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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 28 out of 8,010

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VAERS ID: 1768937 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-10-04
Onset:2021-10-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Lymph node pain, Lymphadenopathy
SMQs:, Anaphylactic reaction (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: metformin 1000mg bid vascepa 1gm bid prozac 40mg daily adderall 25mg daily atorvastatin 10mg daily asprin 81mg daily Fenofibrate 54mg daily glipizide 10mg daily Ozempic 0.5 q7days
Current Illness: none
Preexisting Conditions: Type 2 DM Hyperlipidema ADHD Hypothyroidism General Anxiety
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Large red lump in axilla, appears to be swollen lymph node, painful to touch


VAERS ID: 1768938 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 3 LA / IM

Administered by: Private       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: None


VAERS ID: 1768939 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Patient received vaccine, and during 15 minute post-vaccine waiting period, collapsed and experienced what appeared to be a seizure. Patient quickly regained consciousness and was provided supportive care according to company policy and procedures. Patient declined emergency services when asked. Patient was given Benadryl 25 mg PO x1 dose and observed for $g1 hour prior to discharge from pharmacy waiting area.


VAERS ID: 1768946 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Back pain, Chills, Decreased appetite, Headache, Heart rate increased, Heart rate variability decreased, Muscle spasms, Musculoskeletal stiffness, Nausea, Night sweats, Pain in extremity, Paranasal sinus discomfort, Pyrexia, Sleep disorder
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Tendinopathies and ligament disorders (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: vitamin D, MVI
Current Illness: none
Preexisting Conditions: zero
Allergies: nkda
Diagnostic Lab Data: Oura ring which measured sleep, temperature, heart rate and HRV
CDC Split Type:

Write-up: Muscle spasms in lower & mid back, lower back pain, pain front of hips, quads painful & weak, extremely painful headache, stiff neck, fever of 101.2, chills, night sweats, kept waking up throughout night, elevated heart rate (more than 10 bpm above normal), sinus pressure, no appetite, nausea, decreased heart rate variability


VAERS ID: 1768950 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 3 LA / IM

Administered by: Private       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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: None.


VAERS ID: 1768957 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary pain, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Lump and soreness in the armpit of the injected arm.


VAERS ID: 1768958 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 2 LA / IM

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

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

Write-up: None


VAERS ID: 1768964 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 2 LA / IM

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

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

Write-up: None


VAERS ID: 1769053 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Chromaturia, Dizziness, Fatigue, Feeling cold, Headache, Hot flush, Hyperhidrosis, Myalgia, Peripheral coldness, Sleep disorder, Thirst, Urine abnormality, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Proteinuria (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: 1st (before going to bed) fatigue, tiredness, and headache; 2nd (trying to go to bed) cold feeling, extremities cold to the touch, extreme shivering (causing teeth chattering, thighs shaking, louder breathing), shivering causes inability to seep. Duration: about 2 hours; 3rd (waking up in the middle of the night) hot flashes, sweating, thirst, slight muscle pain in right hand. Duration: 2-3 times throughout the night for about 10-15 minutes each 4th (waking up the next day) dizziness, slightly blurry vision, orange foamy urine (my urine is normally pale yellow and not foamy)


VAERS ID: 1769092 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-14
Onset:2021-10-06
   Days after vaccination:265
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3247 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL92261 / 2 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Decreased appetite, Rhinorrhoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Guillain-Barre syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine, ASA, B12, Calcium citrate,hygroton, enapril, gabapentin, hydralazine, levothyroxine, oxybutin, spironolactone, ocuvite with lutein, Omega-3,
Current Illness: None known
Preexisting Conditions: Degenerative lumbar spinal stenosis, anemia, arrhythmia, diaphagmatic hernia, diverticulosis, GERD, HTN, Hypothyroidism, OSA, Osteoporosis
Allergies: Penicillin
Diagnostic Lab Data: Covid-19 PCR test done 10/6/21 returned positive results. Received Regen-Cov 10/7/21
CDC Split Type:

Write-up: Slight cough and runny nose 10/6/21 lack of energy and poor appetite has been going on for a few months.


VAERS ID: 1769246 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 2 RA / IM

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

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

Write-up: Lump in arm, size of golf ball, swollen arm


VAERS ID: 1769282 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac disorder, Diarrhoea, Dyspnoea, Headache, Nausea, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (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: Epilepsy/seizures
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Nauseous, diarrhea, heart feels bad, breathing is difficult, headache, fever, body ache


VAERS ID: 1769487 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Influenza like illness, Lymphadenopathy, Soft tissue swelling
SMQs:, Angioedema (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: Just usual vitamins, protein drink.
Current Illness: None
Preexisting Conditions: Possible arthritis
Allergies: None
Diagnostic Lab Data: None so far.
CDC Split Type:

Write-up: Large swelling in left armpit, lymph node. Size of an egg, and surrounding tissue swollen. Flu like symptoms, 2 days so far. This is different from previous 2 shots, where I had no problems.


VAERS ID: 1769495 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Headache, Irritability, Lethargy, Migraine, Pain in extremity
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pfizer COVID vaccine, 3/10/21, 4/2/21, 29 years old at time of vaccination, sore arm at injection site
Other Medications: Vyvanse Loratadine losarten/HCT Trazadone
Current Illness: None
Preexisting Conditions: ADHD Asperger?s syndrome Hypertension Mild sleep apnea Obesity Exercise and sickness induced asthma
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Migraine-type headache, lethargy, sore arm around injection site, behavioral irritability. All symptoms began about 18 hours after injection and lasted approximately 24 hours. No professional Treatment sought and PCP was not consulted as symptoms subsided. Patient pursued Bed rest and minimal activity.


VAERS ID: 1769670 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 RA / IM

Administered by: Public       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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Vasovagal Syncope


VAERS ID: 1769672 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysgeusia, Heart rate increased, Pruritus, Rash, Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), 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), 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: Montelukast 10mg Cetirizine 10mg Breo Ellipta 100/25 Fluticasone Propionate 50mcg Vit. C 1000mg Vit D 4000 IU
Current Illness:
Preexisting Conditions: Asthma
Allergies: Peanuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: Metallic taste in mouth approximately 2 minutes after injection. Itching in the inner ear approximately 3 minutes after injection. Rash / hives / small bumps in the back of throat after about 5 minutes. Itching in inner ear dissipated after about 4 minutes. Metallic taste disappeared after about 30 minutes, but has come back intermittently over the next 24 hours. Rash / hives / small bumps in the back of the throat dissipated after about an hour, took 25 mg of Benadryl. No changes in breathing. Minor elevation and heart rate.


