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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 29 out of 8,010

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VAERS ID: 1775153 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE33592 / 3 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Axillary pain, Dizziness, Immediate post-injection reaction, Injection site pain, Myocarditis, Oedema, Pain, Pericarditis, Swelling, Tenderness, Ultrasound scan
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: 72-year-old male status post covid vaccine 3 days ago presenting with right axilla pain and swelling. Tender nodule and ultrasound showing small edema around reactive lymph node. Patient states that immediately after the vaccine he felt very lightheaded, everything went dark and felt like he was going to pass out. Patient denied chest pain or shortness of breath. Suspect pericarditis or myocarditis.He has had pain in the right arm (deltoid) where the shot was given, radiating to his neck , axilla, and right pectoral region. No signs of cellulitis or abscess. He was given medications for pain management and will follow up for repeat evaluations by his PCM in the next 2-3 days.


VAERS ID: 1775166 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-09-25
Onset:2021-10-06
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pregnancy test- negative. Not on birth control pills
CDC Split Type:

Write-up: Menstruation delay from October 5.


VAERS ID: 1775175 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Musculoskeletal stiffness, Pain, Pain in extremity, Skin discolouration, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: "Moderna Vaccine EUA" Stiffness in right arm, swollen and painful with pain and discoloration in fingers


VAERS ID: 1775207 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Unknown  
Location: New York  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Facial paresis, Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Immune-mediated/autoimmune disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? 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: numbness and lack of movement of right side of face


VAERS ID: 1775210 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Hyperhidrosis, Nausea, Presyncope
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: While waiting 15 minutes after vaccine, patient became light headed and dizzy, and almost passed out. He then became very hot sweaty and nauseous. Had patient sit, wait, and use cold compress, water, and ate a granola bar. He stay 30 to an hour afterwards and then was feeling better


VAERS ID: 1775218 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-09-24
Onset:2021-10-06
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arteriogram coronary abnormal, Cardiomegaly, Chest pain, Dyspnoea, Fibrin D dimer, Pulmonary embolism, Right ventricular dysfunction, Systolic dysfunction, Ventricular hypertrophy
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Other ischaemic heart disease (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Simvastatin, amlodipine, levothyroxine, sertraline
Current Illness: No acute illnesses
Preexisting Conditions: hypertension, GERD, hyperlipidemia, IBS
Allergies: No known drug allergies
Diagnostic Lab Data: 10/6/21 CT angiogram of the chest - The heart is mildly enlarged. There is reflux of contrast into the inferior vena cava and hepatic veins. The left ventricle appears small with thickened wall. The aorta is not enlarged. Extensive pulmonary emboli are present bilaterally. Emboli are present distally in the right and left main pulmonary arteries with extension into all five lobes. 10/6/21 D-dimer - 8.33
CDC Split Type:

Write-up: On 10/6/21, patient developed acute chest pain and dyspnea. She was found to have a sub-massive pulmonary embolism (present in bilateral pulmonary arteries with extensive extension into all 5 lobes) causing significant right ventricular strain and subsequent decreased right ventricular systolic function.


VAERS ID: 1775223 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-04
Onset:2021-10-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: left axillary adenopathy


VAERS ID: 1775230 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 091D21A / 3 AR / IM

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

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

Write-up: Patient presented to the pharmacy on 10/08/21 and expressed concern over her arm following her third Moderna vaccine. She stated that her arm that she received the vaccine in is red, swollen, and itchy. She stated that the redness and swelling had spread from the localized injection site extending down to her elbow. She stated that she had brought this to the attention of her physician at the first occurrence of the redness and swelling.


VAERS ID: 1775239 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2888 / UNK LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Extra dose administered, Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: Atenolol; Chlorthalidone; AMBIEN; Aspirin
Current Illness: Diabetes; High Pressure
Preexisting Conditions:
Allergies: No
Diagnostic Lab Data: No
CDC Split Type:

Write-up: It has been 5 days since I had the 3rd dose of PFIZER, the area is swollen, red with itchiness and hot.


VAERS ID: 1775270 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR - / UNK LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK LA / IM

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

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

Write-up: patieht came in 10/9/2021 said that he had gotten 3 vaccines on 10/5/2021 as listed above and the next day 10/6 started developing signs of cellulitis, Patient went to his primary on 10/8/2021 and she sent him directly to the ER. HE was admitted overnight with IV antibiotics and released today 10/09/2021 on oral antibiotics


VAERS ID: 1775333 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-04
Onset:2021-10-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Lymph node pain, Lymphadenopathy, Pain, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin 150mg XL one tablet daily Zyrtec 10mg one tablet daily Nexium OTC Cranberry supplement Multivitamin
Current Illness: None
Preexisting Conditions: None
Allergies: Zoloft and Hydrocodone
Diagnostic Lab Data: None at the moment
CDC Split Type:

Write-up: Severe swelling in the area of the left clavicle at the supraclavicular lymph nodes. The swelling is severe, painful, and causing pain to shoot down left arm and into finger tips at times. Cannot lay on left side at night when sleeping due to severe pain and pressure that starts in the clavicle area and shoots down arm and into finger tips. On the morning of October 8th woke up with swelling on back side of left arm, in armpit area, and also in the left groin area, but not severe like the clavicle region. Currently using warm compresses, Motrin ranging from 600mg to 800mg taken twice daily. Also have applied KT tape with the hope that it will help relieve some of the inflammation. Currently waiting to see if swelling will go down and not sure what outcome will be at this time.


