antithrombotic long-term use 01/30/2016 ? Pulmonary embolism with infarction 10/28/2016 ? Pulmonary hypertension 10/13/2016 ? Pulmonary Mycobacterium kansasii infection 03/20/2012 ? Rash 09/26/2012 ? History of immunosuppression therapy 02/01/2012 ? Stented coronary artery 07/18/2016 ? Coagulopathy 01/18/2012 ? Unstable angina 11/07/2016 ? NSTEMI (non-ST elevated myocardial infarction) 12/03/2016 ? Acute gout 04/26/2020 ? Controlled type 1 diabetes mellitus with left eye affected by mild nonproliferative retinopathy without macular edema 07/07/2020 ? Right leg DVT 10/10/2020 ? Acute deep vein thrombosis (DVT) of femoral vein 10/10/2020 Resolved Ambulatory Problems Diagnosis Date Noted ? No Resolved Ambulatory Problems
Preexisting Conditions: Illnesses: Active Ambulatory Problems Diagnosis Date Noted ? Acute venous embolism and thrombosis of deep vessels of proximal lower extremity [I82.4Y9] 10/28/2016 ? History of pulmonary embolism 10/28/2016 ? Chronic gouty arthritis 11/15/2016 ? Heart transplant status 11/15/2016 ? Morbid obesity 11/15/2016 ? Protein C deficiency 11/15/2016 ? Sarcoidosis 11/15/2016 ? Coronary artery disease involving transplanted heart with angina pectoris 11/15/2016 ? Type 2 diabetes mellitus with retinopathy, with long-term current use of insulin 05/01/2018 ? Back ache 07/09/2019 ? Gout, unspecified 07/09/2019 ? Abnormal cervical Papanicolaou smear 03/08/2019 ? Abnormal uterine bleeding 04/11/2012 ? ACS (acute coronary syndrome) 01/12/2016 ? Hospital discharge follow-up 04/01/2015 ? Anemia 04/01/2015 ? Body aches 07/27/2016 ? Chest pain 11/07/2016 ? Chronic kidney disease, unspecified 10/15/2012 ? CMV (cytomegalovirus infection) not present 06/10/2015 ? CMV infection 05/02/2016 ? Conjunctivitis 02/25/2016 ? Cough 04/11/2016 ? Coronary arteriosclerosis in native artery 07/18/2016 ? Deep vein thrombosis, upper right extremity 09/26/2012 ? Endometritis 08/12/2014 ? Environmental allergies 02/25/2016 ? Exposure to viral disease 06/10/2015 ? Fatigue 07/27/2016 ? History of CMV 06/10/2015 ? History of myocardial infarction 11/07/2016 ? Insomnia 03/15/2016 ? Inadequate sleep hygiene 06/02/2016 ? HTN (hypertension) 11/30/2010 ? HLD (hyperlipidemia) 11/30/2010 ? Long-term use of immunosuppressant medication 04/01/2015 ? Nausea 08/27/2012 ? Obstructive sleep apnea syndrome 03/15/2016 ? Occluded coronary artery stent 12/03/2016 ? Pericardial effusion 01/10/2012 ? Periodic limb movement disorder 03/15/2016 ? Presence of IVC filter 04/01/2015 ? Antiplatelet or antithrombotic long-term use 01/30/2016 ? Pulmonary embolism with infarction 10/28/2016 ? Pulmonary hypertension 10/13/2016 ? Pulmonary Mycobacterium kansasii infection 03/20/2012 ? Rash 09/26/2012 ? History of immunosuppression therapy 02/01/2012 ? Stented coronary artery 07/18/2016 ? Coagulopathy 01/18/2012 ? Unstable angina 11/07/2016 ? NSTEMI (non-ST elevated myocardial infarction) 12/03/2016 ? Acute gout 04/26/2020 ? Controlled type 1 diabetes mellitus with left eye affected by mild nonproliferative retinopathy without macular edema 07/07/2020 ? Right leg DVT 10/10/2020 ? Acute deep vein thrombosis (DVT) of femoral vein 10/10/2020 Resolved Ambulatory Problems Diagnosis Date Noted ? No Resolved Ambulatory Problems
Allergies: Allergies Allergen Reactions ? Lisinopril Other (See Comments) ? Oxycodone Nausea And Vomiting ? Vancomycin Hcl Other (See Comments)
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Angioedema She reports she just got her 3rd COVID shot earlier this afternoon. She reports after the 15 minutes were up, she felt some tingling at the injection site and a bit woozy. She is also feeling a bit tingly around her lips. She feels her lips are a bit swollen and maybe her lower jaw/mouth as well. She otherwise was feeling fine and ignored the tingling feeling in her lips. She and her husband were on her way home and in the car, her husband noticed her lips beginning to swell. They became concerned and she came back to the office. She denies any difficulty breathing or swallowing. She has no difficulty talking and doesn''t feel her tongue is getting larger. Physical Exam Constitutional: General: She is not in acute distress. Appearance: Normal appearance. She is well-developed. She is obese. She is not ill-appearing or toxic-appearing. HENT: Head: Normocephalic and atraumatic. Comments: Mild edema noted to upper lip Right Ear: No decreased hearing noted. Left Ear: No decreased hearing noted. Eyes: General: Right eye: No discharge. Left eye: No discharge. Conjunctiva/sclera: Conjunctivae normal. Right eye: Right conjunctiva is not injected. Left eye: Left conjunctiva is not injected. Comments: Mild edema to upper eyelids with mild erythema Neck: Trachea: No tracheal deviation. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Heart sounds: Normal heart sounds, S1 normal and S2 normal. No murmur heard. No friction rub. No gallop. Pulmonary: Effort: Pulmonary effort is normal. No tachypnea, bradypnea, accessory muscle usage or respiratory distress. Breath sounds: Normal breath sounds. No stridor. No decreased breath sounds, wheezing, rhonchi or rales. Chest: Chest wall: No tenderness. Musculoskeletal: Right lower leg: Edema (trace) present. Left lower leg: Edema (trace) present. Skin: General: Skin is warm and dry. Findings: No rash. Neurological: Mental Status: She is alert and oriented to person, place, and time. Motor: No abnormal muscle tone. Coordination: Coordination normal. Gait: Gait normal. Psychiatric: Attention and Perception: She is attentive. Speech: Speech normal. Behavior: Behavior normal. Behavior is cooperative. Thought Content: Thought content normal. Cognition and Memory: Memory is not impaired. Judgment: Judgment normal. She was given 50mg of benadryl immediately upon assessment. Her upper eyelids were beginning to swell during assessment. Patient was closely monitored for approximately another 10-15 minutes after benadryl oral administration and the swelling of her eyelids, mouth and face, overall, improved. Her vitals were monitored, particularly, her pulse oximeter was monitored continuously and did not drop below 97%. Her HR averaged in the 90s the entire time. No epinephrine administration was required and EMS/911 was not needed to be called. She was stable for discharge home with strict ED precautions. She will do a steroid taper and then stop at her usual 5mg daily dose. Pepcid was also prescribe for her to take daily while on the steroid taper and she was instructed to take benadryl 25mg every 6 hours for the next 3 days around the clock. Vitals: 09/03/21 1514 09/03/21 1540 BP: 104/74 (!) 117/82 BP Location: Right Right Patient Position: Sitting Sitting Pulse: 98 Temp: 36.7 ?C (98.1 ?F) TempSrc: Oral SpO2: 98% Weight: 220 lb 6.4 oz Height: 5'' 2" Body mass index is 40.31 kg/m?.