VAERS ID: 1769676 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD7204 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Angina pectoris, Chest pain, Headache
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (narrow)

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

Write-up: Headache + Chest/Heart Pain. Continued since my dose.


VAERS ID: 1769679 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood pressure decreased, Diarrhoea, Hyperhidrosis, Lethargy, Nausea, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Within 15 minutes of received the vaccine, pt. became lethargic. Blood pressure dropped to below 70/50. Pt began sweating and was nauseated. Pt. began vomiting and experiencing diarrhea.


VAERS ID: 1769684 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Male  
Location: New York  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Chills, Cough, Fluid retention, Myalgia, Pain, Productive cough, Pyrexia, SARS-CoV-2 test negative, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID test 48 hours after injection, results negative
CDC Split Type:

Write-up: Symptoms beginning ~10 hours after injection: Fever (101F) Widespread muscle & body aches Chills Weakness Swelling/fluid in left armpit Cough / phlegm Symptoms subsided after 24 hrs with the exception of swollen armpit which persists 48 hours after injection


VAERS ID: 1769688 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F21A / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Dry mouth, Headache, Hypoaesthesia oral, Oropharyngeal discomfort, Paraesthesia oral
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: abilify
Current Illness:
Preexisting Conditions: bipolar disorder
Allergies: avocados
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 1910 client reported to EMT "feeling a headache." EMT contacted RN for assistance while he set up the anti-gravity chair. RN arrived and client stated she felt fine to transfer to anti-gravity chair. Vitals at 1912: blood pressure 176/96. Client reported feeling tingling and numbness to her tongue, chest pressure and headache. PHN arrived as RN was discussing Benadryl medication with client. PHN asked client to remove mask to assess for swelling and rash. No swelling, flushing or rash noted on face, tongue or neck. Client denied shortness of breath at this time, client describes as "just a tingling sensation." Client accepted Benadryl and PHN administered Benadryl 50 mg IM at 1914. Within a minute of administration client reported feeling her mouth dry and "feeling sensation was going down towards throat." Vitals at 1916: blood pressure 159/108, pulse 96, oxygen sat 99%. Client reported medical history of bipolar disorder, current medication of Abilify, and allergy to avocados. At 1916 client reported chest pressure was improving, headache improving, sensation to tongue returning, and stated, "I feel like it''s opening", when PHN asked regarding her throat. Client alert and oriented x4. Client denied itching, nausea, or blurry vision. Client asked staff for water as her mouth felt dry. EMT gave water and PHN instructed client to take a small sip. Per client, was able to swallow normally. Vitals at 1921: blood pressure 148/100, pulse 91, oxygen at 99%. Client reported improvement of all symptoms. At 1923 client reported all symptoms had resolved. Client asked if she could leave. PHN advised to complete 30 min observation as she had received medication. PHN reviewed with client and client''s husband ER precautions and advised to follow up with medical provider. Per client, client''s husband would drive her home. Client reported "feeling fine." Vitals at 1930: blood pressure 158/103, pulse 97, oxygen sat 96%. PHN reviewed clients blood pressure readings and suggested she follow up with provider. Client verbalized understanding. At 1937 client reported headache was returning and "felt left side of tongue was beginning to feel numb.". At 1937 911 activated by RN. PHN assessed again for swelling on face, tongue, neck. No swelling noted. Client denied shortness of breath. PHN continued to speak with client who was alert and oriented x4, speaking clearly and in full sentences. Fire Department and Paramedics assumed care at 1944. Client left facility via gurney at 1947. Upon leaving client had not decided if she wanted to be taken to another medical facility.


VAERS ID: 1769694 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Anxiety, Headache, Insomnia
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Prozac 30 mg
Current Illness: None
Preexisting Conditions: Dysthymia
Allergies: Allergic to sulfa
Diagnostic Lab Data: None
CDC Split Type:

Write-up: I felt anxious and like I needed to stretch most of the night. Didn?t sleep at all. Severe body aches and sour stomach or about 18 hours after they started. Lingering headache


VAERS ID: 1769866 (history)  
Form: Version 2.0  
Age: 11.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN PT''S DID NOT SPEAK ENGLISH HAD TO EMPLOY USE OF A TRANSLATOR
Current Illness: UNKNOWN PT''S DID NOT SPEAK ENGLISH HAD TO EMPLOY USE OF A TRANSLATOR
Preexisting Conditions: UNKNOWN PT''S DID NOT SPEAK ENGLISH HAD TO EMPLOY USE OF A TRANSLATOR
Allergies: UNKNOWN PT''S DID NOT SPEAK ENGLISH HAD TO EMPLOY USE OF A TRANSLATOR
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT RECEIVED PFIZER VACCINE WHEN HE WAS BELOW 12 - PT''S FATHER INFORMED ME HE WAS 12 AND WHEN I LOOKED AT PASSPORT THE MONTH AND DAY OF BIRTH WERE REVERSED SO BELIEVED HE WAS 12.


VAERS ID: 1769869 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Glossodynia, Nasal congestion, Oropharyngeal pain, Pharyngeal swelling, Stomatitis, Swollen tongue, Throat irritation, Tongue biting
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Angioedema (narrow), Convulsions (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol inhaler, dicyclomine capsule, alprazolam, synthyroid
Current Illness: N/A
Preexisting Conditions: Asthma, hypothyroidism, endometriosis, neutropenia, pancreatitis, celiac disease, migraine
Allergies: Azithromycin, ibuprofen, cephalexin, acetaminophen, codeine, fentanyl, metronidazole, penicillins, sulfa antibiotics, tetracycline
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reports obtaining the first dose of Moderna vaccination on 10/5/21. She states she obtained it in the evening and felt some subsequent nasal congestion and sore throat but went to bed and those symptoms resolved when she woke up. She states when she woke up the next day (10/6/21), she felt like she had a sore on the right side of the tongue which was quite painful. She states as time has gone on, she feels as if her tongue is swollen stating she keeps biting it because it feels like its in the way. She states her throat also feels "different" and mildly swollen.


VAERS ID: 1769879 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / UNK LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Axillary pain, Lymphadenopathy
SMQs:, 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: Simvastatin, amlodipine, calcium, multi vitamin & Fish oil
Current Illness: non
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Soreness of the lymph nodes on the left arm started the day after the shot received. This morning area under arem was was still sore. By the after the tenderness was subsiding.


VAERS ID: 1769999 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-10
Onset:2021-10-06
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Dyspnoea, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad)

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

Write-up: Chest tightness Shortness of breath (intermittent) Tachycardia Dizziness Didn?t receive any treatment.