VAERS ID: 1775384 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Headache, Hypersensitivity, Lethargy, Pruritus, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu, IVIG sub q,
Other Medications: Protonix, ubrevly, relpax, neurontin, maxalt, Adderall, metropol,
Current Illness: Migraine
Preexisting Conditions: Ascending aortic aneurysm and bicuspid valve disorder
Allergies: IVIG - several times 5 Sub q infusion x2 Iron infusion x3
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives, bumps, redness and allergic reaction with itching, massive headache and lethargic for days after


VAERS ID: 1775447 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Balance disorder, Dizziness, Tinnitus
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hearing impairment (narrow), Vestibular 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: None
Current Illness: None
Preexisting Conditions: Occasional sessional allergies, prediabetic,
Allergies: None
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: Dizziness, buzzing sound in ears, disequilibrium


VAERS ID: 1775483 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: New York  
Vaccinated:2021-09-29
Onset:2021-10-06
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? 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: 10.08.2021 and 10.09.2021
CDC Split Type:

Write-up: Hospitalized with determination of pericarditis


VAERS ID: 1775496 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-10-06
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypoaesthesia, Mobility decreased, Seizure, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zinc. d3. Vitamin C.
Current Illness:
Preexisting Conditions: Chrons disease
Allergies:
Diagnostic Lab Data: Monitored by a doctor to be aware of blood clots. Have had a metal toxicity detox treatment.
CDC Split Type:

Write-up: Violent convulsions the night I got the shot for 3 hours. Could not stop shaking couldn?t open fingers. The Wednesday after 10/6 woke up at 6:30 am with both legs numb knees down. During the day the numbness moved up my left thigh. Today, 10/10 my legs are still numb and can?t feel them.


VAERS ID: 1775504 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-05
Onset:2021-10-06
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Atypical pneumonia, COVID-19, Chest X-ray abnormal, Fall, Malaise, Pneumonia, Pyrexia, Rib fracture, SARS-CoV-2 test positive, Traumatic haemothorax
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Osteoporosis/osteopenia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ASA, atorvastatin, vit D, glimepiride, insulin lispro, metoprolol, naproxen, olmesartan, HCTZ, stagliptin
Current Illness: none
Preexisting Conditions: DM, HTN, HLD, emphysema, osteopenia, hiatal hernia
Allergies: metformin
Diagnostic Lab Data: CXR: + atypical PNA, PCR + 10.6.2021
CDC Split Type:

Write-up: initial presentation for fall w/ rib fx, hemo/PTX. developed symptomatic covid symptoms, fevers, PNA,


VAERS ID: 1775516 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-04
Onset:2021-10-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bell's palsy, Physical examination
SMQs:, Hearing impairment (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: Atorvastatin
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Full exam at personal physician''s office
CDC Split Type:

Write-up: Bells Palsy after booster !!!!!


VAERS ID: 1775525 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-25
Onset:2021-10-06
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 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? 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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1775528 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-13
Onset:2021-10-06
   Days after vaccination:235
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Adverse event, 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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1775568 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-04
Onset:2021-10-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Lymph node pain, Lymphadenopathy, Pain in extremity
SMQs:, 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:
Current Illness:
Preexisting Conditions:
Allergies: Penicillin, dust
Diagnostic Lab Data: No tests, I did not seek treatment
CDC Split Type:

Write-up: Two days after receiving my shot I started to get pain in my arm. Almost felt like when you have arthritis and it?s going to rain out and your bones are bothering you. The pain started to get worse and worse very quickly. To the point I had to take Tylenol. Then the next morning, my armpit was extremely swollen and hurt to the touch. Hurt to even put deodorant on. And the pain in my arm continued. It was extremely uncomfortable and the swelling and pain went on till yesterday, Saturday October 9th. Which was 5 days after my covid vaccine. Today, October 10th is the first day I do not have any swelling or pain. Four other co-workers of mine had the exact same reaction but just never reported it. Theirs started on day 2 as well. However mine lasted 2 days longer than theirs did and I was in more pain than theirs. However I am a smoker so that could be the reason. Tylenol is what I took for pain every day.


VAERS ID: 1775570 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-04
Onset:2021-10-06
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 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? 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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series


VAERS ID: 1775629 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-30
Onset:2021-10-06
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 1 RA / SYR

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

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

Write-up: A week after the start of dizziness that feels like vertigo.


VAERS ID: 1775701 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-09-01
Onset:2021-10-06
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cholestyramine
Current Illness: ear inflamation
Preexisting Conditions: in remission for Non Hodgkins lymphoma
Allergies: Latex allergy
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Oct 6, went to Health clinic for a rash, prognosis contact dermatitis or shingles. Rash worsened and started prescription for Valtrex


VAERS ID: 1775879 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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

Write-up: severe upper left abdominal pain for 2 days


VAERS ID: 1776030 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-10-06
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Insomnia, Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20211016087

Write-up: INSOMNIA; WORSE PAIN; This spontaneous report received from a patient via a company representative concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. The patient''s past medical history included: covid-19 infection. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose, start therapy date were not reported for prophylactic vaccination. The batch number was not reported. The company is unable to perform follow-up to request batch and lot numbers. No concomitant medications were reported. On 06-OCT-2021, the patient experienced insomnia. On 06-OCT-2021, the patient experienced worse pain. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the insomnia and worse pain was not reported. This report was non-serious.


VAERS ID: 1776084 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Pain in extremity, Product preparation issue, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad), Medication errors (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: None
CDC Split Type:

Write-up: Vaccine vial was diluted with 0.8 ml instead of 1.8 ml. the patient received the correct volume of a less diluted vaccine. - Wednesday october 6, 2021 - patient received the dose at 11am - Wednesday October 6, 2021 - Patient was made aware of the mistake at around 1pm - Thursday October 7, 2021 - Patient reported some fever ( max 103.7F), repeated vomiting, chill, sore arm and being tied - Friday October 8, 2021 - Patient temperature was normal, no more fever, no vomiting, no chill. patient''s arm was still sore and patient remained "a little tied".


VAERS ID: 1776302 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-04-02
Onset:2021-10-06
   Days after vaccination:187
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 UN / IM

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

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

Write-up: Tested Positive for Covid


VAERS ID: 1776323 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anxiety, Back pain, Chest pain, Chills, Dyspnoea, Dysstasia, Gait disturbance, Muscular weakness, Myalgia, Pyrexia, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (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 (broad), Cardiomyopathy (broad), 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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: fever, chills, shaking, SOB, chest pain, anxiety, muscle aches, back pain, leg weakness, difficulty standing and walking


VAERS ID: 1776390 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adverse reaction, Arthralgia, Electrocardiogram normal, Feeling hot, Full blood count normal, Hypoaesthesia, Metabolic function test, Myalgia, Pain in extremity, Pyrexia, Troponin I normal
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Arthritis (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 10/6/21 ER course included CBC, troponin, BMP, and EKG. All returned negative and r/u MI. Was informed this was an adverse reaction to the vaccine, that this is one providers are seeing more and more just not reported.
CDC Split Type:

Write-up: left arm numbness that started about 12 hours after 2nd COVID Pfizer vaccination. Injection site was left deltoid. Took ibuprofen 600 mg at 0600 on 10/6/21 to assist with side effect/symptoms of arm soreness/muscle aches/fever etc. about 1700 on 10/6/21 developed severe entire left arm numbness in left arm except left hand felt like it was on fire and numb and left elbow was painful like a severe muscle stain. Took 1000 mg of Tylenol to help with pain, this did not help at all. Pain continued to intensify in left elbow for the next hour without any relief. Went to ED to rule out heart issues such as myocarditis or myocardial infarction (strong family history of MI) because there was no relief from OTC treatment.


