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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 280 out of 8,010

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VAERS ID: 1679032 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Fatigue, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: fever, joint pain, exhaustion, pain at injection site


VAERS ID: 1679034 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hot flush, Injection site pain, Migraine, Nausea, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? 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: Migraine, Dizzy, Nausea, Rash across chest, extremely sore arm at injection site, flush fever like


VAERS ID: 1679064 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-01
Onset:2021-09-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Breast discomfort, Erythema, Fungal infection, Injection site erythema, Injection site pain, Injection site warmth, Musculoskeletal discomfort, Pruritus, Skin burning sensation
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: 2009 cellulitis reaction to pneumonia vaccine
Other Medications: Losartin, levothyroxine, vitamins C and D and folic acid
Current Illness: Shingles, was on Valacyclovir that prevented spread
Preexisting Conditions: RA, interstatial fibrosis, hplori that cannot be eradicated by antibiotics,
Allergies: Penicillins , sulfa drugs, coprocessor, Percocet, morphine, zocor, keflex
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Dermatological 3 separate types: Injection site? very red , sore and hot, kept spreading. . possible cellulitis. Prescribed doxycycline. at Urgent care. Red , itchy burning sores on both breasts, diagnosed as yeast infection . Prescribed Mystatin. Red , itchy burning, spots in a row on right hip area, similar to how my previous bout of shingles started, Have been also prescribe Zyrtec for feeling itchy on head and upper body.


VAERS ID: 1679090 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia
SMQs:, Arthritis (broad)

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

Write-up: complained of pain in multiple joints especially left ankle knee and left shoulder that started about 4 hours after receiving 1st dose of pzizer vaccine


VAERS ID: 1679102 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-09-01
Onset:2021-09-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 RA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daflonex xl, Lyrica, Metformin, Vitamin C, Vitamin D, Vitamin E, Vitamin B, Atorvastatin, Biotin
Current Illness: Bilateral venous insufficiency, Coagulation, Fibromyalgia, Diabetes, Cholesterol
Preexisting Conditions: Bilateral venous insufficiency, Coagulation, Diabetes, Cholesterol, Fibromyalgia
Allergies: Nubain Toradol
Diagnostic Lab Data:
CDC Split Type:

Write-up: Friday September 3, I noticed a rash in the axilla area under my right arm the rash was bigger than the other one I had under my arm in the left axilla, the one in the left axilla was smaller. There was no discomfort there was no itching or burning it just started small size and Monday September 7 the rash was bigger. Consulted with my doctor by phone and she recommended applying BENADRYL CREAM in the affected areas. She said it was a reaction to the vaccine that in some days the rash should disappear.


VAERS ID: 1679127 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Bell's palsy
SMQs:, Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: blood pressure med
Current Illness: hx htn, lyme disease, hx Bell''s Palsy
Preexisting Conditions: htn
Allergies: NKDA
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Bell''s Palsy


VAERS ID: 1679154 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2020-12-28
Onset:2021-09-03
   Days after vaccination:249
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 2 - / IM

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

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

Write-up: Patient was admitted to the ER with shortness of breath. She tested positive for COVID-19 on 9/02/21.


VAERS ID: 1679156 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-12
Onset:2021-09-03
   Days after vaccination:144
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Positive Covid-19 test 9/4/21
CDC Split Type:

Write-up: None stated.


VAERS ID: 1679169 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-01-28
Onset:2021-09-03
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PCR COVID test was positive at pharmacy in city, state on 9/05/2021
CDC Split Type:

Write-up: Patient tested positive for COVID after he completed the Pfizer vaccine series $g 14 days prior to this


VAERS ID: 1679177 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FL3182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anger, Anxiety, Burning sensation, Dizziness, Eye pain, Fatigue, Feeling abnormal, Formication, Hypoaesthesia, Immediate post-injection reaction, Injection site pain, Pain, Pain in extremity, Paraesthesia, Vision blurred
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine, December 2020
Other Medications: levothyroxine 50mcg daily; sertraline 100mg daily
Current Illness: No known illnesses.
Preexisting Conditions: Autoimmune disorder; chronic Lyme disease
Allergies: Erythromycin; macrolides - oral and topical; walnuts; latex
Diagnostic Lab Data: I have not seen a doctor about this as in my preliminary phase of trying to gain information for informed consent, my nursing school forced me to get the vaccine, lest I be expelled. I haven''t been met with honest conversation regarding my concerns prior to taking the shot and I suspect it will be no different after.
CDC Split Type:

Write-up: Numb at left arm IM injection site; immediate pain to below elbow - radiating to finger tips - tingling; left-side shoulder to neck strange feeling; creepy crawly sensations in brain/head; dizziness; neurological fog; extreme fatigue; blurred vision; pain in eyes all within hours after first dose. By next morning - approximately 15 hours after injection the tops of my feet/shins were on fire (as if a blowtorch was being used on them) -- $g as day progressed/within 24 hours, this fire radiated through my entire body - especially in my peripheral areas (feet/legs, hands/arms). The fire pain remains and has moments of being very intense. I received the vaccination 5 days ago at this point. I am livid with how it has made me feel and I am concerned for my well-being.


VAERS ID: 1679179 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: California  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / SYR

Administered by: Work       Purchased by: ?
Symptoms: Chills, Dizziness, Oropharyngeal pain, Pain, Pyrexia, Sneezing
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol ,
Current Illness:
Preexisting Conditions: Double by pass surgery
Allergies: Aspirin.flavix,Atorsvastatin,Lisinopril,metformin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever,chill , body ache,sore throught.sneezing,light headed


VAERS ID: 1679188 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / UNK LA / IM

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

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

Write-up: PATIENT RECEIVED MODERNA FOR FIRST DOSE 2/11/2021


VAERS ID: 1679192 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-08-31
Onset:2021-09-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fatigue, Heart rate increased, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: Covid on 8/2/2021
Preexisting Conditions: N/A
Allergies: Oranges, latex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rapid heart beat, fatigue, dizziness, some nausea


VAERS ID: 1679201 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / UNK LA / IM

Administered by: Public       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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: PATIENT RECEIVED FIRST DOSE OF MODERNA 1/27/21


VAERS ID: 1679215 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-07-06
Onset:2021-09-03
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048021A / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT ONLY 15


VAERS ID: 1679220 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Unknown  
Location: Texas  
Vaccinated:2021-07-06
Onset:2021-09-03
   Days after vaccination:59
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048021A / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: UNDER AGE PATIENT


VAERS ID: 1679226 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-09
Onset:2021-09-03
   Days after vaccination:56
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048C21A / 1 LA / IM

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

Write-up: PATIENT UNDER AGE


VAERS ID: 1679229 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-13
Onset:2021-09-03
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

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

Write-up: Patient was asymptomatic at the time of hospitalization. Testing only completed for pre-procedural screening.


VAERS ID: 1679230 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-23
Onset:2021-09-03
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007D21A / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT UNDER AGE.


VAERS ID: 1679234 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-02
Onset:2021-09-03
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 1 - / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT UNDER AGE


VAERS ID: 1679236 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 2 RA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, Chills, Culture urine, Laboratory test, Pollakiuria
SMQs:, Retroperitoneal fibrosis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/a
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: Uti came back negative and urine culture still waiting results
CDC Split Type:

Write-up: Pain in mid back area, chills, pee every 2-3 hours.


VAERS ID: 1679243 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049F21A / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Myalgia, Nausea, Pyrexia, Somnolence, Vaccination site erythema, Vaccination site pain, Vaccination site warmth
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atenolol, Amlodipine, Lisinopril, Trazodone, Vitamin D, Magnesium, Multivitamin
Current Illness: Sore throat
Preexisting Conditions: Heart disease, diabetes
Allergies: Penicillin
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Fever up to 99.4 degrees, nausea, muscle aches, sleepiness, large red area around the vaccine location which was warm to the touch, soreness at vaccine location. Symptoms most acute for 2 days following the vaccine, then started getting better on the 3rd day, almost completely gone by the 4th. The symptom that was most persistent was the large red area around the vaccine location - it continued to be warm to the touch until the end of the 3rd day.