VAERS ID: 1770009 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chills, Headache, Nausea, Neck pain, Paraesthesia, Sensory disturbance, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad)

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

Write-up: 14 hours post vaccination, chills in my body, nausea, and headache with sever pain in left side of neck. Discomfort in chest. Arms tingling and legs tingling along with testicles. 22 hours post vaccination, symptoms persist, unable to hold down fluids and food. Vomiting. 28 hours post vaccination, headache gone and neck pain gone, able to drink fluids and eat food. Tingle lessens but still there. 54 hours later appear to be back to normal.


VAERS ID: 1770012 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Burning sensation, Hypoaesthesia, Injection site pain, Lymphadenopathy
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Injection site soreness, numbness and burning sensation throughout the vaccinated arm extending to finger tips, swollen axillary lymph nodes. Patient did not experience these adverse effects for first nor second dose.


VAERS ID: 1770015 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Blood glucose increased, Chills, Fatigue, Heart rate increased, Injection site pain, Lymphadenopathy, Neck pain, Pyrexia
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (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: COVID-19 vaccination # 2 was sick for 3 days severe
Other Medications: Coreg. Glipazide zyrtec lisinopril ozempec. Lantus multivitamin
Current Illness: None
Preexisting Conditions: Dm htn
Allergies: Wellbutrin tree nuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started out at approximately 3:30 with severe chills , pain to injection sight and surrounding areas up into neck and under arm with swollen lymph node noted under left arm near injection site, noted fever of 102.4 took 2 Tylenol 500 mg to easy pain and fever at approximately 4pm fever continued through the day heart rate was elevated 119-130 blood glucose was elevated 250-350 O2sat was normal 99 bP was normal 106/68 temp . Continued with fever and chills, increased fatigue , until approximately 2am did take repeat dose of Tylenol at 10pm. Woke up on 10-7-21 with no fever but extremely tired and continued pain to injection site with swollen lymph node to left armpit still , if lymph nodes do not improve over the next few days I will report to my physician office


VAERS ID: 1771130 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Abdominal discomfort, Burning sensation, Fatigue, Influenza like illness, Myalgia, Pain of skin
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Muscle aches, skin sensitive to touch, feeling of burning throughout body, fatigue, upset stomach, flu like symptoms on 2nd day.


VAERS ID: 1771141 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydroxychloroquine,Effexor, DICLOFENAC, Atorvastatin, Atenolol, Levothyroxine, Omeprazole, Famotidine, Ellavil, Hydrochloride, Gabapentin, Claritin, Stool softener, Tramadol, And I?m currently receiving radiation for cancer and chemotherap
Current Illness: Anal cancer
Preexisting Conditions: Anal cancer, hypothyroidism, migraines, depression, chronic back and knee pain, neuropathy, bone degenerate disease, Charcot syndrome
Allergies: NKA
Diagnostic Lab Data: Can?t yet or don?t know what to do
CDC Split Type:

Write-up: I received the 1st and 2nd doses of the COVID vaccine of Moderna. Went for the booster due to having cancer and receiving chemo and radiation and being immunocompromised. Filled it paperwork selected which vaccine I had gotten and present vaccination card to pharmacist. My daughter also got her 3rd dose and was with me. Pharmacist gave me injection then my daughter. He went to fill out our cards and saw mine then stated to my daughter ?Oops I didn?t see her card and realize that she got the Moderna vaccine, I saw your car and thought you both got the same vaccine.? ?Well I can?t take it back out of her?. This is a medication error and I don?t know how that?s gonna affect me or if I?ll build up antibodies and be protective for the next year until the next booster. Something needs done.


VAERS ID: 1771170 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Decreased appetite, Eye swelling, Fatigue, Injection site swelling, Lethargy, Mouth swelling, Pain, Swelling face, Swollen tongue, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Site: Swelling at Injection Site-Mild, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Mild, Systemic: Abdominal Pain-Mild, Systemic: Body Aches Generalized-Mild, Systemic: Exhaustion / Lethargy-Mild, Systemic: Fainting / Unresponsive-Medium, Additional Details: patient also claimed to have a decrease in appetite post vaccination.


VAERS ID: 1771176 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / IM

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

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

Write-up: Systemic: Lymph Node Swelling-Mild


VAERS ID: 1771179 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Flushing, Hyperventilation
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

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

Write-up: Systemic: Flushed/Sweating-Mild, Systemic: Hyperventilation-Medium.


VAERS ID: 1771185 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Diarrhoea, Vertigo, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow), Noninfectious diarrhoea (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: Vomiting, diahreah and spinning effect


VAERS ID: 1771429 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Blood lactic acid, C-reactive protein abnormal, Chest X-ray, Chills, Dehydration, Differential white blood cell count, Electrocardiogram, Full blood count, Inflammation, Influenza A virus test, Influenza B virus test, Metabolic function test, Red blood cell sedimentation rate, Respiratory syncytial virus test, SARS-CoV-2 test, Troponin I, Urine analysis
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Guillain-Barre syndrome (broad), Dehydration (narrow), 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: Lab Tests Completed C-REACTIVE PROTEIN (INFLAMMATION) COMPREHENSIVE METABOLIC PANEL ESR LAB ONLY-COMPLETE BLOOD COUNT WITH DIFFERENTIAL LAB ONLY-URINE MICROSCOPIC REFLEX LACTIC ACID SARS-COV-2, INFLUENZA A+B, AND/OR RSV NUCLEIC ACID TESTING PANEL TROPONIN I URINE DIP, REFLEX TO MICROSCOPIC, REFLEX TO CULTURE Icon Imaging Orders Placed Today Imaging Tests EKG XRAY CHEST PORTABLE -
CDC Split Type:

Write-up: Weakness Dehydration Chills (without fever)


VAERS ID: 1771436 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary pain, Extra dose administered, Hypoaesthesia, Injection site pain, Lymphadenopathy, Oedema peripheral, Pain in extremity, Peripheral swelling, Sleep disorder, Swelling, Vaccination complication
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Medication errors (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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra once a day, multi-vitamin once a day, probiotic once a day
Current Illness: None
Preexisting Conditions: Raynaud''s
Allergies: Penicillin, Keflex, Sulfa
Diagnostic Lab Data: Physical exam at the walk-in clinic, no tests done at this time
CDC Split Type:

Write-up: Started having arm pain at site of injection and noticed my arm pit was starting to feel sore the evening of Oct 5th -the first day of receiving the booster vaccine. I started to take 600mg of ibuprofen that first evening and continued to take it at regular intervals and am currently still taking it. I woke up about 3:30am and my arm and armpit we extremely painful to the point I couldn''t get back to sleep. I took my temperature at that time and it was 99.8. The morning of Oct 6th I noticed my armpit was a little swollen and really sore and my arm continued to be really sore at the injection site the entire day and maintained a 99.4-99.8 temperature by ear. The night of the 6th, I woke up and my right arm was completely asleep from the pressure in my armpit but resolved once I moved around. When I woke up the next morning on Oct 7th, the pain at the injection site hand subsided a bit, but my armpit and inside of my arm was even more swollen and really painful. I called the Covid hotline and Medical Center (where I work) and they recommended I get it checked out at a walk-in clinic. I went to the Pharmacy Walk-in at lunch time on Oct 7th and the nurse practitioner noted "Swelling and tenderness to R axillary region "Diagnosis was Axillary lymphadenopathy and Vaccine reaction". She recommended warm compress and continued ibuprofen and if it got worse to call back. Then on the morning of the 8th, I woke up and not only is my armpit swollen and really painful, but not the area behind my collarbone to my neck are now also very swollen and I noticed some swelling into my chest from my armpit as well but neither of the newer swelling are painful.


VAERS ID: 1771495 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-27
Onset:2021-10-06
   Days after vaccination:221
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9809 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, COVID-19, Diarrhoea, Malaise, Mental status changes, Myalgia, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Received Pfizer vaccines on 2/6/21, 2/27/21, 9/28/21. Tested positive for COVID 19 by PCR on 10/6/21 admitted to Hospital on 10/7/21 with fever, malaise, myalgia, abd pain, diarrhea, altered mental status.


VAERS ID: 1771505 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / JET

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Feeling jittery, Hyperhidrosis, Nervousness, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol 500mg Vitamin D3 2000mg Lutein 20
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: none at this time
CDC Split Type:

Write-up: Fever, Weakness, Nervous,Jitters,Sweats,Sleepy


VAERS ID: 1771511 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Feeling hot, Malaise
SMQs:, 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: No prescription medications listed on his profile except for the Moderna vaccine.
Current Illness: None stated on his vaccine form.
Preexisting Conditions: None stated
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was anxious, felt very warm, and said he did not feel well and could not see approximately 5-10 seconds after the injection. Patient did not improve at which time I administered epinephrine 0.3mg IM approximately 5 minutes after the start of the reaction. During this time I placed ice packs on his chest and rotated the ice pack placement to his upper back. Technicians had a small fan on him, cooling measures helped him much. Patient responded well after receiving the epinephrine, was able to see and his body temperature returned to normal. We had called EMS and they arrived to take vitals. By this time patient had markedly improved. Patients father was called and arrived approximately 10 minutes after the start of the reaction. EMS recommended that he be driven to the local hospital for observation but he refused. I spoke with the patients father and recommend the same but I do not know whether he went to the hospital ER or not. I jotted down some notes for the father to show the ER stating that I had administered epinephrine. The father and his son the patient walked out of the pharmacy in no apparent distress. Sincerely, RPh


VAERS ID: 1771522 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

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

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

Write-up: Painful site of shot


VAERS ID: 1771536 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-01
Onset:2021-10-06
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Exposure during pregnancy, Foetal heart rate abnormal, Ultrasound antenatal screen abnormal
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Foetal disorders (narrow)

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

Write-up: At 8 weeks gestation baby had a heartbeat and was healthy. Got the vaccine two days later. Next sonogram visit at 9.5 weeks, no heartbeat detected.


VAERS ID: 1771545 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 LA / IM

Administered by: Private       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: ProAir- as needed Dulera
Current Illness: NA
Preexisting Conditions: Asthma DJD
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Left arm pain Unsure about anything else- have left voicemail for pt to call clinic back


VAERS ID: 1771568 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 182Z809 / 1 LA / IM

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

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

Write-up: Pt. states that after receiving the 1st dose of J&J 10/06/2021, started experiencing symptoms 2 hrs later of blurred vision and headaches. No noted Primary visit, still continuing to experience symptoms.


VAERS ID: 1771569 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: School       Purchased by: ?
Symptoms: Dyspnoea, Eye swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Loratadine
Current Illness: NONE
Preexisting Conditions: Allergic to humidity
Allergies: NONE
Diagnostic Lab Data: Hydrocortisone was applied.
CDC Split Type:

Write-up: Presented with swelling eyes and needed air.


VAERS ID: 1771614 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Extra dose administered, Fatigue, Gait disturbance, Headache, Insomnia, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (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: Synthroid, cytomel, acyclovir, vitamin D, Trazadone, multivitamin, Nexium
Current Illness: NA
Preexisting Conditions: Thyroid
Allergies: Phenergan
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Joint and muscle pain, headache, fatigue that lasted for approx. 24 hours then went away EXCEPT left hip pain that was not there until after the covid booster and has gotten worse over time. My left hip pain has gotten so bad in the last 24 hours that I?m having a hard time walking, sleeping, etc. Have been taking Aleve but the pain isn?t getting better.


VAERS ID: 1771657 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-03
Onset:2021-10-06
   Days after vaccination:125
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Blood immunoglobulin G, Exposure to SARS-CoV-2, Mental status changes, SARS-CoV-2 antibody test, 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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: OXcarbazepine 150 mg Tablet Directions: 1 tablet oral twice a day every morning and at bedtime (Active) sertraline (Zoloft) 50 mg Tablet Directions: 2 tablet oral daily (Active) traZODone 50 mg Tablet Directions: 1 tablet oral daily a
Current Illness:
Preexisting Conditions: hepatitis C; pyschiatric history Significant Surg Hx None. Smoking Status Unknown if ever smoked
Allergies: NKDA
Diagnostic Lab Data: 10/6/2021 - SARS-CoV-2 Antigen (+) 10/7/2021 - SARS-CoV-2 IgM 0.97; IgG 0.03, and IgG2 QT_SPIKE Antibody 17,343.60
CDC Split Type:

Write-up: 52 year old female with hx of bipolar disorder and alcohol dependence who was brought to the ER for evaluation altered mental status and possible overdose. The patient tested COVID positive 3 days ago without any symtoms after being exposed to a covid positve family member. Patient states she received 2 dose Moderna vaccine few months ago ( dose not remember the month and date).


VAERS ID: 1771714 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-28
Onset:2021-10-06
   Days after vaccination:251
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 2 RA / IM

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

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

Write-up: Tested PCR positive for COVID 10/6/21 after being fully vaccinated.