VAERS ID: 1776442 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 049E21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Breast swelling, Injection site pain, Injection site swelling, Neck pain, Oedema peripheral, Peripheral swelling, Pyrexia, Swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, Isosorbide Dinitrate, Simvastatin, Etodolac, Vitamin D, Zinc
Current Illness: NONE!!!!!!!
Preexisting Conditions: Heart disease
Allergies: Ceclor, Silver Sulfadiazine
Diagnostic Lab Data: I''m going to the doctor today at noon.
CDC Split Type:

Write-up: Starting on 10/6/2021 I had swelling under my left arm and a 102 fever. I took Tylenol for the fever. On 10/7/2021 and continuing, I still have the swelling under my arm which has gone into my left breast, my left breast is visably swollen, there is more swelling on my left sholder into my neck and down my back. My left arm is swollen and the sleeves of my shirts on the left side are noticibly tighter than on the right, my bicep is swollen and is painful. I feel pain in my neck, most likely from the swelling.


VAERS ID: 1776497 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-29
Onset:2021-10-06
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050E21A / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Eye pruritus, Injection site erythema, Injection site rash, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Redness and rash to injection site remaining after 2 weeks Patient''s eyes itching and face is itching


VAERS ID: 1776532 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0177 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Arthritis, Condition aggravated, Inflammation, Interchange of vaccine products, Pain, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Systemic lupus erythematosus (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Medication errors (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pt''s routine meds
Current Illness: chronic arthritis
Preexisting Conditions: chronic arthritis and neck pain
Allergies: hydroxychloroquine and methotrexate
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Pt rcv''d COVID vaccine Moderna 1st dose 01/28/2021, 2nd Moderna 02/25/2021, then rcv''d in error Pfizer for 3rd dose on 10/05/2021. Pt then seen here at clinic on 10/09/2021 with what provider states trigger of pt'' s arthritis inflammation response. Hands swollen, pain in joints especially hands and knees. Pt rcv''d RX prednisone and toradol for inflammation and pain.


VAERS ID: 1776543 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-17
Onset:2021-10-06
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Mental status changes, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No Known
Allergies: Enbrel
Diagnostic Lab Data: Covid + 09/05/2021
CDC Split Type:

Write-up: Breakthrough Covid + 65-year-old female who was brought to the emergency room by her daughter for chief complain of change in mental status. Patient continues to describes symptoms as cough and shortness of breath, and with a well known history of chronic obstructive pulmonary disease and cardiac conditions patient was referred approximately 2 days ago for IV concentrated antibodies treatment.


VAERS ID: 1776555 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-04
Onset:2021-10-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Extra dose administered, Haematochezia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (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: 2nd Covid shot 3/18/2021
Other Medications: Losartan, metoprolol,pantoprozole,atorvastatin
Current Illness: None
Preexisting Conditions: Arthritis
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: On Wednesday 10/4/2021 (2 days after my Pfizer booster shot) I had a bowel movement and noticed a great deal of blood in the bowl. I was extremely nervous until I realized I had a similar experience 6 months earlier. That?s when I had my second shot. I immediately googled ?Covid vaccine blood in spool?. The search returned Thrombocytopenia or a drop in platelets. In both instances it only occurred once. Needless to say I was very relieved.


VAERS ID: 1776558 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-20
Onset:2021-10-06
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD
Allergies:
Diagnostic Lab Data: COVID 19 PCR = positive
CDC Split Type:

Write-up: Patient presented to the ED on 10/6/2021 with cough and shortness of breath post COVID-19 exposure. Pulse ox was 80% and he was started on oxygen (4 L nasal cannula), dexamethasone PO daily x 10 days, and remdesivir x 1, then daily x 4 days. As of 10/11/2021, patient is still in the hospital on oxygen.


VAERS ID: 1776560 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-10-01
Onset:2021-10-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / UNK - / SYR

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

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

Write-up: Severe rash on trunk of body. Started small around the belt line area and has spread to the entire abdominal and chest area, back, arms out to the elbow and mid thigh.


VAERS ID: 1776582 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Extra dose administered, Fatigue
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: pfizer 1st and second doses
Other Medications: levothyroxine
Current Illness: no
Preexisting Conditions: no
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Rigors, extreme fatigue x 48 hours


VAERS ID: 1776607 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 391308A / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Injection site pain, Insomnia, Loss of personal independence in daily activities, Malaise, Nausea, Night sweats, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: L-METHYLFOLATE; ADDERALL, LITHIUM BICARBONATE, LAMICTAL, LIBRIUM, LATUDA, LIBRIUM, LIPITOR, VASCEPA, MENS MVI, VIT-D3.
Current Illness: NONE.
Preexisting Conditions: ASTHMA/EXERCISE-INDUCED, BIPOLAR DISORDER/TYPE II.
Allergies: PENICILLINS, AMOXICILLINS.
Diagnostic Lab Data: CLINICALLY OBSERVED. NO TESTS/INVESTIGATIONS PERFORMED, THROUGH TIME AND DATE OF SUBMISSION ONLY.
CDC Split Type:

Write-up: INJECTION SITE PAIN/SORENESS; INSOMNIA x1 DAYS; NIGHT SWEATS x2 DAYS; INSOMNIA x2 DAYS; SUBJECTIVE FEVER x2 DAYS; SEVERE HEADACHE, CONSTANT; NAUSEA, CONSTANT; VOMITTING, x2 INSTANCES, MALAISE, CONSTANT; FATIGUE, CONSTANT; ALL INTERFERE WITH AND/OR PREVENT ADL. AEs CURRENT THROUGH TIME AND DATE OF SUBMISSION ONLY. NOT YET RESOLVED.