VAERS ID: 1679252 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-03
Onset:2021-09-03
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 2 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT UNDER AGE


VAERS ID: 1679253 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       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: Estradiol, multi vitamin, claritan, tylenol
Current Illness:
Preexisting Conditions:
Allergies: Demoral
Diagnostic Lab Data:
CDC Split Type:

Write-up: None stated.


VAERS ID: 1679258 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Diarrhoea, Fatigue, Lymphadenitis, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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? 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: Nausea, vomiting, diarrhea and fever starting the night of the vaccine and lasting for 3 days. Fatigue, weakness and axillary lymphadenopathy starting over the first 24 hours and still persisting today, 4 days later.


VAERS ID: 1679263 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-03
Onset:2021-09-03
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 2 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT UNDER AGE


VAERS ID: 1679269 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-04
Onset:2021-09-03
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT UNDER AGE


VAERS ID: 1679275 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-04
Onset:2021-09-03
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT UNDER AGE


VAERS ID: 1679299 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-12
Onset:2021-09-03
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT UNDER AGE


VAERS ID: 1679306 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-12
Onset:2021-09-03
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT UNDER AGE


VAERS ID: 1679312 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-12
Onset:2021-09-03
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045C21A / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT UNDER AGE


VAERS ID: 1679315 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-09-03
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 05E21A / 1 RA / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT UNDER AGE


VAERS ID: 1679322 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-13
Onset:2021-09-03
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 05E21A / 1 RA / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT UNDER AGE


VAERS ID: 1679327 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-16
Onset:2021-09-03
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT UNDER AGE


VAERS ID: 1679331 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-21
Onset:2021-09-03
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 2 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT UNDER AGE


VAERS ID: 1679342 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-01
Onset:2021-09-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939902 / 2 AR / 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT UNDER AGE


VAERS ID: 1679389 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Pruritus, Rash, Rash erythematous, Rash papular
SMQs:, Anaphylactic reaction (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received their first dose of the Pfizer COVID-19 vaccine in their left deltoid intramuscularly. Patient was advised about the 15 minute recommendation to stay at pharmacy for observation after vaccination. Approximately 20 minutes after vaccination at 5:00, patient returns to pharmacy complaining of extreme itching on her back and legs. I saw redness and raised irritation on her back. I advised patient to sit. I spoke to her and mom and got their consent to give 1 dose of 25 mg Bendadryl (diphenhydramine) by mouth to patient. EMS were called. At 5:30 patient began complaining of "trouble breathing." No wheezing was observed but patient said she could not breath. Epinephrine 0.3 mg was administered to right thigh at 5:33 pm. Immediately pt said she was feeling better however a few minutes later she again said she, "has trouble breathing." A second dose of Epinephrine 0.3 mg was administered at 5:38 pm on the left thigh, 5 minutes after her first dose. EMS arrives at 5:43 pm. All medications administered and times given were provided to EMS as well as a synopsis of situation. Patient will be taken to hospital downtown. Patient alert at time of departure. Pulse ox from EMT showed 100.


VAERS ID: 1679532 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Nebraska  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, 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? 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: extreme fatigue, fever 102 for 6 days, aches for 6 days


VAERS ID: 1679742 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Blood test normal, Chest X-ray, Computerised tomogram thorax, Dizziness, Heart rate increased, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Beans, Benadryl
Diagnostic Lab Data: Chest X ray, blood tests, CT scan of chest
CDC Split Type:

Write-up: Five minutes after receiving injection , I felt lightheaded, faint, and a fast, pounding heart beat. I also felt an overwhelming feeling of anxiety. I reported my symptoms to the nurse, and she came and gave me a bottle of water and checked my pulse. She did not disclose to me my heart rate at the time. Within 15 minutes of receiving I decided to go home and rest. On Saturday I felt body aches and exhaustion . At times , I felt the fast, pounding heartbeat. I therefore rested. On Sunday, 09/03/2021, while shopping, I again , felt lightheaded, anxious, fast, pounding heart beat. I requested for ambulance service and they came and performed an assessment. My initial blood pressure was 160/110. But upon being in ambulance it was re assesesed and was 146/70, approximately. My blood sugar was 97. I therefore decided to attempt to go home and rest. Upon driving approximately 1 mile, I again felt lightheaded, anxious, and a fast, pounding heart beat. I therefore parked my car near by and contacted my parents to drive me home. I went to the Hospital for assessment and they discharged me stating my labs and test were ok. I do not have any history of cardiac issues.


VAERS ID: 1679749 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-09-01
Onset:2021-09-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Intermenstrual bleeding, Ovulation pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Natures Bounty Biotin - Hair, Skin & nails
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None to report at this time.
CDC Split Type:

Write-up: After the second Pfizer vaccine I experienced a very painful menstrual period in-between my cycle. My period had just ended on 8/25 and should not begin until 9/18. The period itself was not super heavy but extremely painful almost contraction like. I have reported this to my primary doctor and I will follow up with my Gyno. Nothing about this seems normal to me so I felt I needed to report this.


VAERS ID: 1679759 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008C21A / 3 LA / SYR

Administered by: Public       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: metoprolol, Hydrochlorothiazide, Plavix, aspirin, losartan
Current Illness:
Preexisting Conditions: Crohn''s disease, heart stent
Allergies: Penicillin class antibiotics, iodine, sulfa class antibiotics, sucralfate, quinolones, clindamycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 8 hours after receiving the booster shot, hives became present all over the body. She took 1 Zyrtec, but there was no relief. Because hives had not let up by the next morning, she took 2 Bendaryl. The Benadryl made the hives tolerable, but the hives are still present (though better) as of 9/7 (4 days post-injection).


VAERS ID: 1679764 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-03-12
Onset:2021-09-03
   Days after vaccination:175
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Atrial fibrillation, COVID-19, Cough, Nasal congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Supraventricular tachyarrhythmias (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acyclovir, calcium carbonate, vitamin D, denosumab (Prolia) SQ, diclofenac gel, magnesium, methocarbamol, MVI
Current Illness:
Preexisting Conditions: HLD, alcohol use disorder, genital herpes, osteoporosis
Allergies: Amoxicillin
Diagnostic Lab Data: COVID status positive on 9/3/21.
CDC Split Type:

Write-up: Patient received Pfizer COVID vaccine on 2/10/21 and 3/12/21. Patient presented to the ED on 9/3/21 with positive COVID symptoms (nasal congestion, mild cough and loss of taste/smell) for consideration of monoclonal antibody on. In the ED, she was afebrile with normal oxygenation. Patient was not hypoxic and not candidate for targeted treatment such as Remdesivir/Dexamethasone. Patient also did not meet criteria of reduced ability to form immunity in vaccinated individuals to receive REGEN-COV treatment. She was, however, found to be in new onset Afib and was admitted for treatment of Afib with RVR (diltiazem drip). Patient was discharged the next day on 9/4/21.