VAERS ID: 1675270 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-30
Onset:2021-09-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024C21A / 2 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Injection site rash, Rash morbilliform
SMQs:, 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: standard cholesterol medication
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe rash at injection; itchy; measles like dots on fingers toes and lips and other isolated areas of body


VAERS ID: 1675294 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-08-20
Onset:2021-09-03
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactic reaction, Blindness, Sensory loss
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Junel Fe 1/20
Current Illness: None
Preexisting Conditions: None
Allergies: Zythromyacin causes upset stomach Hibiclens causes hives Latex causes rash
Diagnostic Lab Data: EMS transport to hospital. 5 day course of prednisone and treatment with Benadryl and Pepcid.
CDC Split Type:

Write-up: Anaphylaxis (loss of vision and sensation in hands) 14 days after vaccine dosage.


VAERS ID: 1675306 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia, Hypoaesthesia oral, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None at the time and still have not taken anything.
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: It is a holiday weekend so, I called the pharmacy that administered the vaccine and they said to contact my doctor, then they told me about the VAERS website since my doctors office is not open due to the holiday weekend.
CDC Split Type:

Write-up: Within 15 minutes of getting Covid19 Pfizer Vaccine my tongue went numb. Detecting hot and cold was difficult. This lasted about 14 hours. The other things I am experiencing is a metalic taste in my mouth and my whole right arm is tingling (Pin pricks) like I slept on it and the blood is rushing back in. These 2 symptoms are still ongoing.


VAERS ID: 1675322 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Burning sensation, Chest X-ray, Feeling jittery, Heart rate increased, Hyperhidrosis, Pharyngeal swelling, Rash
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ibuprofen
Current Illness: No
Preexisting Conditions: Asthma and migraines
Allergies: Contrast dye
Diagnostic Lab Data: Injection of steroids,2 benadryl , breathing treatment ,chest x-ray blood work. Sent home with prescription of steroids,also benadryl and a epi pen
CDC Split Type:

Write-up: Around 9:45 pm that night started to feel my throat swelling a little ,woke up to bad burning rashes on both my arms,sweating ,fast heart beat rash got worse and my throat felt like it was swelling on and off jittery


VAERS ID: 1675325 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Back pain, Chills, Headache, Hypoaesthesia, Hypoaesthesia oral, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms 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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediate numbness to right side of face around the mouth. Later ~12:00 am fever, chills, headache and backache.


VAERS ID: 1675332 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Glossodynia, Oropharyngeal pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever, chills, body ache, joint pain first 24 hours Sore throat and new sore on toungue day two


VAERS ID: 1675345 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Discomfort, Dizziness, Immediate post-injection reaction, Pain
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Macrobid (sensitivity) caused hot flush and increased heart rate for a few minutes
Diagnostic Lab Data:
CDC Split Type:

Write-up: I immediately felt some discomfort in my uterus which increased the following day, which at that point felt like the onset of a huge period. Day 2 it subsided, though I''ve gotten some random small sharp pains in the same area a couple of times now. Other symptoms were decreased appetite on day 1 and a little bit of lightheadedness, which has also dimished this evening of Day 2. I am hoping I do not get a heavier cycle than usual as some have reported. My next one is due in 4 days, and as it is they are usually heavy.


VAERS ID: 1675347 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-23
Onset:2021-09-03
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 3 LA / IM

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

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

Write-up: Small hives all over body with many on both arms, not specific to injection site. Also triggered larger acute urticaria throughout groin, thighs, and lower abdomen, which seemed initially to follow the same pattern as granular perakeratosis that was present in 2019. Granular perakeratosis in 2019 was verified by biopsy and was believed to have been caused by exposure to benzalkonium chloride. After stopping use of laundry sanitizer, the granular perakeratosis began to clear up and went away over time. It''s been completely absent since then, but 12 days after Pfizer, acute urticaria followed the same pattern in groin, thighs, and lower abdomen. The worst seems to have subsided and no signs yet of lichenification as did occur in 2019 with the granular perakeratosis.


VAERS ID: 1675348 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Lethargy, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 1 month earlier
Other Medications: Levithyroxine
Current Illness: Prior CoVid vaccine and Strep Throat
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizziness Lethargy Fever Aches


VAERS ID: 1675352 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Injection site swelling, Pain, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vit D, Vit C, Tylenol, Prenatal Vit, and Nuva Ring
Current Illness: None
Preexisting Conditions: Low and Mid back pain
Allergies: Zyrtec
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness and minimal swelling at site (10 minutes after shot and lasted 2 days), sore arm (an hour after shot to present), body aches over whole body (1 day after shot to present), and fatigue (1 day after shot to present). No treatment from a medical provider. Resting at home and drinking fluids.


VAERS ID: 1675355 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-08-27
Onset:2021-09-03
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C211A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Erythema, Limb mass, Skin warm
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 137mcg
Current Illness: None
Preexisting Conditions: Hypothyroidism
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Covid arm: red burning, hot to the touch, lump that feels hard


VAERS ID: 1675361 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Fatigue, Heart rate increased, Palpitations
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Type 2 Diabetic, AFib, High Blood Pressure, Fibromyalgia, Chronic Fatigue Syndrome, Arthritis, Bursitis.
Allergies: Potassium on fast drip IV
Diagnostic Lab Data: None. I have not left home due to racing heart, high resting heart rate, shortness of breath and severe fatigue.
CDC Split Type:

Write-up: Resting heart rate 135 and racing heart after injection. Resting heart rate continues to be high two days after injection with racing heart and shortness of breath upon walking.


VAERS ID: 1675373 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Axillary pain, Fatigue, Headache, Lymph node pain
SMQs:, Arthritis (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: Forteo Metotrexate Paxil Actical
Current Illness: RA OP OSA Mood disorder
Preexisting Conditions: RA OSA MOOD DISORDER
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Axilary and supra clavicular nodules pain Excessive fatigue Headache Joints pain


VAERS ID: 1675412 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-08-15
Onset:2021-09-03
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 75 mcg, Lisinopril 40 mg, vitamin d 1.25 mg, Zyrtec 10 mg
Current Illness: Seasonal allergies
Preexisting Conditions: Hypothyroidism, hypertension
Allergies: Augmentin, keflex
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Irregular menstrual cycle; initially short and light and now bleeding in between cycle with cramping


VAERS ID: 1675549 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Gait disturbance, Influenza like illness, Injection site pain, Pain, Pain in extremity, Peripheral swelling, Skin warm
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: none
Current Illness: none
Preexisting Conditions: none
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Along with mild flu-like symptoms--esp achy bones, and pain at needle entry site returning next day and lingering, the ball of my right foot became so painful I could hardly walk on it. Feels swollen and hot but not to eye or touch. Any bending or stretching of toes or pressure on the ball is excruciating. Some improvement to almost gone with treatment and over the course of day, by 2nd day, but returns overnight and moving foot in bed causes pain.