VAERS ID: 1776639 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-13
Onset:2021-10-06
   Days after vaccination:176
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0164 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19 pneumonia, Cough, Dyspnoea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atenolol, ibrutinib, kenalog cream, norvasc, losartan-hctz
Current Illness: none
Preexisting Conditions: CKD3, HTN, lymphoma, BPH
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID19 PNA sob, cough, fever. pt now admitted requiring HFNC


VAERS ID: 1776650 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-09-27
Onset:2021-10-06
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN9581 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FFE839 / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Gingival bleeding, Gingival swelling, Glossodynia, Tongue discolouration, Tongue disorder
SMQs:, Angioedema (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal allergic conditions (narrow), Gingival disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow)

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

Write-up: Developed sores on bottom side and top of tongue. Tongue turned white and is sore. Hurts when eating. Gums also swollen and some bleeding. Developed a week after 3rd shot was given. Using mouthwash but not getting any better.


VAERS ID: 1776684 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PFIZER 301308A / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Nodule, Pruritus, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Red swollen knot.Tender and itchy.


VAERS ID: 1776699 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-27
Onset:2021-10-06
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 6205 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER 8727 / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Confusional state, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: diabets, hypertension, schizophrenia, chronic kidney disease on dialysis 3x/week
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: developed COVID 10/06/2021 including myalgias, chills, and confusion. Admitted to hospital on 10/07/2021. Discharged to home on room air on 10/09/2021


VAERS ID: 1776732 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chest discomfort, Dyspnoea, Heart rate irregular, Sensation of foreign body
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: tight in chest, unable to get a deep breath, feeling of lump in throat when attempting to take deep breath, irregular heartbeat


VAERS ID: 1776744 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Arthralgia, Ear pain, Fatigue, Feeling abnormal, Headache, Injection site induration, Lymphadenopathy, Ocular hyperaemia, Oral discomfort, Pain, Peripheral swelling, Throat irritation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: says she reacted to the flu shot 10 years or so ago
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Patient reports that she took some Benadryl and Tylenol, but she did not seek medical treatment/attention. I did tell the patient that she should follow up with her physician.
CDC Split Type:

Write-up: Received the shot in the morning or 10/6/21 and adverse event started the same afternoon and continued to progress. Her symptoms are improving but still ongoing. She says today, 10/11/21, is the first day she feels better. She reports that she took some Benadryl and Tylenol, but she did not seek medical attention. Symptoms included: -mouth/throat felt like it''s on fire -ears felt like they were going to burst -glands swollen, body aches, and all joints hurt -couldn''t open her hands -eyes bloodshot -swollen arm/hard at injection site and down arm towards elbow -feels like she is in a fog -headache and upset stomach -tired


VAERS ID: 1776906 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 439902 / 3 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Feeling abnormal, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (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: The same but statred earlier and over MUCH sooner
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: pennicillan
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever didn''t start till around midnight, 10/6. 100.6 was highest point. Fever was gone by 10 AM, 10/7 but returned early afternoon. Stayed over 100 till after mid night and "slowly" broke till gone by 9AM, 10/8. Felt like I''d been run over by a bus the rest of the day and was some better Saturday. Back to normal routine yesterday.


VAERS ID: 1777084 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / UNK LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7377KA / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: rash on chest


VAERS ID: 1777107 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Heart rate increased, Lymphadenopathy, Lymphoedema, Pain, Tachycardia, Ultrasound scan
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: I take losartan 25 mg daily for hyper tention. 1 a day vitamins, I take one aspirin 325 daily. I take a probiotic daily.
Current Illness: No.
Preexisting Conditions: I periodically have a outbreak herpattic on my left buttocks, every so often.
Allergies: No.
Diagnostic Lab Data: They did a ultrasound, ny pulse came down to 90. They offered , but i declined a EKG. Because I had one two months ago. Also two moths ago I had a cardiac monitor for five days. This was six weeks after my 2nd dose I developed a irregular heart rate. The monitor showed irregularites and tachycardia.
CDC Split Type: vsafe

Write-up: In my left armpit woke up with swollen lymph nodes on the 6th . On the 7th I noticed I had lyphadema on my left arm and moved down y left breast. The next day the pain was down my pain in the form of pain. I was treated, I have a rapid heart rate of 120. and my sat was 97, my respiration was 16 my temputure was 98.0 and I weigh 132 pounds. I was diagnosed by the dr withn tachycardia and lymphodema.


VAERS ID: 1777127 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-01-19
Onset:2021-10-06
   Days after vaccination:260
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 10/8 SARS/COV-2, NAAT, Positive
CDC Split Type:

Write-up: Breakthrough COVID


VAERS ID: 1777143 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin cleomiacin
Diagnostic Lab Data: I have an appointment at the women?s clinic for next Tuesday the 19th but have not been able to get any tests done today.
CDC Split Type:

Write-up: I finished my last period right before my first dose of the Pfizer vaccine, got my first dose September 14th and my second dose October 5th at the pharmacy, and was supposed to start my period the 6th of October. I have never started my period since then and have never missed a period in my life. I am not pregnant and took many tests to confirm that. I also haven?t been sexually actively since my last period. I have had very regular periods since I was 13 and have never missed. I have no stress, have not lost weight, have not changed up my schedule, or done anything else that could possible change my cycle. The only thing that has changed in my life from my last period to this one is the Pfizer vaccine.


VAERS ID: 1777349 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 RA / IM

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

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

Write-up: PATIENT WAS INSTRUCTED TO REMAIN SEATED FOR 15 MIN. APPROXIMATELY 5 MIN AFTER VACCINE GIVEN PT PASSED OUT FORWARD On CHAIR COMPLETELY HUNCHED OVER. When I came and checked on him he was pale and sweating profusely. I gave the patient a cold compress and some water and the patient started to regain coloring and upright. I offered to call paramedics but patient refused. Patient stated for approx 30 min, then said he felt alot better and felt he was ok to go. I asked him to walk around the store to be sure first. His friend gave him a ride home.