VAERS ID: 1679767 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-09-01
Onset:2021-09-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 706-351 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abnormal dreams, Ageusia, Chills, Dyspnoea, Hyperhidrosis, Pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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: Fish oil,Fenofibrate,Zoloft,famotidine,pantoprazole
Current Illness: None
Preexisting Conditions: Anxiety and mood disorder
Allergies: None
Diagnostic Lab Data: No
CDC Split Type:

Write-up: Fever, body aches, shortness of breath, chills and sweats Loss of tastes and weird dreams


VAERS ID: 1679947 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site erythema, Injection site induration, Pain, Pain in extremity, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (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: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Facial numbness?within minutes of shot lasted 12 hours Sore arm?started day after shot lasted 72 hours Red hard injection sight?still evident after 5 days Fever?started 23 hours after injection and went lasted 3? hours Body aches?started 23 hours after injection lasted 4 hours


VAERS ID: 1679951 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Aphasia, Blood test, Chest discomfort, Chills, Computerised tomogram, Dizziness, Dyspnoea, Dysstasia, Electrocardiogram, Facial paresis, Fatigue, Feeling abnormal, Heart rate increased, Hypertension, Joint stiffness, Muscular weakness, Musculoskeletal stiffness, Pain in extremity, Presyncope, Pyrexia, SARS-CoV-2 test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), 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 (narrow), Hypertension (narrow), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin C, B-12, vitamin D, Omeprazole, probiotic
Current Illness:
Preexisting Conditions: Crohn''s Disease
Allergies:
Diagnostic Lab Data: EKG, CT scan, 3 rounds of Blood work, Covid test 09/03/21 negative
CDC Split Type:

Write-up: while driving on highway I experienced extreme fatigue, shortness of breath, lightheaded, dizziness, face/head , legs, arms, feet, hands and abdomen numb and tingling/ strange sensation in head. near syncope. fever. high blood pressure, high pulse, left arm pain, chest and abdomen tightening. high heart rate. stiffening of muscles in arms, hands, face mouth and jaws / loss of control. hard/ unable to speak clearly. leg weakness inability to stand. was taken by ambulance to a hospital before being transported by my wife to a another Hospital 09/03/21 was given Tylenol and IV fluid 09/04 fatigue shortness and breath, 09/05 felt ok, 09/06 extreme fatigue, strange sensation in head,fever, chills, stomach pains, 09/07 fatigue , fever, stomach pain , strange sensation in head


VAERS ID: 1679952 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 RA / SYR

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

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

Write-up: Fever, chills, muscle pain, joints pain, headache , nausea


VAERS ID: 1679969 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac flutter
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Tachyarrhythmia terms, nonspecific (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: Amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fluttering heart that lasted all evening and occasionally the next day


VAERS ID: 1680141 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Vaginal haemorrhage
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: Bleeding from vagina. Blood was thick, black and heavy. Lasted four days. Abdominal pain.


VAERS ID: 1680144 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Cough, Dyspnoea, Fatigue, Migraine, Productive cough, Pyrexia, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (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: Birth control pill
Current Illness:
Preexisting Conditions: Rheumatoid arthritis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Moderns covid-19 vaccine EUA Migraine Shortness of breath Joint pain fever Runny nose Cough with phlegm Extreme fatigue


VAERS ID: 1680293 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Immediate post-injection reaction, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin Sulfa Bee stings Tomato plants
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediate itching Rash developed on day 3 on injection arm and down back Intense joint pain in fingers and wrist is ongoing


VAERS ID: 1681453 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2021-09-03
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Poor quality product administered, Product storage error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210907555

Write-up: THE VACCINE WAS STORED IN THE FRIDGE AFTER PUNCTURE FOR ABOUT 20 HOURS; THE VIAL WAS PUNCTURED THE PREVIOUS DAY, THE PUNCTURED VIAL WAS USED AT LEAST 20 HOURS AFTER IT WAS FIRST PUNCTURED; This spontaneous report received from a health care professional concerned a male of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine (suspension for injection, intramuscular, batch number: 207A21A, expiry: UNKNOWN) dose was not reported, administered on 03-SEP-2021 for prophylactic vaccination. No concomitant medications were reported. On 03-SEP-2021, the patient experienced the vial was punctured the previous day, the punctured vial was used at least 20 hours after it was first punctured. On an unspecified date, the patient experienced the vaccine was stored in the fridge after puncture for about 20 hours. The action taken with covid-19 vaccine was not applicable. The outcome of the the vial was punctured the previous day, the punctured vial was used at least 20 hours after it was first punctured and the vaccine was stored in the fridge after puncture for about 20 hours was not reported. This report was non-serious.


VAERS ID: 1681468 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-09-03
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       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? 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: USJNJFOC20210908207

Write-up: FEVER; This spontaneous report received from a patient concerned a male of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 02-SEP-2021 for prophylactic vaccination. The batch number was not reported. The Company is unable to perform follow-up to request batch/lot numbers. No concomitant medications were reported. On 03-SEP-2021, the patient experienced fever. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from fever. This report was non-serious.


VAERS ID: 1681471 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New Mexico  
Vaccinated:0000-00-00
Onset:2021-09-03
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210908676

Write-up: SORE ARM; This spontaneous report received from a consumer concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 03-SEP-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 03-SEP-2021, the patient experienced sore arm. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of sore arm was not reported. This report was non-serious. This case, from the same reporter is linked to 20210908685 and 20210908729.


VAERS ID: 1682069 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose increased, Mechanical ventilation
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Acute central respiratory depression (broad), Respiratory failure (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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: CREON, LISINOPRIL, TAMSULOSIN, PLUS PATIENT GETS MEDS AT HOSPITAL
Current Illness: DIABETES
Preexisting Conditions: DIABETES
Allergies: NONE
Diagnostic Lab Data: NO INFO
CDC Split Type:

Write-up: WIFE CAME IN 5 DAYS AFTER PATIENT RECEIVED VACCINE AND REPORTED THE NEXT DAY PATIENT WAS ADMITTED TO HOSPITAL WITH A VERY VERY HIGH BLOOD SUGAR (WIFE SAID 1500?) AND IS ON RESPIRATOR. PATIENT''S ENDOCRINOLOGIST STATED PATIENT SHOULD OF NEVER GOTTEN BOTH VACCINES AT THE SAME TIME


VAERS ID: 1682074 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anaphylactic reaction, Blood test, Computerised tomogram, Dizziness, Electrocardiogram, Seizure, Syncope, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Systemic: Allergic: Anaphylaxis-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Severe, Systemic: Seizure-Severe, Systemic: Vomiting-Severe, Additional Details: Provider ordered CT, EKG, and ran bloodwork.


VAERS ID: 1682138 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Myalgia, Pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (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: Medical History/Concurrent Conditions: Anemia (borderline anemia); Anxiety; COVID-19 (Prior to vaccination, was the patient diagnosed with COVID-19?:Yes)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101152705

Write-up: Sore arm; Muscle tenderness; Achiness; Tired; This is a spontaneous report from a contactable healthcare professional, the patient. A 43-year-old non-pregnant female patient received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FC3184) via an unspecified route of administration in the left arm on 03Sep2021 at 17:30 (at the age of 43-years-old) as a single dose for COVID-19 immunisation. Medical history included anxiety, borderline anemia and COVID-19. The patient had no known allergies. Prior to the vaccination, the patient was diagnosed with COVID-19. The patient did not receive any other vaccine within four weeks prior to the COVID-19. The patient received unspecified concomitant medications. On 03Sep2021 at 18:00, the patient experienced sore arm, muscle tenderness, achiness and was tired. The events did not result in doctor or other healthcare professional office/clinic, emergency room/department or urgent care. Since the vaccination, the patient had not been tested for COVID-19. Therapeutic measures were not taken as a result of the reported events. The clinical outcome of the events sore arm, muscle tenderness, achiness and tired were resolved on an unknown date in Sep2021.


VAERS ID: 1682141 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Diarrhoea, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Fruit allergy (Known allergies: grapefruit); Penicillin allergy; Seizure (Seizure disorder)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101152838

Write-up: Body aches; Vomiting; Explosive diarrhea; This is a spontaneous report from a contactable consumer, the patient. A 22-year-old male patient received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the right arm on 02Sep2021 at 14:00 (at the age of 22-years-old) as a single dose for COVID-19 immunisation. Medical history included seizure disorder and allergy to penicillin and grapefruit. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient received unspecified concomitant medications. On 03Sep2021 at 12:00, the patient experienced body aches, vomiting and explosive diarrhea. Therapeutic measures were taken as a result of the event explosive diarrhea which included treatment with loperamide hydrochloride (IMODIUM). Since the vaccination, the patient had not been tested for COVID-19. The clinical outcome of the events body aches, vomiting and explosive diarrhea were resolved on an unknown date in Sep2021. The lot number for BNT162b2 was not provided and will be requested during follow up.