VAERS ID: 1675556 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Lymph node pain, Lymphadenopathy, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine 20 mg, Clonazapam .5 prn, Levothyroxine/liothyronine .100/75
Current Illness: None
Preexisting Conditions: Thyroiditis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Major swelling of lymph node underarm, persistent pain, fatigue and nausea ongoing


VAERS ID: 1675567 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Flushing, Tinnitus
SMQs:, Anaphylactic reaction (broad), Hearing impairment (narrow), Hypersensitivity (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: Escitalipram 20mg/day, 100% natural psyllium husk fiber capsules, PEScience TruMulti Women?s Formula vitamins, Vital Proteins Collagen Peptides 10g/day.
Current Illness: None
Preexisting Conditions: None
Allergies: Nubain sensitivity, Codeine sensitivity
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Flushed - like a surge of adrenaline. This happened twice. First time it occurred, it lasted a few minutes. The second time it was more intense , I got dressed in case it didn?t go away I was prepared to go to the ER. that lasted several minutes as well. I also felt anxious (separate occasion). I am currently experiencing continual tinnitus. It started yesterday 9/5/2021.


VAERS ID: 1675570 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest pain, Computerised tomogram, Contusion, Cough, Dizziness, Dyspnoea, Fibrin D dimer increased, Headache, Nausea, Pain in extremity, Pruritus, Vision blurred
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine (1 month), chlorophyll
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Blood Work, Chest X-Ray, Cat Scan
CDC Split Type:

Write-up: Headache, Sore & Itchy Arm, Bruise on Rt Leg, Lightheaded, Nausea, Blurred Vision, Chest Pain, Cough, Difficulty Breathing, Elevated D-Dimer


VAERS ID: 1675600 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-27
Onset:2021-09-03
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Activated partial thromboplastin time shortened, Bacterial test, Blood potassium normal, Blood sodium decreased, Blood urine, C-reactive protein normal, Coagulation test, Colitis, Colitis ischaemic, Colonoscopy abnormal, Computerised tomogram abdomen, Diarrhoea, Diarrhoea haemorrhagic, Haemoglobin increased, International normalised ratio normal, Platelet count normal, Protein urine present, Respiratory viral panel, SARS-CoV-2 test negative, Scan with contrast abnormal, White blood cell count increased
SMQs:, Acute renal failure (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Ischaemic colitis (narrow), Chronic kidney disease (broad), Noninfectious diarrhoea (narrow), Proteinuria (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol, Probiotics, Fish Oil, Zyrtec, MVI, Immunoflex
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: WBC-16.60 (9/4/21); 13.80 (9/5/21); 14.50 (9/6/21) Hgb 16.3 (9/4); 14.6 (9/5); 13.7 (9/6) PLT 267 (9/4); 218 (9/5); 207 (9/6) Na 135, 140, 136 (Same dates as above) K 4.7, 4.3, 3.4 (Same dates as above) CRP 0.4 (9/4/21) Urine 2+ Protein, Trace Blood, 2+ urine bacteria (9/4/21) Diarrhea PCR Panel (Neg for all infectious causes, pos for blood and lactoferrin (9/4/2021) Respiratory PCR Panel (Biofire), (Neg for all infections tested including SARS Co V2) (9/4/21) INR 0.97 (9/5/21) PTT 23.4 (9/5/21) (below normal) Hypercoag panel pending CT abd/pelvis with IV contrast IMPRESSION: 1. Extensive colonic inflammatory change within the left colon spanning the distal transverse through the sigmoid. Differential considerations include both infectious and inflammatory colitis entities. Less likely vascular/ischemic injury given the distribution of findings and the patient''s lack of atherosclerosis. 2. No bowel perforation, pneumatosis, portal venous gas, free air, or abscess. 3. No acute intraabdominal findings are otherwise apparent. Colonoscopy 9/5/21 - Provisional diagnosis ischemic colitis
CDC Split Type:

Write-up: The patient developed severe left sided abdominal pain, followed by frank bloody diarrhea. Current provisional diagnosis is ischemic colitis.


VAERS ID: 1675624 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dyspnoea, Hyperhidrosis, Injection site erythema, Injection site pruritus, Injection site swelling, Nausea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lexipro Buspar Invokonmet Synthrois Plavix Statins (2) Prilosec
Current Illness: none
Preexisting Conditions: Diabetes 2 CAD Hypo thyroid PTSD treatment resistant depression acute axiety
Allergies: none known
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Fever +4 degrees to 101.5 labored breathing excessive sweating chills nausea swollen, red, itchy injection site


VAERS ID: 1675656 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-29
Onset:2021-09-03
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM
FLUR4: INFLUENZA (SEASONAL) (FLUBLOK QUADRIVALENT) / PROTEIN SCIENCES CORPORATION - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Burning sensation, Dyspnoea, Erythema, Full blood count, Metabolic function test, Swelling face, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa tramdaol Demerol
Diagnostic Lab Data: hospital Aug 3rd - IV steroids, IV benedryl, zofran, Pepcid Labs - CBC and CMP
CDC Split Type:

Write-up: Hives on face, Facial swelling, facial redness, face felt like burning, shortness of breath


VAERS ID: 1675668 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Cough, Diarrhoea, Dizziness, Feeling cold, Headache, Nausea, Oropharyngeal pain, Pain, Pain in extremity, Rash, Rash erythematous, SARS-CoV-2 test, Tremor
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (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), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No tests only physical exam and checked blood pressure and sats
CDC Split Type:

Write-up: Approx 6 hours after vaccine developed a headache and sore arm which was to be expected . Headache continued for 2 days . Approx 48 hours after vaccine diarrhea , nausea , dizziness and cold spells started . Approx 72 hrs post vaccine chest was very tight and very watery cough, sore throat and slight red rash on chest and arm. Went to ER . They tested for Covid and sent me home with medication to treat symptoms ( anti nausea , anti diarrhea , anti histamine , cough mixture) , more cold spells in the evening and woke up very achy this morning . Also had slight tremor in my leg this morning . Went to my GP in the afternoon as chest still felt tight . Advised to use asthma pump and anti histamines .


VAERS ID: 1675675 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-15
Onset:2021-09-03
   Days after vaccination:111
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0170 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 2 LA / IM

Administered by: Pharmacy       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: Hodgkin''s Lymphoma/CLL - on ibrutinib
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt tested positive for COVID on 9/3, admitted to the hospital 9/5. On supplemental oxygen, decadron and remdesivir


VAERS ID: 1675695 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Blood test, Chills, Dehydration, Dizziness, Electrocardiogram, Headache, Hyperhidrosis, Loss of consciousness, N-terminal prohormone brain natriuretic peptide, Pyrexia, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Lupus
Allergies:
Diagnostic Lab Data: Went to ER where I was vomiting and needed an IV for dehydration. They also injected zofran. Conducted blood tests and EKG.
CDC Split Type:

Write-up: Received vaccine Thursday 4pm. By Friday 9am started to get chills. A few hours later fever of 101.9. Overnight chills and fever for worse raising to 102.7. Sweats, nausea and waking up to blood pressure dropping where I had passed out twice. Today, 9/6 still feeling lightheaded, headache and dizziness.