VAERS ID: 1771773 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Pharmacy       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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol
Current Illness: none
Preexisting Conditions: asthma
Allergies: previous reaction to the flu vaccine
Diagnostic Lab Data: none
CDC Split Type:

Write-up: broke out in hives approximately 1 hour after receiving the vaccine


VAERS ID: 1771775 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Pyrexia, Skin warm
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic 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: Metoporol, zoloft
Current Illness: n/a
Preexisting Conditions: Rheumatoid Arthritis , heart condition - SVT
Allergies: Penicillin
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: large red circle that is feverish and hot to the touch


VAERS ID: 1771791 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Dyspnoea, Extra dose administered, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: about 2 minutes after receiving her 3rd pfizer dose, developed rapidly progressive symptoms of cough/sob/throat swelling. received 2 puffs of albuterol and one epipen. moderate improvement of symptoms. transported to Emergency Department


VAERS ID: 1771821 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site erythema, Injection site induration, Injection site pruritus, Injection site warmth, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (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: Fatigue headache and dizziness after 2nd Pfizer COVID vaccine Jan 26, 2031
Other Medications: Metoprolol succinate, VitD, daily vitamins, calcium/magnesium supplements, glucosamine , Zyrtec
Current Illness: NA
Preexisting Conditions: NA
Allergies: Codiene
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Raised, hard, red, warm and itchy area at injection site. Started size of quarter and has increased to twice that size. No change since Thursday morning. Fatigue and sleepy all day Thursday. Overnight had feverish chills and headache. Tylenol helped relieve those symptoms.


VAERS ID: 1771873 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Heart rate increased, Night sweats
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

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

Write-up: Increased heart rate, night sweats


VAERS ID: 1771882 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / IM

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

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

Write-up: Patient reports a "goose egg" red bump at the injection site that hurts and itches.


VAERS ID: 1771914 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-04
Onset:2021-10-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / UNK RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Fatigue, Hypersomnia, Pain, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MetFORMIN, Pioglitzone HCL, Rampril, Atorvastatin, D3 2000, MULTIVITAMIN, Fish Oil
Current Illness: None
Preexisting Conditions: Diabetes 2, Hypertension
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: At about 6PM, Wednesday, October 6, he began with shaking chills that lasted for at least 30 minutes. He was tired and sent to bed at 8PM, body aches continued to next morning with tiredness and slept all day. After about 24 hours, ate evening meal around 5:30 and felt good. Felt fine for rest of evening and feels fine today, October 8th.


VAERS ID: 1771916 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthritis reactive, Chills, Fatigue, Headache, Insomnia, Pain, Pyrexia, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conjunctival disorders (narrow), Ocular infections (broad), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Initial Maderna covid 19 vaccine on 9/7/21 at age 24 years old. fever, chills, vomiting, muscle pain, reactive arthritis, insomn
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever, chills, fatigue, headache, reactive arthritis, body aches, vomiting, insomnia, shakes.


VAERS ID: 1771963 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Autonomic nervous system imbalance, Chills, Dizziness, Electrocardiogram normal, Fatigue, Haematology test normal, Headache, Hypoaesthesia, Laboratory test normal, Pain, Pain in extremity, Paraesthesia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flu Shot Age somewhere between 32-35; syncope; short of breath, several rash & arm swelling
Other Medications: Levoxyl; Pepcid AC; Metoprolol Tartrate; Vitamin B Complex, Vitamin C, Zofran
Current Illness: None
Preexisting Conditions: Autonomic dysfunction (postural orthostatic tachycardia syndrome/orthostatic intolerance) Probable Mitochondrial dysfunction Complex regional pain syndrome type 2 GERD Classic Migraine Chronic Fatigue Hashimoto''s thyroiditis
Allergies: Acyclovir, Aldomet, Contrast/IVP dye; Diphenhydramine; Flu Shot (not allergic to eggs); Latex; Lidocaine if sprayed in mouth or nose topical has given no reaction; Rizatriptan; Metoclopramide; Midodrine; Morphine; Esomeprazole; Omeprazole; Pantoprazole; Shellfish; banana; avacado; kiwi; strawberry; eggplant; apple, peach, cantaloupe; pecan; walnut; pine nuts; cashew
Diagnostic Lab Data: Blood chemistry & hematology labs were all normal, ekg good. There were no other tests to address the numbness and tingling in my feet.
CDC Split Type:

Write-up: Received vaccine 10a.m. est on 10/6/21; approx 10:10 developed headached; approx 10:20 heart rate & bp spike but came back down fairly quickly; by 10:30 had dizziness, lightheaded about 10:45 started getting chills. Was monitored at facility until 10:45 and then went home. Between 12:00-12:30pm developed sudden numbness, tingling & pain in both feet. Around 8:00p.m. arm started to hurt; around 10p.m. was hit with profound fatigue. On 10/7/21 approx 6:50a.m. had syncopal episode. Went to Emergency room 10/7/21 about 7:30a.m because both feet and lower legs still numb, tingling and pain. Dr. said he thinks it''s my dysautonomia but I respectfully disagree. I have dealt with dysautonomia for many years and have never had sudden numbness and tingling and pain in both feet at the same time.


VAERS ID: 1771968 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-01
Onset:2021-10-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Periorbital swelling, Pruritus, Rash, Sinus congestion
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt. states that after receiving the 1st dose of J&J 10/01/2021, started experiencing symptoms 10/06/2021 of itchy face, rash across on the side of the right neck, sinus congestion, and puffy eyes. Self-treating with Benadryl, still continuing to experience symptoms. No noted Primary visit.


VAERS ID: 1772006 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 3 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TDAP vaccine and Steriod Injection were administered on the same day as the covid vaccine
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sunburn rash on chest, upper back, face, neck and arms. Going to be evaluated by PCP today.


VAERS ID: 1772021 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: hydrozyzine hcl 50 mg, clonazepam 2mg, lamotrigine 150 mg, duloxetine 60mg, methylphenidate 20mg, praluent 150mg
Current Illness:
Preexisting Conditions: ptsd, anxiety, depression, a.d.d., seizures, high cholesterol
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lady came in and got her Covid vaccine at 11 AM. After waiting 10 minutes, she proceeded to go shopping in the store. About 15 minutes later, she came to the pharmacy and stated she didn''t feel well. She sat down.... then her seizure alert dog allerted her of an upcoming seizure. A few minutes later, patient had a mild seizure.