VAERS ID: 1682145 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Ear pain, Fatigue, Headache, Impaired work ability, Myalgia, Oropharyngeal pain, Pharyngeal swelling, Pollakiuria, Pyrexia, Swelling face
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101153492

Write-up: Frequent urination; Ear ache; Incapacitated; Sore throat; Weakness; Swelling of the face and throat; Swelling of the face and throat; Exhaustion; Headache; Muscle pain; Chills; Fever; This is a spontaneous report from a contactable consumer, the patient. A 51-year-old non-pregnant female patient received second dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 03Sep2021 at 10:00 (at the age of 51-years-old) as a single dose for COVID-19 immunisation. Medical history was not reported. The patient had no known allergies. Prior to vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccines within four weeks prior to the vaccination. The patient did not receive any concomitant medications. The patient previously received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: UNKNOWN) via an unspecified route of administration in the left arm on 13Aug2021 at 16:00 as a single dose for COVID-19 immunisation. On 03Sep2021 at 14:00, the patient experienced swelling of the face and throat, weakness, exhaustion, head ache, muscle pain, chills, fever, sore throat, ear ache, frequent urination and incapacitated. The events did not result in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care. Therapeutic measures were not taken as a result of the events. The clinical outcome of the events swelling of face and throat, weakness, exhaustion, headache, muscle pain, chills, fever, sore throat, ear ache, frequency urination and incapacitated were resolving at the time of the report. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


VAERS ID: 1682166 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Palpitations, Vaccination site pain
SMQs:, Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: GABAPENTIN; BACLOFEN; CYMBALTA; MAGNESIUM;POTASSIUM; CALCIUM
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Herniated disc
Allergies:
Diagnostic Lab Data:
CDC Split Type: USPFIZER INC202101161284

Write-up: Exhaustion; Racing heart; Sore arm at injection site; This is a spontaneous report from a contactable consumer, the patient. A 39-year-old non-pregnant female patient received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE; Lot Number: FC3182) via an unspecified route of administration in the right arm on 03Sep2021 at 15:15 (at the age of 39-year-old) as a single dose for COVID-19 immunisation. The medical history included herniated disc. The patient had no known allergies. Prior to the vaccination, the patient was not diagnosed with COVID-19. The patient did not receive any other vaccine within four weeks prior to the vaccination. The concomitant medications included gabapentin (MANUFACTURER UNKNOWN), baclofen (MANUFACTURER UNKNOWN), duloxetine hydrochloride (CYMBALTA), magnesium/ potassium (MANUFACTURER UNKNOWN) and calcium (MANUFACTURER UNKNOWN); all taken for an unknown indication from an unknown date and unknown if ongoing. On 03Sep2021, the patient experienced exhaustion, racing heart and sore arm at injection site. The events did not result in a visit to the doctors or other healthcare professional office/clinic visit, and emergency room/department or urgent care. Since the vaccination, the patient had not been tested for COVID-19. Therapeutic measures were not taken as the result of the events. The clinical outcome of the events exhaustion, racing heart and sore arm at injection site was not resolved at the time of report.


VAERS ID: 1682422 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-23
Onset:2021-09-03
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Vaccine breakthrough infection
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: DM 2 , HTN, COPD
Allergies: methotrexate
Diagnostic Lab Data:
CDC Split Type:

Write-up: Breakthrough case


VAERS ID: 1682426 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-15
Onset:2021-09-03
   Days after vaccination:231
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL EXTRA STRENGTH) 500 MG tablet amiodarone (CORDARONE) 200 MG tablet aspirin low dose 81 MG chew tablet atorvastatin (LIPITOR) 10 MG tablet bisacodyl (DULCOLAX) 10 MG suppository brimonidine (ALPHAGAN) 0.2 % ophthalmic
Current Illness: None known
Preexisting Conditions: CAD S/P CABG x 4 in 5/1992 HTN (hypertension) SSS S/P radiofrequency ablation 2005, S/P PPM in 3/2010 Hyperlipidemia Atrial fibrillation (HCC) Glaucoma ASCVD (arteriosclerotic cardiovascular disease) Vitamin B 12 deficiency Neuropathy in diabetes (HCC) Low HDL (under 40) CHF (congestive heart failure) (HCC) Bradycardia OSA on CPAP PLMD (periodic limb movement disorder) Diabetes mellitus type 2, controlled (HCC) Tachy-brady syndrome (HCC) Pacemaker generator end of life 4/22/2015 Medtronic Syncope Hypotension Pacemaker CKD (chronic kidney disease) stage 3, GFR 30-59 ml/min Overweight (BMI 25.0-29.9) Acute kidney injury (HCC) Leg injury, right, initial encounter Elevated INR Gait instability Anemia, unspecified type Elevated serum creatinine Lumbar transverse process fracture, closed, initial encounter (HCC) Dyspnea on exertion Non-insulin dependent type 2 diabetes mellitus (HCC) Current use of long term anticoagulation Frequent falls Generalized weakness Unsteady gait
Allergies: None known
Diagnostic Lab Data: COVID-19 test positive on 9/3/2021
CDC Split Type:

Write-up: Patient presented from an assisted living facility to the emergency department on 9/3/2021 following a fall from a chair. He was found to be COVID-19 positive and was administered monoclonal antibodies on 9/5/2021. He remained asymptomatic during admission. He was discharged to skilled nursing facility on 9/7/2021.


VAERS ID: 1682437 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-08
Onset:2021-09-03
   Days after vaccination:57
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 - / -

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

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

Write-up: positive COVID test


VAERS ID: 1682471 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-08-28
Onset:2021-09-03
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthma
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (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: Adderall 30mg, amlodipine 5mg, alprazolam 0.5 mg, vitamin D3, sertraline 100mg
Current Illness: None
Preexisting Conditions: Chronic sinusitis, hypertension, Asthma
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was vaccinated on 8/28/21. On 9/3/21 patient broke out into hives over entire body. The patient was seen at a walk in clinic and was given a steroid injection.


VAERS ID: 1682493 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-13
Onset:2021-09-03
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EK9231 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin; HCTZ; Amlodipine; Atorvastatin; Omeprazole; Escitalopram; Pro Air, Cyclobezaprine; Valtrex.
Current Illness: None
Preexisting Conditions: hypertension; GERD; overactive bladder; diabetes type 2; anxiety; submucous uterine fibroid
Allergies: Simvastatin; Lisinopril, Macrobid.
Diagnostic Lab Data:
CDC Split Type:

Write-up: not documented.


VAERS ID: 1682515 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Lip swelling, Oral pruritus, Pyrexia, Throat irritation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: Paxil, Thrive Vitamins
Current Illness: none
Preexisting Conditions: none
Allergies: Shell Fish Red Dye
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swollen Lips, itchy throat and mouth, fever


VAERS ID: 1682519 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 088D21A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Injected limb mobility decreased
SMQs:, Arthritis (broad)

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

Write-up: Four hours after vaccine he started getting severe pains in left shoulder joint. Unable to move arm.


VAERS ID: 1682552 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-25
Onset:2021-09-03
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 2 RA / 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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: hospitalization (non-ICU)


VAERS ID: 1682555 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-01
Onset:2021-09-03
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Dyspnoea, Endotracheal intubation, Hypoxia, Lung infiltration, Mechanical ventilation, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (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? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: elderly gentleman with a history of diabetes hypertension hyperlipidemia and BPH presented with worsening shortness of breath over the last several days. He has been COVID-19 vaccinated and both him and his wife have been suffering similar symptoms. He presented to emergency room and was noted to be hypoxic with chest x-ray revealing bilateral infiltrates suggestive of COVID-19. COVID-19 was found to be positive per discussion with ED provider. He was intubated and placed on a ventilator shortly after admission to this hospital. Patient did show nurse his COVID vaccination verification card. He was vaccinated in January and February 2021. Patient was treated with dexamethasone and remdesivir.