VAERS ID: 1675697 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-02
Onset:2021-09-03
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 03OL20A / 2 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: CASE WAS VACCINATED USING MODERNA 1/05/21 (LOT 025J20A) + 2/02/21 (LOT 03OL20A). S/O BEGAN 8/29/21, TESTED + 9/3/21


VAERS ID: 1675704 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Body temperature increased, Headache, Heart rate increased, Migraine, Thirst
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

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: Pantoprazole, claritin, anacin
Current Illness: none
Preexisting Conditions: allergies, headaches
Allergies: codeine, environmental allergies (grass, ragweed, oak, dust)
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Within an hour of the shot, elevated heart rate recorded on smart watch and continued for 24 hours. Resting heart rate is usually 85; after shot it was sustained at 120 bpm, spiking as high as 145 bpm at times. No physical activity was recorded after the shot. Occasionally, heart rate increases to 120 at rest, even 96 hours later. Extreme thirst noted at 1am, woke up from sleep. Dehydration continues 96 hours later. Also, bad taste in mouth has been noted since the shot. Nothing has helped. Headache, migraine like, began at 2am, continued for 72 hours. Anacin used but did not help much. Elevated temperature 100.2 noted at 8pm, continued for 24 hours.


VAERS ID: 1675713 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-11
Onset:2021-09-03
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT WAS VACCINATED USING PFIZER 2/15/21 (LOT EL9267) + 3/11/21 (LOT EN6206). S/O BEGAN 8/30/21, TESTED + 9/3/21


VAERS ID: 1675739 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye swelling, Hypersensitivity, Mouth swelling, Pruritus, Rash, Swelling face, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Systemic: Allergic: Itch (specify: facial area, extremeties)-Severe, Systemic: Allergic: Itch Generalized-Medium, Systemic: Allergic: Rash (specify: facial area, extremeties)-Medium, Systemic: Allergic: Rash Generalized-Medium, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Medium, Additional Details: PATIENT''S FACE AND EYES WERE SEVERELY SWOLLEN AND ALLERGIC


VAERS ID: 1675750 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: TB test, 9 years old
Other Medications: Smartie pants teen vitamins Methlyfolate Vitamin D Probiotic Omega 3 Zinc L-theanine
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Physician evaluation, apple watch heart rate monitor.
CDC Split Type:

Write-up: Fatigue, dizziness, irregular and elevated heart rate.


VAERS ID: 1675755 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Cough, Dizziness, Injection site nodule, Injection site reaction, Nasal congestion, Oropharyngeal pain, Pain in extremity, Peripheral swelling, Pharyngeal swelling, Rash erythematous, Swelling face, Throat irritation, Throat tightness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair/montelukast 10mg Zyrtec 10mg Protonix-40mg Famotidine 20mg Multivitamins Zinc Depo-provera shot Dymista- nose spray Trulance-as needed
Current Illness: Sinus infection at the end of July beginning of August.
Preexisting Conditions: Gluten intolerance
Allergies: Penicillin -(Penvee K) red lacy rash Hydrocodine- puke uncontrollably Gluten intolerance Latex
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 5:55pm- 9/3/2021- swelling of face and throat - took Benadryl 10pm- 9/3/2021- face still swelling- took another Benadryl 8am-8/4/2021- left arm, shoulder and shoulder blade swollen and sharp pain. Benadryl and ibuprofen taken 12pm-9/4/2021- swelling of face gets worse and pain worsens in shoulder. Swelling of shoulder and shoulder blade area getting worse. Took two Benadryl and ibuprofen. Used cold pack on swollen shoulder and shoulder blade area. 4pm-9/4/2021- swelling still in shoulder and shoulder blade area. Throat began feeling tight. Took more Benadryl and took Tylenol. Sore throat begins. 8pm-9/4/2021 no change from 4pm. 12am- 9/5/2021- throat feels tight, pain in shoulder and shoulder blade area is gone. Red rash around injection sight area. Took Benadryl went back to sleep. 4am- 9/5/2021-took more Benadryl- face is swollen, throat feels tight, began coughing, once Benadryl kicked in coughing eased. 8am-9/5/2021- swollen face and dizzy. Took Benadryl. 12pm-9/5/2021- face and throat continue to swell about 30 min before Benadryl is due. Kept taking Benadryl every four hours. 4pm- 9/5/2021- knot formed above injection sight , still a red rash around injection sight. Throat still swelling. Took Benadryl. 8pm-9/5/2021- face and throat swell take Benadryl 12am-9/6/2021- face and throat swell took Benadryl 4am-9/6/2021- throat itchy and sore and nose swollen and stuffy. Took Benadryl 8am-9/6/2021- face slightly swollen, coughing, and sore throat. Took Benadryl. Which helped with the coughing. 2pm- 9/6/2021- face and throat slightly swollen took Benadryl.


VAERS ID: 1675771 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Condition aggravated, Nausea, Vertigo
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular 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:
Current Illness:
Preexisting Conditions: frequent vertigo
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: A couple of minutes after receiving vaccine pt began having sx''s of vertigo(room spinning, nausea). She was still at the administration desk at that point and was assisted to a stretcher for observation. During her observation, she stated to the department nurses that she frequently gets vertigo. She thinks her ear had popped causing this episode as she has been having allergy sx''s recently. Pt was observed for approximately 50 minutes until a ride arrived to take her home. She states she had medication at home for the nausea and was comfortable treating this there. Pt was taken via WC to her family member''s vehicle and assisted into the vehicle. Pt tolerated Moderna #1 dose w/o any signs or sx''s of acute allergic rxn.


VAERS ID: 1675791 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / UN

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

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

Write-up: headache, fatigue, fever/chills, and sore muscles


VAERS ID: 1675838 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 RA / IM

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

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

Write-up: Rash that covered her whole right side of her thigh and the back of that leg. She noticed this rash in the evening when getting ready for bed. This rash did not itch, was not warm, or bother her in any other way. She called me on Monday 9/6 and let me know. She also said that it was almost gone at that point


VAERS ID: 1675845 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Nausea Diarrhea Hypotension
Preexisting Conditions:
Allergies: Codeine Diphenhydramine Gluten Erythromycin Lactose Sulfa
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body aches Nausea Fever vomiting epigastric tenderness Headaches