VAERS ID: 1772037 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Tinnitus, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Cuvitru, Azythromycin, Synthroid, digestive enzymes, probiotics, multi-vitamin
Current Illness:
Preexisting Conditions: Systemic Mastocytosis - Confirmed by Clinc Bone Marrow Biopsy, Sinusitis, Occasional short term tinnitus, Sjogrens Syndrome, Common Variable Immune Deficiency, Non-Alcoholic Fatty Liver Disease
Allergies: Many antibiotics and H1 blockers
Diagnostic Lab Data: Was seen at ER on 10-7-21 and treated for nausea /vomiting.
CDC Split Type:

Write-up: Approximatly 1 hour and 15 min tinnitus began and hasn''t stoppen . I have had occasssional tinnitus in the past that would cease. The tinnitus has not stopped yet. I also had vomiting within 17 hours of the vaccine.


VAERS ID: 1772042 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 2 LA / IM

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

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

Write-up: was taken to medical facility - unknown outcome


VAERS ID: 1772051 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Formication, Headache, Injection site pain, Muscle twitching, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt. states that after receiving the 1st dose of Moderna 10/05/2021, started experiencing symptoms 10/06/2021 of pain at injection site, headaches, fever (100.4), feeling of crawling in the face (left), and twitching in the face and left arm. Still continuing to experience symptoms. No noted Primary visit.


VAERS ID: 1772068 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 1 LA / IM

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

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

Write-up: PATIENT WAS ADMINISTERED COVID-19 VACCINE MODERNA WITH THE LOT # MENTION ABOVE, AFTER IT WAS NOTICED THE VACCINE VIAL THAT WAS ADMINSITERED WAS EXPIRED ALREADY ON 10/04/2021. PATIENT DID NOT SHOW OR HAD ANY SYMPTOMS OR SIDE EFFECTS TO THE VACCINE. PATIENT WAS MONITORED FOR 15 MINUTES IN THE EXAM ROOM THEN PATIENT WAS DISCHARGE HOME WITH NO COMPLAINTS.


VAERS ID: 1772100 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Cold sweat, Hyperhidrosis, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

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

Write-up: Post injection, pt was observed to have "slight convulsing", clammy, sweaty hands. HR and SpO2 WNL., BP normal. Denied dizzyness, chest pain, nausea. at 10:10 pt noted to show improvement in skin conditions. Pt ate granola bar, drank juice and water, tolerated well. She ambulated without difficulty, steady gait. At 10:40 pt left clinic, denied SOB, pain, dizziness. She was accompanied by her mother.


VAERS ID: 1772101 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041B21A / 1 LA / IM

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

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

Write-up: PATIENT WAS ADMINISTERED COVID-19 VACCINE MODERNA WITH THE LOT # MENTION ABOVE, AFTER MA NOTICED THE VACCINE VIAL THAT WAS ADMINSITERED WAS EXPIRED ALREADY ON 10/04/2021. PATIENT DID NOT SHOWED OR HAD ANY SYMPTOMS OR SIDE EFFECTS TO THE VACCINE. PATIENT WAS MONITORED FOR 15 MINUTES IN THE EXAM ROOM THEN PATIENT WAS DISCHARGE HOME WITH NO COMPLAINTS.


VAERS ID: 1772103 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 2 RA / IM

Administered by: Private       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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives over whole body


VAERS ID: 1772122 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-09-27
Onset:2021-10-06
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 AR / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Benign prostatic hyperplasia, Urinary retention
SMQs:, Anticholinergic 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: Losartan, allopurinol
Current Illness: None
Preexisting Conditions: High blood pressure, gout
Allergies: None known
Diagnostic Lab Data: 10/06/2021- ER visit for straight cath/foley placement 10/08/221- urology visit - dx with BPH, started on medication
CDC Split Type:

Write-up: Acute urinary retention


VAERS ID: 1772194 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dizziness, Flushing, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Pt became flushed, dizzy. Complained of some mild tongue swelling and a few minutes later started having mild chest pain.


VAERS ID: 1772213 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-28
Onset:2021-10-06
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, 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: 2nd dose pfizer, muscle aches, fatigues and headaches.
Other Medications: MUCINEX; prednisone; albuterol
Current Illness: No
Preexisting Conditions: Lung Disease; Bronchitis; Asthma; COPD
Allergies: Augmentin; COMPAZINE; BIAXIN
Diagnostic Lab Data: Covid - Positive; Bloodwork - normal
CDC Split Type: vsafe

Write-up: Tested positive for Covid Wednesday, pulmaory and monoclonal infusions. Bad head cold Tuesday night. I could smell and taste, major running nose. ER on 7Oct2021.


VAERS ID: 1772222 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-01-15
Onset:2021-10-06
   Days after vaccination:264
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / UNK - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Loss of personal independence in daily activities, Psychotic symptom
SMQs:, Dementia (broad), COVID-19 (narrow)

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

Write-up: asymptomatic covid and Psychotic Features, Unable to Care for Self


VAERS ID: 1772234 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Lip pain, Lip swelling
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen and painful lips


VAERS ID: 1772257 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-10-04
Onset:2021-10-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Echocardiogram, Myocarditis, Troponin I increased
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: Galactosemia (Duarte variant)
Allergies: NA
Diagnostic Lab Data: Admitted to Hospital on 10/7 after presenting to the ED 10/6. TPN -I HS 14,382 nl TTE
CDC Split Type:

Write-up: Acute myocarditis ~48 hours after vaccination with shortness of breath and chest pain, TPN elevation


VAERS ID: 1772259 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 3 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: No adverse event, Vaccination error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Seroquel, temazepam, Kepra, morphine, Lexapro, lamotrigine, Ty
Current Illness: COPD, dimentia, seizre disorder, no acute ilnesses
Preexisting Conditions: COPD, dimentia, seizure disorder, depression
Allergies: Xanax
Diagnostic Lab Data: none
CDC Split Type:

Write-up: This vaccination was inadvertently given to resident instead of another resident at the adult foster home. This writer failed to identify the patient correctly. Resident had no local reaction at the injection site. Nor did he have an allergic reaction.


VAERS ID: 1772265 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 3 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Diarrhoea, Fatigue, Neck pain, Pain in extremity
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lipitor 40mg, Lasix 20mg, Losartan 25mg, Metoprolol ER 150mg BID , Warfarin 3mg, Ditropan 5mg daily, Trazodone, Spironolactone 25mg, Biotin, Magnesium, multi vitamin
Current Illness: no
Preexisting Conditions: Congestive Heart Failure , has a pacemaker
Allergies: Penicillin''s, Sulfa and Tetracycline (severe )
Diagnostic Lab Data: none
CDC Split Type:

Write-up: severe pain in left arm down to fingers and sore neck , extreme fatigue slept for 20 hours, Diarrhea that lasted 12hours


VAERS ID: 1772287 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cellulitis, Erythema, Peripheral swelling, 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: EGGS, LACTOSE, MILK, FLUOROQUINOLONES
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: PATIENT IS EXPERIENCING COVID ARM, CELLULITIS. ARM IS HOT, SWOLLEN, AND RED. THE BOARDERS ARE GROWING. SHE WAS ORIGINALLY PRESCRIBED KEFLEX AND THEN SWITCHED TO BACTRIM DS.