VAERS ID: 1682564 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-29
Onset:2021-09-03
   Days after vaccination:217
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: CHF, Asthma, UTI, Pacemaker
Allergies: NKDA/ Shrimp
Diagnostic Lab Data: COVID swab positive
CDC Split Type:

Write-up: Breakthrough case


VAERS ID: 1682575 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-05-27
Onset:2021-09-03
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Cough, Erythema, Gait inability, Limb injury, Nasopharyngitis, Oedema, Oropharyngeal pain, Pain, Pollakiuria, Rhinorrhoea, SARS-CoV-2 test positive, Skin warm, Swelling, Wound secretion
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Anticholinergic syndrome (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chief Complaint R leg wound 1 week. Pain, edema +4, erythema. Denies fevers. History of Present Illness 62 year old female patient who presented to the ER with progressive right lower extremity wound, swelling, pain. Patient first noticed that there was a problem with her leg last Sunday evening. She has not seen/called her doctor, been to urgent care/wound care center. She has not put anything on the wound, nor started any antibiotics. The affected area is quite painful, rated at 10/10, described as sharp, stabbing, burning. Pain is worse with weight baring and at present she is unable to walk on the RLE at all due to pain. She has noticed progressive edema, erythema, warmth and weeping of a serosangui fluid. She denies fever, chills, chest pain, SOB, diarrhea, constipation, dysuria. She reports urinating frequently, cold symptoms like runny nose, sore throat, dry cough. She denies sick contacts or known COVID-19 exposure. She has completed Pfizer COVID vaccine series. She has tested positive for COVID-19 today. She is aware that she was also positive pre-vaccination in 11-2020.


VAERS ID: 1682577 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-02-17
Onset:2021-09-03
   Days after vaccination:198
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 LA / IM

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

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

Write-up: patient tested positive 8/28/21


VAERS ID: 1682590 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-01
Onset:2021-09-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Pain
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: body aches for 7days now


VAERS ID: 1682591 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-28
Onset:2021-09-03
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness postural, Electrocardiogram, Fatigue, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: obesity
Allergies: none
Diagnostic Lab Data: EKG 9/7/21
CDC Split Type:

Write-up: Vaccine administered 8/28/21 Persistent dizziness since 9/3/21, when getting up from lying or sitting Subjective complaint of fatigue and leg weakness, not noted on on exam


VAERS ID: 1682609 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-16
Onset:2021-09-03
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8731 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain lower, Acute myocardial infarction, Adenovirus test, Anticoagulation drug level above therapeutic, Asthenia, Atrial fibrillation, Blood creatinine increased, Blood culture, Blood lactic acid normal, Blood magnesium normal, Blood urea increased, Body temperature increased, Bordetella test negative, Bronchiectasis, COVID-19, COVID-19 pneumonia, Cardiomegaly, Cerebral atrophy, Cerebral small vessel ischaemic disease, Chest X-ray abnormal, Chest pain, Chills, Chlamydia test negative, Computerised tomogram abdomen abnormal, Computerised tomogram head abnormal, Condition aggravated, Confusional state, Coronavirus test negative, Cough, Diarrhoea, Enterovirus test negative, Fatigue, Human metapneumovirus test, Human rhinovirus test, Hyperlipidaemia, Hypertension, Hypophagia, Infection, Influenza A virus test negative, Influenza B virus test, Influenza virus test negative, Insulin-requiring type 2 diabetes mellitus, International normalised ratio increased, Interstitial lung disease, Intervertebral disc space narrowing, Lung opacity, Mental status changes, Moaning, Mycoplasma test negative, Procalcitonin, Pulmonary mass, Renal cyst, Respiratory syncytial virus test negative, Respiratory viral panel, SARS-CoV-2 test positive, Scan with contrast abnormal, Sepsis, Spinal deformity, Testicular pain, Troponin, Urine analysis normal, Vascular calcification, Viral test negative, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Cardiac failure (broad), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Dyslipidaemia (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, arterial (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Lipodystrophy (broad), Osteoporosis/osteopenia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaZOLAMIDE (DIAMOX) 500 mg capsule albuterol HFA (VENTOLIN HFA) 90 mcg/actuation inhaler (Expired) atorvastatin (LIPITOR) 40 mg tablet blood sugar diagnostic strip cholecalciferol, vitamin D3, (cholecalciferol) 25 mcg (1,000 unit) ta
Current Illness:
Preexisting Conditions: Non-Hospital Diabetic ulcer of toe of left foot associated with type 2 diabetes mellitus, limited to breakdown of skin (CMS/HCC) Incidental lung nodule Deep venous thrombosis of lower extremity (CMS/HCC) Abnormal chest x-ray Arteriosclerosis of coronary artery Atherosclerosis of right carotid artery Paroxysmal atrial fibrillation (CMS/HCC) Coronary atherosclerosis of autologous vein bypass graft Carotid artery stenosis, asymptomatic, right Chest pain Stage 3 chronic kidney disease Uncontrolled type 2 diabetes mellitus with complication (CMS/HCC) SOB (shortness of breath) Sebaceous cyst S/P AKA (above knee amputation) (CMS/HCC) Rash Pre-syncope Peripheral vascular disease (CMS/HCC) Peripheral neuropathy Overweight(278.02) Pleural thickening Male erectile disorder Long term current use of antithrombotics/antiplatelets Hypertension Hyperlipidemia Atherosclerosis of native artery of left lower extremity with intermittent claudication (CMS/HCC) Essential hypertriglyceridemia Esophageal reflux Dysphagia Diabetes mellitus (CMS/HCC) Complications due to vascular device, implant, and graft Colon polyps Actinic keratosis of scalp Chronic kidney disease-mineral and bone disorder Other emphysema (CMS/HCC) OSA (obstructive sleep apnea) Right above-knee amputee (CMS/HCC) Phantom pain (CMS/HCC) Diabetic foot infection (CMS/HCC) Atherosclerosis of bypass graft of left lower extremity with ulceration (CMS/HCC) Long term (current) use of anticoagulants Cellulitis and abscess of foot Gangrene of toe (CMS/HCC) History of stroke Hx of CABG Warfarin anticoagulation Diabetic ulcer of toe of left foot associated with type 2 diabetes mellitus (CMS/HCC) Hx pulmonary embolism History of blood transfusion reaction Cellulitis of left lower leg History of right-sided carotid endarterectomy Atherosclerosis of native artery of left lower extremity with ulceration of midfoot (CMS/HCC) Gangrene associated with type 2 diabetes mellitus (CMS/HCC) Chronic kidney disease, stage 3b Diabetic ulcer of toe of left foot associated with type 2 diabetes mellitus, unspecified ulcer stage (CMS/HCC) Delirium Acute respiratory failure (CMS/HCC) Pseudoaneurysm following procedure (CMS/HCC) Gangrene of toe of left foot (CMS/HCC) Atrial fibrillation with rapid ventricular response (CMS/HCC) Paroxysmal atrial fibrillation with RVR (CMS/HCC) Elevated troponin level Atherosclerosis of bypass graft of left lower extremity with ulceration of other part of foot (CMS/HCC) Critical lower limb ischemia Malnutrition (CMS/HCC) S/P bilateral above knee amputation (CMS/HCC) Dehiscence of operative wound Sepsis (CMS/HCC) Acute cystitis without hematuria AKI (acute kidney injury) (CMS/HCC) COVID-19 Acute respiratory failure with hypoxia (CMS/HCC)
Allergies: ClopidogrelRash HydromorphoneHallucinations Plasma Protein FractionRash, Hives / Urticaria Adhesive Tape-siliconesOther (document details in comments) AmiodaroneOther (document details in comments
Diagnostic Lab Data: 09/06/21 0354 Respiratory virus detection panel Collected: 09/06/21 0246 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected 08/30/21 2206 Respiratory virus detection panel Collected: 08/30/21 2104 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result DetectedCritical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected Procedure Component Value Ref Range Date/Time X-ray chest 1 view, Portable [3301524308] Resulted: 09/07/21 0901 Order Status: Completed Updated: 09/07/21 0901 Narrative: XR CHEST 1 VW PORT IMPRESSION: Patchy airspace opacities bilaterally in the mid to lower lung zones, slightly increased compared to prior radiographs. END OF IMPRESSION: INDICATION: Follow-up pneumonia. Covid 19. TECHNIQUE: AP upright projection of the chest is acquired. COMPARISON: Radiographs of 9/5/2021. FINDINGS: The cardiomediastinal silhouette is unchanged. Evidence of prior median sternotomy surgical changes again identified. Vascular calcifications are noted. Persistent patchy airspace opacities bilaterally in the mid to lower lung zones, slightly increased compared to prior radiographs. No evidence of pleural effusion or pneumothorax. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. CT abdomen pelvis with contrast [3301435000] Resulted: 09/06/21 0057 Order Status: Completed Updated: 09/06/21 0057 Narrative: PROCEDURE INFORMATION: Exam: CT Abdomen And Pelvis With Contrast Exam date and time: 9/5/2021 10:54 PM Age: 79 years old Clinical indication: Other: Na; Additional info: Testicular/lower abdominal pain TECHNIQUE: Imaging protocol: Computed tomography of the abdomen and pelvis with contrast. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. Contrast material: VISI 320; Contrast volume: 80 ml; Contrast route: INTRAVENOUS (IV); COMPARISON: CT CHEST WO CONTRAST 8/30/2021 11:48 PM FINDINGS: Lungs: Paraseptal emphysematous changes in the lung bases with septal thickening and mild bronchiectasis. Heart: Mild cardiomegaly. Liver: Normal. No mass. Gallbladder and bile ducts: Normal. No calcified stones. No ductal dilation. Pancreas: Atrophic. No ductal dilation. Spleen: Normal. No splenomegaly. Adrenal glands: Normal. No mass. Kidneys and ureters: Small subcentimeter right renal cyst. No follow-up imaging recommended. No hydronephrosis , no stones seen bilaterally. Stomach and bowel: Unremarkable. No obstruction. No mucosal thickening. Appendix: No evidence of appendicitis. Intraperitoneal space: Unremarkable. No free air. No significant fluid collection. Vasculature: Unremarkable. No abdominal aortic aneurysm. Lymph nodes: Unremarkable. No enlarged lymph nodes. Urinary bladder: Unremarkable as visualized. Reproductive: Unremarkable as visualized. Bones/joints: Narrowing of L2-L3 disc space with vacuum disc seen. Compression deformity T12, with vertebral body reduced to approximately 50% of its original height. Chronicity of the compression deformity is not certain. Soft tissues: Surgical clips both inguinal region with bilateral femoral graft present, incompletely image. IMPRESSION: No bowel obstruction. No hydronephrosis seen bilaterally. COMMENTS: Consistent with the College of Radiology''s Incidental Findings Committee white paper (J Am Coll Radiol 2018): Any incidental renal lesion less than 1 cm or classified as too small to characterize, or any incidental cystic renal lesion characterized as simple-appearing, is likely benign. No follow-up imaging is recommended for these lesions per consensus recommendations based on imaging criteria. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD CT head without contrast [3301435030] Resulted: 09/06/21 0047 Order Status: Completed Updated: 09/06/21 0048 Narrative: PROCEDURE INFORMATION: Exam: CT Head Without Contrast Exam date and time: 9/5/2021 10:54 PM Age: 79 years old Clinical indication: Other: Na; Additional info: AMS, moaning, supratherapeutic inr TECHNIQUE: Imaging protocol: Computed tomography of the head without contrast. Radiation optimization: All CT scans at this facility use at least one of these dose optimization techniques: automated exposure control; mA and/or kV adjustment per patient size (includes targeted exams where dose is matched to clinical indication); or iterative reconstruction. COMPARISON: CT HEAD WO CONTRAST 8/17/2020 2:29 PM FINDINGS: Brain: Old infarct in the right occipital lobe. Generalized atrophy and chronic white matter ischemic changes. There is no mass, acute hemorrhage or acute infarct. Cerebral ventricles: No ventriculomegaly. Paranasal sinuses: Visualized sinuses are unremarkable. No fluid levels. Mastoid air cells: Visualized mastoid air cells are well aerated. Bones/joints: Unremarkable. No acute fracture. Soft tissues: Unremarkable. IMPRESSION: No acute abnormality. THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED BY MD X-ray chest 1 view - Portable [3301434990] Resulted: 09/05/21 2013 Order Status: Completed Updated: 09/05/21 2013 Narrative: XR CHEST 1 VW PORT IMPRESSION: Wispy opacity within the peripheral lungs left greater than right in keeping with Covid 19 pneumonia. END OF IMPRESSION: INDICATION: weakness, fatigue. TECHNIQUE: AP portable chest. COMPARISON: 8/30/2021 FINDINGS: Diffuse interstitial prominence. Patchy wispy opacity within the peripheral lungs, left greater than right kidney with Covid 19 pneumonia. Heart size remains within normal limits. No pneumothorax or pleural effusion. No acute bony abnormalities.
CDC Split Type:

Write-up: ED to Hosp-Admission Current 9/5/2021 - present (3 days) Hospital Hospital Problems POA * (Principal) Pneumonia due to COVID-19 virus Yes Sepsis (CMS/HCC) Yes Mental status alteration Yes Supratherapeutic INR Yes Plan Chief Complaint Patient presents with ? Weakness - Generalized 1. Mental status alteration Sepsis -suspect secondary to infection -follow neuro exam 2. -hx covid now with dexamethasone, not hypoxic -possibly pulmonary source -s/p blood cx -iv abx -iv fluids 3. COVID PNA without hypxia -contact and droplet isolation -obtain and trend markers -titrate o2 satn$g95% -continue dexamethasone 6 more days 4. PAF -tele -rate control and anticoagulation with coumadin 5. supratherapeutic INR -hold coumadin -daily INR; pharmacy to dose 6. Type II dm-insuln dep-uncontrolled -CCD diet -accu check qac,hs with ss 7. 5mmRUL nodule -identified last hospitalization; follow outpt. Thoracic surgery aware 8. Elevated troponin -tele -trend troponins; suspect demand 9. HTN -follow bp; cpm 10. HLD 11. Code Status- Full code 12. DVT prophylaxis -coumadin/as above 13. All medical problems listed above are present upon admission 14. Role of the hospitalist is explained to the patient in some detail questions answered to his satisfaction Pt is an 79 y.o. male. The past medical history significant for hospital discharge on September 2. That time the patient did have chest pain with a non-STEMI was diagnosed with Covid (He had been previously vaccinated). Patient was given Decadron in the ED and was not hypoxic.This patient presents to the emergency room from home via his wife. Patient continues to haveChills, diarrhea, cough and altered mental status. Patient''s wife notes that he has had diarrhea on and off since Friday he has been moaning and unable to tell her what is wrong.Decreasing oral intake, using his medication and care. On entry to the hospital Patient''s wife has concerns regarding her ability to care for her husband. T-max in the ER is 101.5 patient met sepsis criteria. Labs include BUN/creatinine of 49 of 1.9, Magnesium 1.5, INR 4.1, troponin of 0.03, normal white count, negative urinalysis. CT scan head is unremarkable. Chest x-ray shows wispy opacity within the peripheral lungs left greater than right(keeping with a Covid pneumonia.) Lactic acid is negative. Procalcitonin 0.26. The emergency room the patient denies chest pain, pressure, palpitations, syncope. Patient has a history of bilateral AKA and his sacral area Was visualized there is no open wound. The patient appears slightly confused in the ED By my assessment can give a only moderate history. Cultures were obtained and IV antibiotics Initiated. Patient is now seen at the request of ED staff.