VAERS ID: 1675865 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH HRSAFC3183 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain, Breast engorgement, Breast swelling, Breast tenderness, Chills, Feeling hot, Gait disturbance, Headache, Injection site pain, Malaise, Neck pain, Pain, Pain in extremity, Pain in jaw, Pyrexia, Sleep disorder, Speech disorder
SMQs:, Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Osteonecrosis (broad), Normal pregnancy conditions and outcomes (broad), Arthritis (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: severe achiness/headaches, fatigue, swollen lymph nodes/pain in armpit
Other Medications: vitamin C, vitamin D3, grass fed beef liver pills, zinc, vitamin B12, probiotics
Current Illness: minor cold the weekend before
Preexisting Conditions: n/a but I am a breastfeeding mom of a newborn
Allergies: none known other than dust, and sensitivities to those awful chemically bound fragrance laden detergents/house cleaning products/etc.
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Within several hours I had extreme tenderness and soreness at the site of the injection. I began to feel headache and body aches after dinner. I fell asleep at around 10 pm, and then woke several hours later feeling very hot, achy all over, with an awful headache- I felt like a had a bad case of the flu. My arm where I got the shot hurt so bad I couldn''t lean on it, and grimaced when my 12 year old hugged me a little too enthusiastically. I then started to have the chills and severe body aches and a fever that made me so uncomfortable I could not sleep. I am breastfeeding currently and the day after I got my 2nd dose of Covid19, I had engorgement in my right breast and a lot of tenderness in my breast (probably due to my lymph nodes there on the right side)- I also felt like my baby was more fussy than she normally is- maybe picking up on me not feeling well. It almost felt like the swelling of my breast would become mastitis due to feeling so hot and achy and tender, but luckily my daughter nursed and I kept nursing and drinking lots of water and it has mostly subsided now. The next day I had no fever but still felt like I was running warm; I still felt very achy all over- especially in my back, and had severe abdominal cramping as well that hurt so bad I had trouble walking or talking. The terrible headache persisted. Today is Monday and I still have a really bad headache- top and front of my head. The site of the injection is still very sore. The back of my neck- occiput area as well as jaw on my right side are also very tender/achy/sore. I have not taken any OTC to deal with any of it, I am just letting it run its course, and resting and hydrating as much as possible. Sunday afternoon I did take a brisk walk carrying my 13 lb 12 week old, and then came home to do a small work out, and that made me feel a lot better; I followed this up with a cold shower and felt very refreshed.


VAERS ID: 1676250 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-03
Onset:2021-09-03
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M30A / 2 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 UN / IM

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

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

Write-up: Breakthrough COVID infection requiring hospitalization


VAERS ID: 1676256 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Alabama  
Vaccinated:0000-00-00
Onset:2021-09-03
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash, SARS-CoV-2 test negative, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft-50mg
Current Illness: None Known
Preexisting Conditions: None Known
Allergies: None Known
Diagnostic Lab Data: Covid test 9/6
CDC Split Type:

Write-up: Started as a pinprick rash a few hours after injection and to a full blown hives rash on left armpit. Continued to get more inflamed and I went to the ER. They gave me IV steroids and Benadryl. Helped but I still have the rash.


VAERS ID: 1676469 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Headache, Nausea, Pain, Vertigo
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular 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: Mirena IUD, Zyrtec
Current Illness: NONE
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Very fatigued, body soreness, vertigo, headache, and extremely nauseous.


VAERS ID: 1676637 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FEJ592 / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Dyskinesia, Dyspnoea, Headache, Musculoskeletal stiffness, Vertigo
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol SUCC ER 25mg. Elderberry tea
Current Illness: Tachycardia
Preexisting Conditions: Cervical herniated disc. Tachycardia for several months.
Allergies: Reglan. Red grapes with seeds
Diagnostic Lab Data:
CDC Split Type:

Write-up: About 30 minutes after the shot, I started to have shortness of breath and chest tightness. It lasted about 10 minutes and went away. Two hours later, I began to have jerk motions on the left arm. I rested and woke up on day two with mild vertigo and headaches. The shortness of breath returned two days after the shot with soreness to the chest while taking deep breaths. I also have stiffness to my left arm and left leg. The shortness of breath is worse while climbing stairs or talking. Day 3, these symptoms became worse with movement. I?m currently reaching out to my doctor for a visit for an assessment.


VAERS ID: 1676781 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

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

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

Write-up: Chills, fever, headache, extreme fatigue


VAERS ID: 1676787 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-03
Onset:2021-09-03
   Days after vaccination:184
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood glucose increased, Glycosylated haemoglobin increased, Headache, Hypertension, Lethargy, Type 2 diabetes mellitus
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypertension (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen, halobetasol
Current Illness: none
Preexisting Conditions: psoriasis mild-moderate plaque
Allergies: none
Diagnostic Lab Data: BP - $g150/$g100mm Hg - Sept 2021 Blood Glucose - consistently 400mg/dL - 500 mg/dL - Sept 2021 HbA1C - 9.6% Sept 2021
CDC Split Type:

Write-up: Received 2nd dose of COVID-19 vaccine on 3/3/2021. On 9/3/2021, I was advised following routine lab testing go to to the Emergency Room and was newly diagnosed with diabetes type 2 and new diagnosis of hypertension - had pounding headache, lethargy, diabetes symptoms. My blood sugar was 467 and blood pressures had been $g150/$g100. My A1C (3 month average of glycosylated Hemoglobin was 9.6%), which suggests that I had been experiencing these disease states issues for months. I am not sure if either is related to the Moderna Vaccination for Covid-19, and have not raised or discussed the topic with my doctors at the Emergency Room, and while I do not perceive there to be causation, I am reporting in case there is any possibility of similar cases.


VAERS ID: 1676801 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-29
Onset:2021-09-03
   Days after vaccination:127
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: metoprolol, coumadin,lasix,pradaxa
Current Illness: a flutter, DM@ w/ CKD, severe obesity
Preexisting Conditions: see above
Allergies: PCn, sulfa,codine
Diagnostic Lab Data: positive covid pcr
CDC Split Type:

Write-up: hospitalizedfor urosepsis and covid 9/3


VAERS ID: 1677098 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Indiana  
Vaccinated:0000-00-00
Onset:2021-09-03
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Fatigue, Pain, Paraesthesia, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: The patient had not provided medical history and had no known allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210907847

Write-up: ENTIRE BACK IS ITCHING BUT NO RASH OR HIVES; ACHINESS ALL OVER THE BODY; TINGLING TO LEFT HAND; CHILLS; EXTREME FATIGUE; This spontaneous report received from a patient concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: The patient had not provided medical history and had no known allergies. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number:1808980,expiry:18-SEP-2021) dose was not reported, administered on 03-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On SEP-2021, treatment medications included: paracetamol. On 03-SEP-2021, the patient experienced entire back is itching but no rash or hives. On 03-SEP-2021, the patient experienced achiness all over the body. On 03-SEP-2021, the patient experienced tingling to left hand. On 03-SEP-2021, the patient experienced chills. On 03-SEP-2021, the patient experienced extreme fatigue. The action taken with covid-19 vaccine was not applicable. The patient recovered from entire back is itching but no rash or hives on 04-SEP-2021, was recovering from extreme fatigue, chills, and achiness all over the body, and had not recovered from tingling to left hand. This report was non-serious.


VAERS ID: 1677102 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New Mexico  
Vaccinated:0000-00-00
Onset:2021-09-03
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210908685

Write-up: SORE ARM; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 03-SEP-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 03-SEP-2021, the patient experienced sore arm. The action taken with covid-19 vaccine was not applicable. The outcome of sore arm was not reported. This report was non-serious.


VAERS ID: 1677109 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: New Mexico  
Vaccinated:0000-00-00
Onset:2021-09-03
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210908729

Write-up: SORE ARM; This spontaneous report received from a consumer concerned multiple patients. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 03-SEP-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 03-SEP-2021, the patients experienced sore arm. The action taken with covid-19 vaccine was not applicable. The outcome of sore arm was not reported. This report was non-serious. This case, from the same reporter is linked to 20210908676 and 20210908685.