VAERS ID: 1777803 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-03
Onset:2021-10-06
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: Missed period for cycle following 2nd vaccine dose


VAERS ID: 1777950 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 LA / IM

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

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

Write-up: Left axillary lymphadenopathy and pain at onset 10/6/21, gradually improving and no longer painful.


VAERS ID: 1778395 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-01
Onset:2021-10-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Basilar artery occlusion, Brain stem infarction, Magnetic resonance imaging head abnormal
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: metformin, lisinopril, glimepiride, spironolactone, levothyroid, novilin reg insulin
Current Illness: none
Preexisting Conditions: Diabetes, hypertension, hyothyroidism, PCOD
Allergies: none
Diagnostic Lab Data: MRI brain w/o contrast
CDC Split Type:

Write-up: Small left para midline pontine acute infarction with the basilar artery territory infarction


VAERS ID: 1778816 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-05-12
Onset:2021-10-06
   Days after vaccination:147
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 UN / SYR

Administered by: Public       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: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies: Unknown
Diagnostic Lab Data: Antigen test taken on 10/08/2021
CDC Split Type:

Write-up: Patient contracted COVID-19


VAERS ID: 1778819 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-01
Onset:2021-10-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / SYR
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Condition aggravated, Contusion, Eye contusion, Fatigue, Headache, Memory impairment, Nasal oedema, Skin laceration, Suture insertion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: experienced chills, headache with dose 2
Other Medications: ASA 81 mg Omeprazole 20 mg Lutein 20 mg Amlodipine 2.5 mg Ambien 10 mg Gabapentin 100-300 mg bisphosphonate calcium/vitamin D azelastine flonase
Current Illness: none
Preexisting Conditions: insomnia osteopenia degenerative disc disease back
Allergies: nka
Diagnostic Lab Data: Dr at walk-in clinic gave me a tetanus-diphtheria
CDC Split Type:

Write-up: Wednesday night I started experiencing pretty severe chills (had happened with dose #2 so I was expecting it). Chills off and on through Thursday. Headaches. Tiredness. At some point Friday I fainted (had not happened before), but do not remember many details. I called a friend to pick me up & take me to walk in clinic. I do not remember much from that visit. My friend would be very happy to provide additional details as my memory is foggy. The gash required 3 stitches which come out Thursday. I have a black eye, swollen nose (not broken), contusions on both elbows, and a huge bruise on one hip. My permanent damage will be an unsightly scar across my forehead.


VAERS ID: 1778829 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Headache, Rash, Rash pruritic, 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: Pfizer
Other Medications:
Current Illness:
Preexisting Conditions: Heart disease t, thyroid Hypothroid.
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: skin rashes on both arms, groin area and legs . Patches of itchy bumps and area of raised, red itchy hives. Still have thse bumps today 10/12/2021 Fever over 100 degrees the following day 10/7/2021. gnawing headache for 4 days 10/7/2021 to 10/10/2021


VAERS ID: 1778841 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-01
Onset:2021-10-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Coordination abnormal, Feeling abnormal, Pain in extremity, Thinking abnormal, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Brief fainting and loss of ability function on the side of injection shot upon waking the morning after, chest heaviness that la
Other Medications: None.
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin, latex
Diagnostic Lab Data: None as of yet.
CDC Split Type:

Write-up: Hand/Arm/muscle tremors and hand incoordination. I am noticing that I am now struggling with muscle coordination in my hands/fingers/arm muscles. There is also a lot of brain for or loss of thought after receiving the vaccination. There was also some arm soreness but that was expected.


VAERS ID: 1778853 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2021-09-22
Onset:2021-10-06
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Postmenopausal haemorrhage, Urine analysis, White blood cell count decreased
SMQs:, Haematopoietic leukopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Phentermine 30 mg
Current Illness:
Preexisting Conditions: iron deficiency anemia
Allergies: N/A
Diagnostic Lab Data: Thinking I had an UTI I went to a local MedExpress on 10/10 and urinalysis only showed red blood cells with only a trace of white blood cells and no nitrates, no fever. No other test performed.
CDC Split Type:

Write-up: I am post menopausal and I started my menstrual cycle 14 days post first dose of Covid vaccine. I have been bleeding for 7 days and at present have not stopped. Today''s date is 10/12. The start date of menstrual cycle was 10/6. Thinking I had an UTI I went to a local urgent care on 10/10 and urinalysis only showed red blood cells with only a trace of white blood cells and no nitrates, no fever.


VAERS ID: 1778875 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-09-30
Onset:2021-10-06
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 UN / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Alanine aminotransferase normal, Albumin globulin ratio, Aspartate aminotransferase normal, Bacterial test, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium decreased, Blood chloride normal, Blood creatinine normal, Blood fibrinogen increased, Blood glucose normal, Blood lactate dehydrogenase normal, Blood potassium normal, Blood smear test abnormal, Blood sodium normal, Blood urea normal, C-reactive protein increased, Carbon dioxide normal, Condition aggravated, Decreased appetite, Furuncle, Gamma-glutamyltransferase normal, HIV test negative, Hepatitis viral test negative, International normalised ratio normal, Liver function test normal, Metabolic function test normal, Nitrite urine absent, Platelet count decreased, Pyrexia, Red blood cell sedimentation rate increased, Red blood cells urine positive, SARS-CoV-2 test negative, Thrombocytopenia, Urinary sediment present, Urinary tract infection, Urine analysis abnormal, Urine leukocyte esterase positive, Weight decreased, White blood cell count increased, White blood cells urine positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Haematopoietic thrombocytopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ibuprofen, Tylenol, Vitamin D3, Vitamin B complex, glucosamine, omega fatty acids
Current Illness: Had an episode of fever, chills, and muscle aches 9/25 that self-resolved prior to getting the COVID booster.
Preexisting Conditions:
Allergies: Childhood allergy to penicillins
Diagnostic Lab Data: 10/6: wbc 19.4, Hb 15.3, plts 24. Na 139, K 3.8, Cl 102, CO2 25, BUN 16, Cr 1.0, Ca 8.9. Glucose 112, AG 12. Tbili 0.9, alk phos 61, AST 21, ALT 26, LDH 174, GGT 20. CRP 174, ESR 29. HIV negative, acute hepatitis panel negative. UA: moderate blood, 11-25rbc, $g100 wbc, large leuk esterase, neg nitrites, many bacteria, rare squamous epithelial cells. 10/6 evening: wbc 15.98, Hb 14.1, plts 24. 10/7: Peripheral smear: rbc wnl, wbc mild neutrophilic leukocytosis, plts severe thrombocytopenia with normal platelet morphology 10/8: INR 1.1. Fibrinogen 646. Wbc 10, Hb 13.9, plts 51.
CDC Split Type:

Write-up: Had an episode of fevers/chills/muscle aches on 9/25 that self-resolved. After the booster shot 9/30, fevers returned and were persistent until 10/6 to 102-103 degrees. See ROS as below. Wasn''t seen by a physician until 10/6. WBC were 19 and platelets found to be in the 20s on labs. Concern for ITP. LFTs, BMP unremarkable. INR normal with elevated fibrinogen to 646. Peripheral smear with no evidence of hemolysis, just thrombocytopenia. CRP 174. ESR 29. HIV, hepatitis panel negative. UA consistent with UTI. Prescribed empiric course of doxycycline 100mg BID for 10 days to cover tick illnesses. Also prescribed cefpodoxime 200mg BID for 10 days for complicated UTI. Platelets 10/8 improved to 51. - Pertinent negatives: Congestion, cough, shortness of breath, chest pain, n/v, diarrhea, rashes, joint pains (aside from chronic OA of both knees), sick contacts, dysuria. - Pertinent positives: Decreased appetite, weight loss (205-$g197 pounds). Did endorse epigastric abdominal pain this morning. Had a small boil on his buttocks that occasionally drains, no surrounding erythema. He was tested for COVID with negative results. No recent animal exposure, just 2 dogs. Went hiking around 9/25 but doesn''t know of any tick bites. No recent travel except in early September.


VAERS ID: 1778940 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Military       Purchased by: ?
Symptoms: Cough
SMQs:, Anaphylactic reaction (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: cough


VAERS ID: 1778974 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 067C21A / 1 LA / IM

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

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

Write-up: Teen age 16 given Moderna vaccine-under age for this particular vaccine according to requirements/recommendations


VAERS ID: 1779015 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-29
Onset:2021-10-06
   Days after vaccination:160
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Atelectasis, COVID-19, COVID-19 pneumonia, Computerised tomogram thorax abnormal, Lung disorder, Lung opacity, Pleural effusion
SMQs:, Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amoxicillin-potassium clavulanate, atorvastatin, ...
Current Illness: N/A
Preexisting Conditions: Chronic atrial fibrillation, sciatica, back pain, HTN, hemorrhoids, nephrolithiasis, OA, ED, hypothyroidism, HLD, GERD
Allergies: Amlodipine
Diagnostic Lab Data: Outside provide COVID diagnosis CT: Small left pleural effusion with adjacent airspace disease/atelectasis. Perihilar airspace opacities.
CDC Split Type:

Write-up: 10/6 COVID Diagnosis 10/9 CT: Small left pleural effusion with adjacent airspace disease/atelectasis. Perihilar airspace opacities. 10/11 COVID-19 pneumonia: on Remdesivir and steroids, O2 therapy


VAERS ID: 1779030 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Blood test, C-reactive protein, Full blood count, Headache, Metabolic function test, Pyrexia, Red blood cell sedimentation rate, SARS-CoV-2 test, Streptococcus test negative
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (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? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall XR 10mg
Current Illness: None
Preexisting Conditions: Intermittent constipation; chronic abdominal pain
Allergies: No medication or food allergies
Diagnostic Lab Data: strep test: negative (10/12/21) COVID-19 PCR test: pending (obtained specimen on 10/12/21) CBC, metabolic panel, erythrocyte sedimentation rate, C-reactive protein, celiac disease antibody panel: pending (ordered 10/12/21)
CDC Split Type:

Write-up: Developed headache, abdominal pain, and low grade fever on 10/6/21. He has had no nausea/ vomiting/ diarrhea. Of note, he also received the Gardasil vaccine (dose #1) concurrently with his Pfizer COVID-19 vaccine. HPV vaccine was received in right arm, lot # T026324.


VAERS ID: 1779129 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: body aches, headache, nausea, chills, fever


VAERS ID: 1779201 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-25
Onset:2021-10-06
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

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

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

Write-up: Covid positive household contact son


VAERS ID: 1779203 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-10-01
Onset:2021-10-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test normal, Chest X-ray normal, Fatigue, Influenza virus test negative, Somnolence, Urine analysis, Urine calcium
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrochlorothiazide 25mg, Amlodipine 5mg, metoprolol ER 50mg, venlafaxine ER 150mg, aspirin 81mg, colesvelam 1875mg,alendronate 70mg once a wk and other OTC vitamins and minerals
Current Illness: UTI
Preexisting Conditions: Osteoperosis
Allergies: Penicillen
Diagnostic Lab Data: all on Oct 6, 2021: Flu test - Neg, Covid test - Neg, Chest xray - Neg, Biood panel - no elevated enzymes, Urine test - Pos for UTI and some calcium so possible kidney stones ). No pain at all
CDC Split Type:

Write-up: Beginning the night of Oct 5, I felt extremely tired. On the morning of Oct 6, I still felt very tired, became groggy and feeling as though I may be coming down with the real flu in terms of tiredness. I left the meeting I was attending abt 10:40 am, and went home. I felt more and more tired. I laid down to nap and felt crushing fatigue. I slept for 5 hours straight, awakened and had to struggle mightily to get out of bed. I again felt paralyzing fatigue. Since I live alone, I was afraid of falling asleep and never waking up. So I called 911 and was taken to the hospital.


VAERS ID: 1779215 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 RA / IM

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

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

Write-up: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-


VAERS ID: 1779224 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Headache, Heart rate decreased, Hypotension, Nausea
SMQs:, Anaphylactic reaction (broad), 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), Hypokalaemia (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: Multi vitamin, blood pressure medication, inhaler for asthma.
Current Illness: Kidney disease, asthma.
Preexisting Conditions: Kidney disease, asthma.
Allergies: Morphine, bees, hydrocodone.
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 10/06/2021 dizziness, nauseous, low blood pressure, low pulse, headache.