VAERS ID: 1682614 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Headache, Muscle spasms, Neck pain, Pain, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Arthritis (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: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC Split Type:

Write-up: vision became blurry on her left side which started 25 mins after receiving the shot, having a real bad headache on left side and has been hurting really bad every day also the pain radiates down her neck and leg cramps


VAERS ID: 1682621 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-08-25
Onset:2021-09-03
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3184 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash, Rash erythematous, Rash pruritic, Rash vesicular
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: Birth Control
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: Was precribed Valacyclovir three times a day!
CDC Split Type:

Write-up: Broken out in rash - all over body including inside mouth and under the tongue. It''s a red, small, blistery rash - extremely itchy and sore!


VAERS ID: 1682629 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051E21A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dysphonia, Dyspnoea, Extra dose administered, Immunodeficiency, Throat irritation
SMQs:, Anaphylactic reaction (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient fills rxs at another pharmacy so no data available, but stated she currently is on Symzia
Current Illness: None noted
Preexisting Conditions: Fills all medications at another pharmacy so unable to tell, patient was not able to provide any more information
Allergies: Patient states allergies to 5 different medication classes but didn''t have information available to provide
Diagnostic Lab Data: NA- see above
CDC Split Type:

Write-up: No problems with 1st 2 shots in series other than fever/fatigue side effects. Candidate for 3rd dose due to immusuppression with Symzia. No problems during injection, 24 hours later reported itching around throat, trouble breathing, and hoarsness in throat. Due to her history of allergic reactions she took a benadryl 25 mg which resolved side effects after 3 doses. Stated she was traveling and not able to go see a Dr or ER when symptoms occurred. Reported this side effect to pharmacy on 9/8/21 and back in normal state with just a slight hoarse throat.


VAERS ID: 1682639 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-08-24
Onset:2021-09-03
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Headache, Impaired work ability, Nausea, Pyrexia, SARS-CoV-2 test negative, Urine analysis normal
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac, Klonopin, Vit D + Calcium, iron, prenatal vitamin, AZO Cranberry
Current Illness: None
Preexisting Conditions: Depression/Anxiety
Allergies: None
Diagnostic Lab Data: 09/05/21- COVID PCR: Negative 09/05/21- UA: Normal
CDC Split Type:

Write-up: Low-grade fever 99.1-99.6 F, nausea, headache beginning day 10 after injection. Symptoms lasted 3 days. Visited urgent care center, missed 1 day of work due to illness symptoms.


VAERS ID: 1682646 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Condition aggravated, Dizziness, Glossitis, Head discomfort, Headache, Hypoaesthesia, Musculoskeletal pain, Paraesthesia, Post-acute COVID-19 syndrome, Throat irritation, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: B12, Vitamin C
Current Illness: POST COVID syndrome. ie:Heart palpitations, fatigue, lightheadedness, dizziness, elevated heart rate.
Preexisting Conditions: Anemia, POST COVID syndrome
Allergies: Augmentin
Diagnostic Lab Data: Nothing as of yet
CDC Split Type:

Write-up: Left shoulder blade pain, throat and tongue fuzzy feeling, tingle, vision blurred, head pressure and slight pain. Left arm numbing. Dizzy. POST COVID syndrome symptoms worsened and regressed from recovery.


VAERS ID: 1682684 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ear pain, Fatigue, Headache, Incorrect dose administered, Myalgia, Oropharyngeal pain, Pain in jaw, Product preparation issue
SMQs:, Rhabdomyolysis/myopathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

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

Write-up: Patient arrived to receive Pfizer vaccination. RN obtained new vial of Pfizer vaccine. Lot #301358A Exp Date: 11/2021 Nurse drew 0.3 ml of medication, and confirmed with patient and assisting RN dosage, medication, and vaccine information. RN administered dosage to patient. Patient was given vaccination card and instructed to be monitored for 15 minutes. The administering RN read the Pfizer vial afterwards to discover that the medication should have been diluted with a saline solution. The patient received the concentrated amount of .03 of the Pfizer vaccination. Dr. CMO and OccMed Manager, was notified. The patient was immediately notified of the error, and Dr. closely monitored the patient. The patient declined to go the ED for overnight observation at the advice of Dr. Patient c/o headache and cervical muscle soreness, fatigue, sore throat, left earache, left jaw pain in right arm . 2nd Pfizer vaccine at the discretion of the patient and Dr. Patient has followed up with Occupational Medicine on 09/07/21 with Dr. No work restrictions. OccMed will follow up with patient on 09/20/21.


VAERS ID: 1682687 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Delaware  
Vaccinated:2021-08-31
Onset:2021-09-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 064F21A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain, Facial paralysis, Hypertension, Motor dysfunction, Muscle spasms, Neurological symptom, Paraesthesia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 9/1- cramping on the top of her stomach, 9/2 and 9/3 the cramping intensified and began to spread throughout her body. On 9/3 she took an antacid and immediately vomited, whole body was cramping, she was unable to bend her fingers and the left side of her face was drooping. hospitalization 9/3- 9/6. Employee stated that her doctor shared that he believed it was a negative reaction to the 2nd vaccination. However, the discharge paperwork states hypertension, hand-tingling and stroke-like symptoms.


VAERS ID: 1682693 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939901 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: 45-year-old female received her second dose of the Covid-19 vaccine mRNA Moderna on September 03, 2021. On September 03, 2021, the patient stated she felt dizzy after vaccine. Patient also complained of feeling very sore on her right arm after receiving vaccine and was in pain. Patient was given acetaminophen 325mg and recommended to rest. On September 07, I spoke with health care provider who state that patient is doing okay, and pain related to COVID-19 vaccine has resolved.


VAERS ID: 1682730 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Immediate post-injection reaction, Injection site pain, Injection site swelling, Muscular weakness, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Immediate pain and swelling of injection site, not previously noted with first vaccine dose. Onset of fever and muscle aches/weakness 12 hours after vaccination; symptoms continued for 24 hours. No other symptoms developed.


VAERS ID: 1682737 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Flushing, Rash pruritic
SMQs:, Anaphylactic reaction (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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Flushed, itchy rash, difficulty breathing. Required 2 doses of IM epi and 2 doses of 25 Benadryl, first oral then IV. Ambulance arrived 30 minutes after reaction.


VAERS ID: 1682743 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 3 LA / -

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

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

Write-up: During the administration of the vaccine the needle detached from the syrenge. Leaving the patient with most of the vaccine still admistered,


VAERS ID: 1682772 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-02
Onset:2021-09-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH SN6202 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH GN6207 / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Cough, Dyspnoea, Pulmonary thrombosis
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine besylate 5mg; Losartan 25mg; Atorvastatin 40mg
Current Illness:
Preexisting Conditions: High blood pressure; High Cholesterol; Type 2 Diabetic
Allergies: Penicillin
Diagnostic Lab Data: CT Scan; checked blood; X-ray.
CDC Split Type:

Write-up: Patient stated that the day of the vaccine he was fine. The next day he had a cough and was getting shortness of breathe. His wife took him to the ER. They found two blood clots in his lungs.


VAERS ID: 1682779 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A DD / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood pressure decreased, Dyspnoea, Face injury, Fatigue, Heart rate decreased, Hyperhidrosis, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: no prescriptions
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: na
CDC Split Type:

Write-up: First five minutes seemed normal but suddenly passed out and hit my face on the floor. paramedics were called and my blood pressure dropped and pulse was as low as 32 bpm. I had a lot of sweat everywhere as well. I was feeling tired as well. I thought I was getting better then passed out again. For about 10 seconds I couldn''t get enough air and thought I was going to die. I finally returned to normal after an hour.