VAERS ID: 1772300 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: 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: Ropinrole, Vitamin D, Ginkgo biloba
Current Illness: no
Preexisting Conditions: Cerebral Palsy
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: Extreme fever started around 4pm day after 2nd dose received until I peaked at 105 degrees at 9pm that evening.


VAERS ID: 1772325 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Breast pain, Chills, Headache, Hyperhidrosis, Neck pain, Pain in extremity
SMQs:, Neuroleptic malignant syndrome (broad), Lipodystrophy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: sore left arm, neck pain, headache, pain on surface of breasts, chills, sweats


VAERS ID: 1772332 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-04
Onset:2021-10-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Erythema, Injection site erythema, Injection site swelling, Menstrual disorder, Pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: 1) After first dose, menstrual period started although was not scheduled to start at that time, and had abdominal cramps similar to those of period pain. 2) Starting 3 days after injection, redness at injection site and swelling. This has continued to get worse, has become more red and swollen, and has started to itch/hurt.


VAERS ID: 1772361 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-03
Onset:2021-10-06
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram thorax abnormal, Pain in extremity, Pulmonary embolism, Thrombosis, Ultrasound Doppler abnormal
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Clonazepam, Depakote ER, Lisinopril, Seroquel, Eliquis, Multivitamin, Vitamin C.
Current Illness: None.
Preexisting Conditions: Hypertension, Parkinson''s, PTSD, depression, anxiety.
Allergies: Barley, Hops, Tramadol, Yeast, Wheat.
Diagnostic Lab Data: Patient admitted to hospital with right lower extremity non-occlusive clot (ultrasound 10/6) and moderate volume of pulmonary embolism most pronounced in right lower lobe (chest CT 10/6). Remains in hospital at time of filing this form. 5 months post vaccine - possible connection?
CDC Split Type:

Write-up: Came into hospital with right lower leg pain 10/6/2021. Had vaccine 5/3/2021 at pharmacy.


VAERS ID: 1772388 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Axillary pain, Breast pain, Lymphadenopathy, Musculoskeletal chest pain, Pain
SMQs:, Lipodystrophy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Swollen lymph nodes and pain from left armpit to left breast and ribs


VAERS ID: 1772399 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dyspnoea, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), 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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: anaphylaxis to flu vaccine
Other Medications: 81 mg Aspirin
Current Illness: Positive COVID test 2 weeks before
Preexisting Conditions: Hx/o CVA, Menieres Disease, stroke
Allergies: Contrast media, flu vaccine, latex, sulfa antibiotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed hives on both arms and shortness of breath. NP administered 25 mg benadryl IM, Offered 911 but patient refused. Transferred from the vaccine to Medical department and seen by physician for evaluation. Prednisone 40 mg administered along with albuterol treatment. Stabilized and discharged


VAERS ID: 1772565 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ766AA / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphagia, Dyspnoea, Pharyngeal swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, metoprolol, atorvastatin, clopidgrel, losartan, hydrochlorothiazide, isosorbide mononitrate
Current Illness:
Preexisting Conditions: Heart disease, hypertension, hyperlipidemia, hypothyroidism. Patient also said he uses a CPAP machine.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came to the pharmacy today. He said he had an adverse reaction to his COVID vaccine or flu shot during the middle of the night, following his immunization. He was vaccinated around 11:23 AM. He experienced swelling of his throat around 2:00 AM that night. He had difficulty swallowing and breathing for about 10 minutes. He said he was on a CPAP machine and was able to increase his air flow for the duration of the swelling. He got through it on his own and decided not to go to the emergency room.


VAERS ID: 1772582 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-04
Onset:2021-10-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / IM

Administered by: Private       Purchased by: ?
Symptoms: ADAMTS13 activity assay, Activated partial thromboplastin time prolonged, Alanine aminotransferase normal, Anti-platelet factor 4 antibody negative, Aspartate aminotransferase normal, Blood alkaline phosphatase normal, Blood creatinine increased, Blood fibrinogen increased, Blood lactate dehydrogenase increased, Computerised tomogram head normal, Fibrin D dimer normal, Glomerular filtration rate decreased, Haematuria, Haemoglobin normal, International normalised ratio normal, Mouth haemorrhage, Platelet count decreased, Thrombocytopenia, Thrombocytopenic purpura, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: COPD, HTN, HLD, history of lung cancer status post right lower lobe lobectomy, without any evidence of recent lung cancer.
Allergies: Biaxin, doxycycline, Floxin, PCR, penicillin
Diagnostic Lab Data: PLT < 2, WBC 5.4, Hgb 12.3, fibrinogen 432, PTT 22.9, INR 0.93, LDH 288, creatinine 1.66, AST 34, ALT 18, alk phos 96, GFR 83, CT head without contrast: Intact brain without any new findings, platelet factor 4 antibody/poorly benign sulfate test negative, D-dimer < 0.19, adamts 13 activity: 66%,
CDC Split Type:

Write-up: Severe life-threatening thrombocytopenia, with platelet count undetectable, with mucocutaneous bleeding from oral mucosa as well as bilateral lower extremity purpura along with hematuria


VAERS ID: 1772784 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-10-01
Onset:2021-10-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / -

Administered by: Public       Purchased by: ?
Symptoms: Back pain, Headache, Injection site pain
SMQs:, Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (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: Parkinson?s
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mild headache, back pain, and injection site.


VAERS ID: 1772793 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Axillary pain, Injection site pain, Injection site reaction, Injection site swelling, Injection site warmth, Lymphadenopathy, Pain, Pain of skin, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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: Humalog Levothyroxine Amitriptyline Effexor Noreth/e FE Famotidine
Current Illness: N/A
Preexisting Conditions: Type 1 diabetes Hypothyroidism
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Body aches Headache Low grade fever Pain, heat, swelling, throbbing at injection site Swollen and painful lymph node in left arm pit Skin and hair follicles painful to the touch


VAERS ID: 1772974 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Headache
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril, rosuvastatin, januvia, furosemide, diltiazem, repaglinide sodium bicar, iron, wal-flex, vitamin d3
Current Illness: none
Preexisting Conditions: diabetic, arthritis, kidney disease
Allergies: penecillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache for 2 days, severe diarrhea for 3 days


VAERS ID: 1772984 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chills, Headache, Myalgia, Pyrexia, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Pneumovax
Other Medications: Gabapentin, tamoxifen
Current Illness:
Preexisting Conditions:
Allergies: Morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever up to 102.5, chills, muscle and joint pain all over body, headache, tremor


VAERS ID: 1773448 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

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

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

Write-up: Fever, night sweats, chills, fatigue, pain and soreness for two days post vaccine.