VAERS ID: 1779298 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-29
Onset:2021-10-06
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B212A / UNK - / -

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

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

Write-up: Covid positive contact unknown


VAERS ID: 1779324 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-08-19
Onset:2021-10-06
   Days after vaccination:48
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / UNK - / -

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

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

Write-up: Covid positive contact unknown


VAERS ID: 1779461 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: C-reactive protein increased, Chest pain, Echocardiogram normal, Electrocardiogram PR segment elevation, Electrocardiogram ST segment elevation, Fibrin D dimer increased, Magnetic resonance imaging heart, Nausea, Pericarditis, Pleuritic pain, Troponin increased, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vyvanse, oral contraceptives
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Troponins trended up to high of 84 before trending down. D-dimer elevated 0.98, CRP elevated at 78. Initial EKG normal sinus rhythm; subsequent EKG very mild ST elevations consistent with pericarditis with PR elevation. 2D echo showed normal LV systolic function and possible very trace pericardial effusion adjacent to the distal rt. ventricle, otherwise no structural heart disease.
CDC Split Type:

Write-up: Got 2nd Pfizer vaccine dose 10/5. Had nausea and vomiting on 10/6. Woke up 10/7 with diffuse sharp chest pain, pleuritic, non-radiating, non-exertional, unclear if positional. Symptoms waxed and waned into evening - coming and going 5 minutes at a time. After she received dose of Tylenol, pain dissipated completely. Came to ED, had observation admission, had cardiology consult and sent home 10/9 to f/u with cardiologist within 1 week. No further chest pain. Sent home on colchicine for at least 1-3 months, ibuprofen tid x7 days, outpt cardiac MRI, no vigorous activity 4-6 wks, f/u with cardiologist in office within 1 week.


VAERS ID: 1779625 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-04
Onset:2021-10-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
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: NO
CDC Split Type:

Write-up: SWELLING AND REDNESS ON INJECTION SITE.


VAERS ID: 1779694 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Body temperature increased, Fatigue, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: I believe I received the anthrax vaccine in the service. I was about 26 years old. I believe I developed arthritis as a result
Other Medications: Multi-vitamin and vitamin D
Current Illness: None.
Preexisting Conditions: Sleep-apnea and arthritis.
Allergies: Bacterium (medication)
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: I got a headache, a slight increase in temperature, and fatigue for the first two days. These symptoms subsided, but I have had lingering muscle and joint pain. I got the J&J COVID-19 vaccine.


VAERS ID: 1779706 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Dizziness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypertension (narrow), Vestibular disorders (broad)

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

Write-up: On 10/07/21, Patient received first dose Pfizer COVID vaccine 0.3mL. Patient stated felt lightheaded, BP elevated 153/105. Unable to obtain manual blood pressure reading. Urgent care was contacted and arrived. Patient was transferred to urgent care and subsequently discharged.,


VAERS ID: 1779886 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Feeling abnormal, Mobility decreased
SMQs:, Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin 81 mg oral tablet, delayed release 81 mg = 1 Tablet, Orally, Daily atorvastatin 10 mg oral tablet 10 mg = 1 Tablet, Orally, QPM cyanocobalamin 1000 mCg sublingual lozenge 1,000 mCg = 1 Lozenge, Sublingually, Daily Ditropan XL 5 mg/2
Current Illness: None, but had kidney stones and pulmonary embolism in July
Preexisting Conditions: Diabetes, obesity, hyperlipidemia, osteopenia
Allergies: penicillins (Swelling) Losartan Potassium (unknown) lisinopril (unknown) Social History
Diagnostic Lab Data:
CDC Split Type:

Write-up: Proximal weakness that started the next evening, difficult to get off the couch. Improving daily but still not feeling back to normal.


VAERS ID: 1779896 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 LA / UN

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Fatigue, Heart rate increased, Lymph node pain, Lymphadenopathy
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Compazine, Reglan, traMADol
Diagnostic Lab Data: Could not be determined at ER.
CDC Split Type:

Write-up: Rapid heartbeat, chest pain, shortness of breath, swollen and painful lymph nodes, extreme fatigue


VAERS ID: 1780152 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Crying, Dizziness, Dyspnoea, Inappropriate schedule of product administration, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypersensitivity (broad), 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: Pfizer dose 1, March 2021, similar response.
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Previous reaction to Pfizer Covid Vaccine Hydrocodone
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 5 minutes after pt received her 2nd Pfizer vaccine, she came out of the room and caught the attention of vaccine staff stating she felt tightness in the chest. she was escorted to the exam room and laid down on exam table. BP 112/80. Patient stated her throat started to feel like it was tightening up, and she felt short of breath. Rapid Response was called:. 1102: RRT called and patient crying and c/o chest tightness and dizziness. Patient alert and oriented. SPO2 99% RA HR 87 BP 126/84. Patient denies chest pain, sob, lip/tongue swelling, palpitations. Dr. in room assessing patient and listening to heart and lungs. Per MD no medication needed at this time. 1105: SPO2 100% HR 85 Per MD order patient may be d/c home if feeling better and VSS. Will continue to monitor. 1116: SPO2 100% RA HR 61 BP 122/84. Patient reports feeling better and denies chest pain, sob, lip/tongue swelling, dizziness, or any other s/s distress. Patient states that husband in the parking lot. Patient offered UC appt but refuses at this time. ED and 911 precautions provided with any change or worsening in condition and patient verbalized understanding with intent to comply.She was discharged shortly after additional observation by their nurse. FYI, while I was giving her her vaccine, pt reported she ended up in the ED after her first dose back in March. She had similar symptoms almost immediately after the shot that lasted a couple hours, and then it happened again 3 days later which is when she went to the ED. They told her it was most likely a panic attack and that it was fine to get the second dose.