VAERS ID: 1678304 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Lethargy, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Systemic: Body Aches Generalized-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fever-Medium, Systemic: Nausea-Medium, Additional Details: patient''s temp is elevated at 102 degrees and feels lethargic. advised to call PCP


VAERS ID: 1678306 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Illness, Injection site swelling, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Rash all over arm, hand, and neck only on the side of the shot. Swelling around injection sight. Fever and sick day after shot.


VAERS ID: 1678317 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 RA / IM

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

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

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


VAERS ID: 1678322 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 LA / IM

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

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

Write-up: RN had diffuse urticarial rash that appeared 9 hours after receiving Moderna vaccine (1st dose) today. No wheezing, difficulty breathing or throat discomfort reported. Lungs were clear. Throat exam was normal. Code blue was activated. Vitals signs were normal. She was given Benadryl 50 mg PO x 1 & transferred.


VAERS ID: 1678326 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3181 / 1 LA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: No illness
Preexisting Conditions: obese
Allergies: No allergies
Diagnostic Lab Data: None yet, Patient has been recommended to see primary care provider if symptoms persist for another 24 hours
CDC Split Type:

Write-up: "Red swollen arm. The size of an medium apple. Warm to the touch. Very itch." Symptoms still remain 5 days after vaccination. Patient instructed to take Benadryl, and acetaminophen at the 5 day mark after vaccination.


VAERS ID: 1678480 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Dizziness, Ear pain, Fatigue, Headache, Hyperacusis, Hypoaesthesia, Paraesthesia, Photophobia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), 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: Levothyroxine
Current Illness: None
Preexisting Conditions: Hypothyroidism Anxiety Depression Obesity
Allergies: Levoquin Metronidazole
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizziness, lightheaded, numbness/tingling, ear pain, sound/light sensitive, diarrhea, extreme headache, fatigue


VAERS ID: 1678485 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling hot, Hypoaesthesia
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: Omega 3
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I received the shot in my left arm. Later that night I was washing a dish . The water felt extremely hot on my middle finger, pointer finger and thumb., however not on the rest of my hand. It felt like I had burned that portion of my hand. I stopped running the water over it. The hot/numb feeling radiated from those 3 fingers up my arm , ending at about my shoulder. The hot numb feeling continued until about 12:00 a.m. that night.


VAERS ID: 1678531 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient falsified the COVID questionnaire and did not disclose they had previous received both doses of Moderna. Patient then received Pfizer under the impression it was their first dose from their screening with a healthcare professional. No adverse reactions at this time.


VAERS ID: 1678543 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-08-20
Onset:2021-09-03
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscle twitching
SMQs:, Dyskinesia (broad), Dystonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Consumer states that she has a twitch near injection site that comes and goes


VAERS ID: 1678557 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products, No adverse event
SMQs:, Medication errors (narrow)

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

Write-up: Patient falsified covid questionnaire and reported they had not received any previous covid vaccinations. That was determined to be false after medication administration it was determined patients had received both doses of moderna prior to receiving the dose of Pfizer. Patient contacted and he did not have any adverse effects.


VAERS ID: 1678565 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN FC3183 / 2 LA / IM

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

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

Write-up: Vaccine was given past the 6 hour time limit from first puncture


VAERS ID: 1678568 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-01
Onset:2021-09-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Facial paresis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ambien , Lexapro
Current Illness: None
Preexisting Conditions: None
Allergies: No
Diagnostic Lab Data: Diagnosed with Bell''s Palsy
CDC Split Type:

Write-up: Loss of facial muscle control on right side of face lips, eyes etc approx 36 hrs after shot


VAERS ID: 1678574 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

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

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

Write-up: Pt was nauseated, no other symptoms. BP: 118/82, so she was monitored for 15 more minutes. Pt states she is felling fine, so she left the building after 30'' of monitoring.


VAERS ID: 1678592 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Decreased appetite, Epistaxis, Fatigue, Feeling abnormal, Pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Venlafaxine HCL Er 225mg
Current Illness: none
Preexisting Conditions: Had Covid in December of 2020
Allergies: NKA
Diagnostic Lab Data: none yet
CDC Split Type:

Write-up: The day after my second covid vaccine shot, I felt run down and tired, weak appetite, and ached all over. But I also have been getting nose bleeds nearly every morning since, today it was particularly bad, took almost 5 minutes to stop. Waiting to hear back from doctor about what I should do.


VAERS ID: 1678604 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-01
Onset:2021-09-03
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / UNK - / IM

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

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

Write-up: None stated.


VAERS ID: 1678605 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Feeling abnormal, Heart rate increased, Panic attack, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: Patient received vaccine and waited her 15 mins. Patient stated that she went back to work and started to feel bad. Patient came back to the vaccine clinic where she was instructed to sit down. Upon sitting down patients vitals and O2 sat checked and noted to be in normal ranges. WIth an elevated heart rate. Patient was instructed to take some deep breaths. Patient was talking and laughing. Patient given some water and crackers. 5 mins after given food and water patient threw-up the water and crackers. Patient states that her head feels light and dizzy. Patient encouraged to go to hospital seeing that patient stated that symptoms not getting better. Ambulance ride offered and patient refused to go via ambulance. Patient stated that she would go with her emergency contact (Her mom). Patient''s mom called, mom came and picked patient up. Patient instructed to go to ER. Patient verbalized understanding. Patient called Tuesday morning. Patient states that she is feeling much better. She states that her mom took her to urgent care and it was later determined that the patient was having a panic attack.


VAERS ID: 1678611 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW173 / 1 RL / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, Chest discomfort, Dizziness, Fatigue, Full blood count, Metabolic function test, Muscle tightness, Troponin T normal
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dystonia (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Patient reports having swelling on her arm when she was a kid.
Other Medications: calcium carbonate (TUMS ORAL) citalopram (CeleXA) 10 MG tablet prednisoLONE acetate (PRED FORTE) 1 % ophthalmic suspension RESTASIS 0.05 % ophthalmic emulsion Ventolin HFA 90 mcg/actuation inhaler
Current Illness:
Preexisting Conditions: Circulatory Essential hypertension Digestive Morbid obesity Immune Tonsillar hypertrophy Nervous Sciatic leg pain Bilateral hearing loss Respiratory Exercise-induced asthma Obstructive sleep apnea Genitourinary Uterine leiomyoma Urge incontinence of urine Other Attention deficit disorder Borderline personality disorder Chronic post-traumatic stress disorder (PTSD) Tremor Binge eating disorder MDD (major depressive disorder), recurrent severe, without psychosis Herniation of lumbar intervertebral disc Major depressive disorder, recurrent, moderate Adult learning disorder Acute pain of right knee
Allergies: Wellbutrin [Bupropion Hcl] Abilify [Aripiprazole] GabapentinSwelling Lamictal [Lamotrigine]Swelling Seroquel [Quetiapine] Zyprexa [Olanzapine] Adhesive Tape-siliconesRash Adhesive [Tape] Geodon [Ziprasidone Hcl] Risperidone Trazodone
Diagnostic Lab Data: Fri Sep 03, 2021 1705 No significant abnormalities CBC and differential(!) [JG] 1735 Troponin T: <0.01 [JG] 1748 No significant abnormalities Basic Metabolic Panel [JG] 1748 No consolidation, no mediastinal widening XR chest 1 view portable [JG]
CDC Split Type:

Write-up: Patient given Pfizer Covid vaccine in Right vastus lateralis IM. Patient requested site due to being "unable to get shots in her arms." Patient had CDC information sent to her that stated Deltoid or Thigh muscles can be used for administration. At 15 minute mark patient began complaining of tight right sided neck muscle, feeling dizzy and extremely tired. Also complained of feeling as if there was a "hole in her chest that went to her back." . Patient requesting transport to the ER. Ambulance called and patient transported to hospital.