VAERS ID: 1773403 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Nevada  
Vaccinated:0000-00-00
Onset:2021-10-06
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), 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:
Current Illness:
Preexisting Conditions: Comments: The patient had no change in lifestyle.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211012833

Write-up: TINGLING SENSATION BEHIND THE LEFT KNEE (LIKE PINS AND NEEDLES WHEN FOOT FALLS ASLEEP, BUT NOT PAINFUL); This spontaneous report received from a consumer concerned a 28 year old male. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included: The patient had no change in lifestyle. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1822809 and expiry: 07-MAR-2022) dose was not reported, administered on 06-OCT-2021 13:30 for prophylactic vaccination. No concomitant medications were reported. On 06-OCT-2021, the patient experienced tingling sensation behind the left knee (like pins and needles when foot falls asleep, but not painful). The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from tingling sensation behind the left knee (like pins and needles when foot falls asleep, but not painful). This report was non-serious.


VAERS ID: 1773407 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:2021-10-06
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211014279

Write-up: ADMINISTRATION OF AN EXPIRED VACCINE; This spontaneous report received from a health care professional concerned a 24 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 202A21A, expiry: 21-SEP-2021) dose was not reported, administered on 06-OCT-2021 for prophylactic vaccination. No concomitant medications were reported. On 06-OCT-2021, the patient experienced administration of an expired vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administration of an expired vaccine was not reported. This report was non-serious. This case, from the same reporter is linked to 20211014509, 20211015239, 20211014463 and 20211015303.


VAERS ID: 1773412 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:2021-10-06
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211014463

Write-up: ADMINISTRATION OF AN EXPIRED VACCINE; This spontaneous report received from a health care professional concerned a 23 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 202A21A, and expiry: 21-SEP-2021) dose was not reported, administered on 06-OCT-2021 for prophylactic vaccination. No concomitant medications were reported. On 06-OCT-2021, the patient experienced administration of an expired vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administration of an expired vaccine was not reported. This report was non-serious. This case, from the same reporter is linked to 20211014509, 20211015239, 20211015303 and 20211014279.


VAERS ID: 1773413 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:2021-10-06
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211014509

Write-up: ADMINISTRATION OF AN EXPIRED VACCINE; This spontaneous report received from a health care professional concerned a 25 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 202A21A expiry: 21-SEP-2021) dose was not reported, administered on 06-OCT-2021 for prophylactic vaccination. No concomitant medications were reported. On 06-OCT-2021, the patient experienced administration of an expired vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administration of an expired vaccine was not reported. This report was non-serious. This case, from the same reporter is linked to 20211014463 and 20211014279.


VAERS ID: 1773425 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:2021-10-06
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211015239

Write-up: ADMINISTRATION OF AN EXPIRED VACCINE; This spontaneous report received from a health care professional concerned a 37 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 202A21A, and expiry: 21-SEP-2021) dose was not reported, administered on 06-OCT-2021 for prophylactic vaccination. No concomitant medications were reported. On 06-OCT-2021, the patient experienced administration of an expired vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administration of an expired vaccine was not reported. This report was non-serious. This case, from the same reporter is linked to 20211014279, 20211014509, 20211015303 and 20211014463.


VAERS ID: 1773427 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:2021-10-06
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211015303

Write-up: ADMINISTRATION OF AN EXPIRED VACCINE; This spontaneous report received from a health care professional concerned a 52 year old male. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 202A21A, expiry: 21-SEP-2021) dose was not reported, administered on 06-OCT-2021 for prophylactic vaccination. No concomitant medications were reported. On 06-OCT-2021, the patient experienced administration of an expired vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of administration of an expired vaccine was not reported. This report was non-serious. This case, from the same reporter is linked to 20211015239, 20211014463, 20211014279 and 20211014509.


VAERS ID: 1773468 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-09-25
Onset:2021-10-06
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Erythema, Fatigue, Injection site rash, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine Liothyronine Lisinopril Estradiol
Current Illness: None
Preexisting Conditions: High blood pressure Hypothyroidism
Allergies: Peanut allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: ?Covid arm.? Large, red, swollen, rash at injection site, 5.5 inches in diameter. Joint pain, weakness, tiredness.


VAERS ID: 1773469 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Arthralgia, Chills, Pain in extremity, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Shingex 2nd dose.
Other Medications: Multi-vitamin
Current Illness: None
Preexisting Conditions: Mild kidney insufficiency
Allergies: Penicillin, Phenergan, Latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Stomach cramps, achy joints, mild fever and chills, very sore arm that received the injection. Symptoms lasted approx. 1 day. Note: This was the third dose (booster). Dose one produced no symptoms. Dose two produced moderate joint pain.


VAERS ID: 1774977 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-01
Onset:2021-10-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Vaccination complication
SMQs:

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

Write-up: ?Covid arm?


VAERS ID: 1775059 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Decreased appetite, Extra dose administered, Headache, Injection site pain, Lymphadenopathy, Malaise, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 2ND COVED 19 SHOT; PFIZER LOT# EN6200 ADMIN DAGE 2-20-2021. AGE OF PATIENT 64
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: SYMPTOMS BEGAIN APPROXIMATELY 10 HOURS AFTER INJECTION. ALL WERE PRETTY SEVERE FOR 24 HOURS. ABATED AFTER 36 HOURS GONE AFTER 48 HOURS INJECTION SITE PAIN TIREDNESS HEADACHE MUSCLE PAIN CHILLS FEVER NAUSEA FEELING UNWELL SWOLLEN LYMPH NODES IN UNDERARM OF INJECTION ARM DECREASED APPETITE


VAERS ID: 1775098 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Flushing, Pain in extremity, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Patient returned to pharmacy about 45 minutes later reporting tightness in chest and throat. Asked if he should be concerned -- he said his breathing was fine but felt a little flush. Pulse oximeter 97 pulse 70 bp 138/83 and rpm 16. Vitals and breathing did not indicate anaphylaxis and could have been anxiety over receiving vaccination. Patient felt ok to continue home and he did state he had an Epi-pen at home if needed. Called patient next day --- he reported the tightness lasted a few hours but no worsening of symptoms and he felt fine at that time with just a sore arm .


VAERS ID: 1775128 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 LA / IM

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

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

Write-up: Error: Booster Given Too Early-


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