VAERS ID: 1682799 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / SYR

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

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

Write-up: extreme headache, body chills, fever


VAERS ID: 1682827 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-18
Onset:2021-09-03
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol 90 mcg/actuation HFA inhaler baclofen 10 mg tablet ESCITALOPRAM OXALATE 20 mg tablet fexofenadine 180 mg tablet HYDROmorphone 4 mg tablet HYDROmorphone 4 mg tablet HYDROmorphone 4 mg tablet lamoTRIgine 100 mg tablet lithium carbon
Current Illness:
Preexisting Conditions: bIpOLAR MIGRAINES CERVICAL NECK PAIN WITH RADICULOPATHY CHRONIC PAIN
Allergies: Bupropion HclOther Non-Immunologic Reaction ClarithromycinRash LevofloxacinAnaphylaxis QuetiapineAgitation
Diagnostic Lab Data:
CDC Split Type:

Write-up: SHINGLES TO RIGHT FOREHEAD


VAERS ID: 1682854 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-26
Onset:2021-09-03
   Days after vaccination:161
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, Endotracheal intubation, Haemodialysis, Hypervolaemia, Mechanical ventilation, Positive airway pressure therapy, Respiratory distress, SARS-CoV-2 test positive
SMQs:, Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Respiratory failure (narrow), 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? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: ESRD, COPD, CHF
Preexisting Conditions:
Allergies: Sulfa
Diagnostic Lab Data: Rapid Covid positive
CDC Split Type:

Write-up: Patient apparently experienced difficulty breathing for several days at home. When EMS arrived at home on 9/3/2021, she was in respiratory distress and did not respond to BiPAP reportedly. She was endotracheally intubated in the field. Evaluation in the emergency room revealed positive rapid COVID-19 testing. She was weaned off the ventilator on 9/4/2021. She received dexamethasone. She was also treated for fluid overload with fluid restriction, furosemide, and hemodialysis. She was discharged on 9/7/2021.


VAERS ID: 1682872 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-08-31
Onset:2021-09-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 - / -

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

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

Write-up: Itchy rash on right arm, face, neck and chest. Took Benadryl 25mg.


VAERS ID: 1682873 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-08-31
Onset:2021-09-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Back pain, C-reactive protein increased, Cardiac telemetry, Chest X-ray normal, Chest pain, Chills, Echocardiogram normal, Electrocardiogram normal, Fibrin D dimer normal, Full blood count normal, Headache, Hyperhidrosis, Metabolic function test normal, Monocyte count increased, Muscle tightness, Myocardial necrosis marker, Pain, Pallor, Pyrexia, Red blood cell sedimentation rate normal, Troponin increased
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Pt received his first COVID vaccine on 08/10/2021. Developed body aches, weakness, headache, stomachache, "burping", and chills on 8/11/2021.
Preexisting Conditions: Allergic Rhinitis- Allergic to Pollen
Allergies: None
Diagnostic Lab Data: EKG and CXR were normal on 9/3/21. CMP, D Dimer, Sedimentation Rate were normal. CBC on 9/3/21 was normal outside of monocyte level of 13.1. Troponin on 9/3/21 was elevated at 251 ng/L. CRP on 9/3/21 was also elevated at 13 mg/L. Troponin on 9/4/21 at 0400 was elevated at 378. Troponin level 6 hrs later at 1000 was still 378. Echocardiogram on 9/4/21 showed a normal cardiac structure with normal ventricular function. No signs of acute mycoarditis.
CDC Split Type:

Write-up: Pt received the second COVID shot on 8/31/21. On 9/1/21 he developed a headache, body aches, chills, and a low grade fever. On 9/3/21 he developed dull sternal chest pain that radiated to the center of his back, neck tightness, and bilateral shoulder pain around noon. He was also pale and diaphoretic. Mom called the PCP after these symptoms started. PCP directed mom to take pt to the ED. He was taken to Hospital Emergency Room on 9/3/21. Chest pain resoled on its own before pt arrived in the ED, according to the ED report. In the ED labs were drawn, EKG, and Chest Xray were completed. Pt was admitted to cardiology in stable condition for an echocardiogram in observation as well as to trend his cardiac enzymes. Pt was monitored overnight via telemetry. Echocardiogram was completed on 9/4/21. Two repeat Troponin levels were drawn the morning of 9/4/21, 6 hrs apart from one another. Pt was discharged home due to a normal echocardiogram and asymptomatic status. Pt has a follow up appointment with Cardiology on 9/9/21. Cardiology will do another echo and draw another Troponin level. Cardiology recommended no athletic activity until cleared by Cardiologist.


VAERS ID: 1682893 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Diarrhoea, Headache, Pruritus, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UC
Allergies:
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: itching all over body, headaches, fever, lost taste in mouth and diarrhea


VAERS ID: 1682906 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Diarrhoea, Systemic lupus erythematosus, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Systemic lupus erythematosus (narrow), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Patient stated that she can provide a list of medication if needed
Current Illness:
Preexisting Conditions: patient stated she can provide a detail list bc she had many medical conditions Lupus Diabetes COPD hypertension
Allergies: Latex Penicillin Iodine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated that she had no reaction from the first vaccine. Patient stated that her air ways was cut off and her Lupus flared up and she ended up in the hospital. Patient received the booster shot and she had five days of loose stool and her air ways was closing. Her throat was closing up. Patient went to the Dr. on 9/8/21. DR. called 911 and sent her right to the ER.


VAERS ID: 1682923 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039C21A / 1 LA / IM

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

Write-up: Patient under 18 yo


VAERS ID: 1682950 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA BAYFRONT MODERN / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chills, Fatigue, Headache, Myalgia, Pain, Sleep disorder
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: liothyronine. liothyroxine, premarin, montelucast, guifenecsin, aspirin 81 mg., zyrtec., multivitamins, acidopholis probiotic, prednisone,proair albuterol inhaler, albuterol and sodium chloride by inhalation
Current Illness: COPD with bronchiectasiis
Preexisting Conditions: COPD with bronchiectasis
Allergies: keflex, bactrim, some probiotics
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 8 hrs. after injection began to have severe chills, bundled up, took sleeping pill and went to sleep. Woke multiple times during night with aching muscles and joints. Early AM awoke with chills gone but increased body ache, temp 99.8, headache. Symptoms persisted during that day and evening with feeling of total fatigue which kept me in bed all day. Tylenol 500mg. gave some relief. Slept better that night and were improved enough to return home.


VAERS ID: 1682956 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Echocardiogram, Joint stiffness, Pain, Pain in extremity, Peripheral swelling, Ultrasound scan normal
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fenofibrate, levothyroxine, xyzal, montelukast, pantoprazole. Naturemade B-complex, turmeric, women''s one a day prenatal vitamins, D3, cranberry.
Current Illness: Diverticulitis and Uti 2 weeks before and was treated 2 weeks before with cipro and Flagyl.
Preexisting Conditions: Hashimotos, PCOS, High triglycerides, endometriosis, allergies to the above listed.
Allergies: Surgical tape, amoxcicillian, pollen, ragweed, grass, mustard seed, mangoes, apples, peanuts, tree nuts
Diagnostic Lab Data: A few hours before getting the injection I had a heart ultrasound done and had a visit and bloodwork weeks before. Nothing was amiss or unusual that would cause swelling and pain in my legs and feet like I was experiencing. After dealing with the usual swelling and pain I spoke with the Cardiologist''s office and everything was perfect healthwise with my scan and I have never had swelling like this before so I was advised to contact the CDC.
CDC Split Type:

Write-up: I recieved the shot around 12pm and after a couple hours my arm felt really sore I got achy and felt stiff in my joints. Then my legs and feet were extremely swollen around 9pm that same night and it was painful it felt like my legs were being squeezed tightly. It continued for 3 days and after the three days it went away.


VAERS ID: 1682976 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / SYR

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

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

Write-up: Hives at injection site noticed at 9pm, Claritin given, 9:30pm hives spread to neck and back, Benadryl given. Symptoms resolved 11pm.


VAERS ID: 1683009 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-08-30
Onset:2021-09-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / 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? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Hives


VAERS ID: 1683015 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-09-03
Onset:2021-09-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / UNK RA / IM

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

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

Write-up: Patient came in to clinic requesting second covid vaccine. He stated he lost his vaccine card but received Pfizer for the first dose. Dose was not verified by the nurse administering vaccine. Pfizer vaccine was administered, however patient received Moderna vaccine for the first dose.


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