VAERS ID: 1678659 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-04
Onset:2021-09-03
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

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

Write-up: Patient developed COVID-19 requiring hospitalization


VAERS ID: 1678690 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-06
Onset:2021-09-03
   Days after vaccination:240
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Laboratory test abnormal, Vaccination complication
SMQs:

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

Write-up: positive test and symptoms


VAERS ID: 1678720 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR 2579B / N/A LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. T028929 / 2 LA / IM

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

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

Write-up: Patient fainted appox 5 mins after injections.


VAERS ID: 1678748 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, 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? 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: face numb and tingly 45 minutes post vaccination. headache immediately and still continues today (9-7-2021)


VAERS ID: 1678787 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-08-27
Onset:2021-09-03
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Blood pressure increased, Hypoaesthesia, Magnetic resonance imaging, Oedema peripheral, Tinnitus
SMQs:, Cardiac failure (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Hearing impairment (narrow), 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: Prempo daily and Levothyroxine daily
Current Illness: m/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: MRI: negative Blood Pressure: now at 120/78 Hearing Test: Pending
CDC Split Type:

Write-up: woke up with ringing in right ear and discomfort under armpit, discovered had grapefruit size inflammation under armpit area. Later felt sensation of borderline numbness in arm and side of face. Went to ER, had an MRI and blood pressure was very high for myself reading at 159/98. Followed up with primary physician several days later with concerns. Increasing ringing of the right ear increasing daily, made appointment with ENT on 9/07/21 along with a hearing test to be conducted.


VAERS ID: 1678794 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall 20mg/daily Metoprolol XR 50mg/daily Cyanocobalmin 1000mg/ monthly Metformin 1000mg/daily
Current Illness: None
Preexisting Conditions: Endometriosis Wolf Parkinson White Vitamin B12 deficiency Polycystic Ovarian Syndrome Infertility OCD
Allergies: Lupron Demerol Hydrocodone HCTZ Amoxicillin Dermabond
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Redness, warmth, swelling around the injection site in a 2in X 2in area. ?Firm? feeling to the deltoid muscle.


VAERS ID: 1678798 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-31
Onset:2021-09-03
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047A21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Inappropriate schedule of product administration, SARS-CoV-2 test positive
SMQs:, 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT WAS VACCINATED USING MODERNA ON 2/24/21 (LOT 015M20A) + 3/31/21 (LOT 047A21A). TESTED + 9/03/2021


VAERS ID: 1678803 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-09
Onset:2021-09-03
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood immunoglobulin G, Blood immunoglobulin M, COVID-19, Infusion, SARS-CoV-2 test positive, Urine output decreased, Weight increased
SMQs:, Acute renal failure (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amiodarone 100 mg po daily Amlodipine 5 mg po daily Clarinex 5 mg po daily Atorvastatin 40 mg po daily Lutein po daily Metoprolol 25 mg po daily Finasteride 5 mg po daily Tamsulosin 0.4 mg po daily Trelegy 1 puff daily Esomeprazole 40 mg po
Current Illness:
Preexisting Conditions: Hypertension, Hyperlipidemia, Diverticulitis, BPH, s/p MVrepair, PAF-SR, Pneumothorax in past, diastolic heart failure, LHC normal coronaries COVID 19 on 8/25 and Regeneron on 8/26.21. s/p MVR, right leg surgery removal of fatty tumor, RO D placement in right leg, plate placed in right foot, nasal reconstruction. Smoking Status Former Smoker. Alcohol Use Current.
Allergies: Codeine, penicillins, adhesive tape
Diagnostic Lab Data: Prior to MCAs, on 8/25 both SARS-CoV-2 Antigen and PCR (+) On admission 9/3. SARS-CoV-2 Antigen (-) On 9/4/21 SARS-CoV PCR (+) On 9/4/21 IgM 1.64, IgG 0.53
CDC Split Type:

Write-up: 77 year male with hx HTN, HLP, PAF, CKD, MV repair/annuloplasty 8/2020, GERD, BPH, PTx, recurrent heart failure, last Echo was a year ago with presrved EF, normal coronaries per LHC, last year, presents to ED tonite for weight gain of 12 pounds x 1 week, and decrease in urine output. He reports to occasional use of diuretics but does no take regularly. Recently he was positive for COVID 19 on 8/25/21, presented to ED for monoclonal antiboidies-Regeneron on 8/26, had the infusion and went home. ***Patient was noted to be on ivermectin by his PMD.


VAERS ID: 1678813 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-02-15
Onset:2021-09-03
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, COVID-19, Fibrin D dimer increased, Inflammatory marker increased, Infusion, Laboratory test abnormal, Oxygen saturation decreased, Red blood cell sedimentation rate increased, SARS-CoV-2 antibody test positive
SMQs:, Haemorrhage laboratory terms (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, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atenolol-chlorthalidone 50 mg-25 mg Tablet Directions: 1 tablet oral daily (Active)
Current Illness:
Preexisting Conditions: Significant for hypertension on meds.
Allergies: NKDA
Diagnostic Lab Data: SARS_CoV-2 Antigen (+) on 9/3/21 SARS-CoV- 2 IgM 2.53; IgG 2.03 on 9/4/2021 SARS-CoV-2 UgG2 QT-SPIKE antibodies $g25,000 on 9/4/21
CDC Split Type:

Write-up: She was tested as an outpatient, which resulted positive. She presented to the ED today for a MAB infusion. She was initially going to be discharged to home, however 02 sats started to drop to 90% on room air. She was then admitted to inpatient medical for further work up and evaluationLabs showed elevated inflammatory markers, elevated Ddimer, ESR, CRP. She was placed on 2L supplemental 02 and 02 sats improved to 95%.


VAERS ID: 1678817 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site mass, Injection site pain, Injection site pruritus, Injection site warmth, Migraine, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: spironolactone, fluoxetine, Mirena IUD, OTC Women''s Multivitamin
Current Illness: None
Preexisting Conditions: generalized anxiety and depression, cystic acne
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Onset of 100 degree fever accompanied with body aches and migraine headache without aura. Treated with 1 gram acetaminophen every 6-8 hours. fever broke Saturday 9/4/21 in the afternoon. Vaccine injection site is still a red, hot, itchy lump that hurts to touch as of today 9/7/21


VAERS ID: 1678838 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-08-31
Onset:2021-09-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aggression, Depression, Paranoia, Suicidal ideation, Vaccine positive rechallenge
SMQs:, Suicide/self-injury (narrow), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (narrow), Depression (excl suicide and self injury) (narrow)

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

Write-up: Patient stated he became aggressive, paranoid, severely depressed. Also considered suicide. Symptoms were similar but mild with the first dose. Patient stated he did not drink any alcohol or take any medications during this time. No family history of mental disorders. Symptoms lasted approximately 4 days. Patient did not contact physician or get medical treatment.


VAERS ID: 1678843 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 2 RA / IM

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

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

Write-up: Client called the clinic today, 9/7/2021, at 11:00 AM to inform me that she became very light-headed from the vaccine after returning home from waiting 15 minutes at our facility. She also stated that she completely passed out which scared her grown sons and they called for an ambulance. The ER staff at the hospital (don''t know which hospital) gave her fluids and told her this was a normal reaction to a COVID vaccine. She just wanted to let me know that this happened.


VAERS ID: 1678846 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-25
Onset:2021-09-03
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 059EZ1A / UNK - / -

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

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

Write-up: positive test and symptoms


VAERS ID: 1678850 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-08-30
Onset:2021-09-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Pain in extremity, Sensory disturbance, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine 100mcg, multi-vitamin, Vitamin D, flaxseed oil
Current Illness: None
Preexisting Conditions: Hashimoto''s disease, Arthritis, Mitral valve regurgitation, Gilbert disease, Raynauds phenomenon
Allergies: Albuterol, Nitrofurantoin Monohyd/M-Cryst, Polymyxin B Sulf-Trimethoprim, Polymyxin B. Lactose intolerant, allergic to some adhesives
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I started getting hives on Friday 9/3, after receiving my shot on Monday, 8/30. Then on 9/7, my left arm became really sensitive and sore and a large red circle about the size of an egg appeared. The red circle included the injection site at the bottom and spread up towards my shoulder.


VAERS ID: 1678887 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse reaction, Chills, Immediate post-injection reaction, Injection site pain, Paraesthesia, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily multivitamins
Current Illness: No
Preexisting Conditions: No
Allergies: IV Rocephin (rash) Flagyl (tingling)
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Immediately after the shot I did develop some pain in the shoulder and a little tingling in the left hand. This was not a concern to me . I figured that was normal. Within six hours I started to develop tingling in my feet which moved up to my legs through the night and over the course of the next couple days. I experienced tingling, twitching, mild tremors in my quads. Sunday morning I had two bouts of chills. The tingling and the twitching in my feet and legs were bothersome: Ibuprofen and Tylenol seemed to help.. Last night I decided not to take any medicine to see if I continue to have this response. I took melatonin and while in bed I felt that my symptoms were improving. I woke up with minimal neurological involvement (still some twitching and tingling , though not painful, but noticeable. I believe I?m improving. I did make an appointment virtually with the Ireland Army health clinic today at 11 AM. My doctor was not available so I was lined up with another Primary Care Provider. He told me he believes this was an adverse reaction to the vaccine and since I?m starting to see some improvement he told me to only go back if I started to get worse. He felt that I would continue to improve over time.


VAERS ID: 1678896 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-25
Onset:2021-09-03
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Food refusal, Mental status changes, SARS-CoV-2 test positive
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: anastrozole 1 mg oral tablet 1 mg = 1 TAB, PO, Daily aspirin 81 mg oral delayed release tablet 81 mg = 1 TAB, PO, Daily bisacodyl 10 mg rectal suppository 10 mg = 1 supp, PRN, PR, Daily bumetanide 2 mg oral tablet 2 mg = 1 TAB, PO, BID (
Current Illness:
Preexisting Conditions: Congestive heart failure Knuckle pads AVR - Aortic valve replacement Appendectomy Atrial fibrillation Back pain Breast cancer COPD Cholecystectomy Diastolic heart failure GERD - Gastro-esophageal reflux disease Glaucoma... Home oxygen supply Hyperlipidemia Hypertension Implantation of cardiac pacemaker Knee replacement Osteoporosis Parkinson disease... Stimulator, device Stroke Wheelchair bound
Allergies: DEMEROL HCL, NIACIN, OXYCODONE, VISTARIL
Diagnostic Lab Data: POSITIVE COVID TEST
CDC Split Type:

Write-up: Family calling EMS d/t change in mental status. Pt has been refusing to eat. Temp


VAERS ID: 1678906 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 filled out her VAR and stated she has had no reaction to vaccines before. She states that she has a needle phobia. After receiving her vaccine, she felt dizzy and fainted twice. EMS was called and took over the situation. The patient was walked away at her own free will.


VAERS ID: 1678929 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 2 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Pharyngeal paraesthesia, Vaccine positive rechallenge
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre 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: On 8/10/2021, patient received the first dose of Pfizer. Patient reported she felt "tingling of the throat" a "few minutes" afte
Other Medications: None reported
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: Penicillin
Diagnostic Lab Data: None
CDC Split Type:

Write-up: At approximately 1626, patient reported tingling of throat to RN. Patient denied difficulty breathing, difficulty swallowing, itchiness and rashes. RN offered to take vital signs. Patient denied vitals signs. RN offered diphenhydramine. Patient denied diphenhydramine. Patient reported "I''m fine". Patient given water. Patient able to drink water. Patient reported similar reaction to the first dose of Pfizer Covid Vaccine (LOT# EW0168, exp. 08/2021) administered on 08/10/21. Patient reported she felt the "same thing" and "didn''t say anything". Patient reported it "felt like a panic attack starting". At 1634, RN reassessed patient. Patient reported "it didn''t get any worse". Patient denied itchiness, rashes, difficulty breathing and difficulty swallowing. RN offered diphenhydramine. Patient denied diphenhydramine. RN offered to take vital signs. Patient denied vital signs. At 1642, RN reassessed patient. Patient reported the symptom had "gone down". Patient denied itchiness, rashes, difficulty breathing, difficulty swallowing. RN offered diphenhydramine. Patient denied diphenhydramine. RN offered to take vital signs. Patient denied vitals signs. At 1645, RN reassessed patient. Patient reported the symptom is "gone". Patient denied itchiness, rashes, difficulty breathing and difficulty swallowing. RN educated patient on signs/symptoms of when to seek emergency care, to follow up with primary care provider, and to sign up on v-safe. At 1647, patient left facility with steady gait and unlabored respirations.


VAERS ID: 1678948 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2020-12-23
Onset:2021-09-03
   Days after vaccination:254
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 2 RA / 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Rapid COVID test.
CDC Split Type:

Write-up: Tested positive for COVID-19 after being vaccinated.


VAERS ID: 1678998 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-29
Onset:2021-09-03
   Days after vaccination:127
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Fatigue, Infection, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Taste and smell disorders (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known
Current Illness: none known
Preexisting Conditions: none known
Allergies: none known
Diagnostic Lab Data: 9/3/2021 + PCR for Covid
CDC Split Type:

Write-up: Client was vaccinated with Moderna vaccines for Covid on 4/29 and 6/4/2021. Client was symptomatic with runny nose, fatigue, and loss of taste/smell on 9/1/2021. Tested positive with PCR on 9/3 for Covid. Reported as a case of breakthrough Covid illness in a fully vaccinated person.


VAERS ID: 1679006 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-02-09
Onset:2021-09-03
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL1284 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 RA / 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 Sofia antigen test with a positive result.
CDC Split Type:

Write-up: Patient received the Pfizer COVID-19 vaccine on 1/19/21 and 2/9/21 so was fully vaccinated when they tested positive for COVID-19 on 9/3/21.


VAERS ID: 1679012 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-05
Onset:2021-09-03
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 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? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt received vaccine- pt is hospitalized with covid +, on nasal cannula


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