VAERS ID: 1780322 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-03
Onset:2021-10-06
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Heart rate increased, Hypoaesthesia, Hypoaesthesia oral, Tachycardia, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad), Dehydration (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MULTIVITAMINS, SYNTHROID
Current Illness: NONE
Preexisting Conditions: HYPOTHYROIDISM
Allergies: NONE
Diagnostic Lab Data: NONE BECAUSE ASIDE FROM INTERMITTENT TACHYCARDIA, MY VITAL SIGNS HAVE BEEN OK
CDC Split Type:

Write-up: RECEIVED THE SHOT ON 10/2/21, THREE DAYS LATER FACIAL NUMBNESS OCCURRED. NOT SWOLLEN, JUST NUMB. THIS DISAPPEARED AFTER A DAY AND THEN MY LIPS BECAME NUMB FOR THREE DAYS BEFORE SUBSIDING THEN LOWER LIP CONTINUED TO BE NUMB UNTIL THIS AFTERNOON. I HAVE ALSO EXPERIENCED OCCASSIONAL RAPID HEARTBEATS THAT CAUSE MY HANDS TO SHAKE/TREMBLE BUT IT HAS SUBSIDED.


VAERS ID: 1780476 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-05-03
Onset:2021-10-06
   Days after vaccination:156
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, Chronic obstructive pulmonary disease, Condition aggravated, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol inh PRN, apixaban, atorvastatin, Advair diskus inh, furosemide, Duoneb, lisinopril, omeprazole
Current Illness:
Preexisting Conditions: COPD, HFpEF, hypertension, a flutter status post ablation on apixaban, and peripheral neuropathy
Allergies: Keflex, Levaquin
Diagnostic Lab Data: COVID status positive on 10/6/21.
CDC Split Type:

Write-up: Patient received Pfizer COVID vaccine on 4/7/21 and 5/3/21. On 10/6/21, patient was admitted to our facility with acute hypoxic respiratory failure, COPD exacerbation, and COVID infection (positive status). Patient was discharged home on 10/8/21 in good condition.


VAERS ID: 1782312 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-25
Onset:2021-10-06
   Days after vaccination:254
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Shingles diagnosis by Dr. on 10/12/2021
CDC Split Type:

Write-up: Eleven days after receiving the Pfizer booster shot I developed a painful rash on the left side of my back. This was diagnosed as Shingles. My Doctor does not think this was caused by the vaccine, however I felt the need to report. I am a healthy individual with no underlying health conditions.


VAERS ID: 1782331 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-17
Onset:2021-10-06
   Days after vaccination:203
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chest pain, Chills, Dehydration, Dyspnoea, Fatigue, Hypophagia, Myalgia, Pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hospital Hypertension Essential Primary Diabetes Mellitus Type 1 Transplant Renal Reflux Esophageal Immuno
Allergies: NKA
Diagnostic Lab Data: 10/9/2021 Patient reported +Covid test results from outside facility
CDC Split Type:

Write-up: CHIEF COMPLAINT/REASON FOR VISIT Shortness of Breath (Pt reports testing positive for Covid yesterday. Pt states he feels as though his SOB is getting worse and rates his body aches 8/10.) HISTORY OF PRESENT ILLNESS 58-year-old male past medical history of end-stage renal disease secondary to diabetic nephrosclerosis status post kidney transplant 2010 on triple immune suppression therapy, history of hypertension who is COVID positive day 4 of illness who presents with myalgia and dyspnea. Patient states over the past 3-4 days he has had progressive fatigue myalgias and weakness. Today developed some dyspnea fever and chills. He states he has had some intermittent mild chest pain. Has no history of PE DVT, CHIEF COMPLAINT/REASON FOR VISIT Shortness of Breath (Pt reports testing positive for Covid yesterday. Pt states he feels as though his SOB is getting worse and rates his body aches 8/10.) HISTORY OF PRESENT ILLNESS 58-year-old male past medical history of end-stage renal disease secondary to diabetic nephrosclerosis status post kidney transplant 2010 on triple immune suppression therapy, history of hypertension who is COVID positive day 4 of illness who presents with myalgia and dyspnea. Patient states over the past 3-4 days he has had progressive fatigue myalgias and weakness. Today developed some dyspnea fever and chills. He states he has had some intermittent mild chest pain. Has no history of PE DVT, unilateral leg swelling or redness, no recent immobilization or surgery. He has had decreased oral intake over the past several days and states he feels dehydrated. Patient has received all 3 COVID vaccines Additional information for Item 12: Hospital Hypertension Essential Primary Diabetes Mellitus Type 1 Transplant Renal Reflux Esophageal Immunodeficiency Due To Drugs Hyperlipidemia On Treatment Neuropathy Peripheral Pneumonia Due To COVID-19 Nodule Pulmonary Hyponatremia Thrombocytopenia Non-Hospital Chronic Kidney Disease NOS Hyperlipidemia Fitting Or Adjustment Of Insulin Pump


VAERS ID: 1782352 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-09-27
Onset:2021-10-06
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse reaction, Blood test normal, Body temperature increased, Cough, Diarrhoea, Dizziness, Fatigue, Feeling abnormal, Gait disturbance, Hypoacusis, Illness, Oropharyngeal pain, Pain, Pharyngeal erythema, SARS-CoV-2 test negative, Somnolence, Throat irritation
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Pseudomembranous colitis (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol Sulfate - as needed, Symbicort - 2 puffs/2xday, Phenadrine - 180mg/2xday, Acolate - 20mg/2xday, Vastatin - 5mg/1xday, Synthroid - 1xday, Omeprazole - 40mg/2xday, Gabapentin - 3/1xday, Zolare injections - once every 6 weeks, Aspiri
Current Illness:
Preexisting Conditions: Asthma, Arthritis, Allergies
Allergies: seasonal allergies to different pollens, betadine, iodine, myroxyon pereirae resin, thimerosal merthiolohe, benzol peroxide
Diagnostic Lab Data: Covid test - negative (nasal) Blood work - normal
CDC Split Type: vsafe

Write-up: I went to lunch on 10/06 and was having some hearing problems. The next day I woke up aching all over and very sleepy. On Friday 10/08, I was very dizzy and lightheaded. I had to hold onto the furniture because I felt like I was going to fall. I had a little temperature that day. Saturday morning when I woke up, I was coughing a little bit and had a sore throat. I went to Urgent Care around 2PM that afternoon. Sunday, I had diarrhea. The rest of the week I just felt really tired. On Tuesday, I had more diarrhea. The doctor gave me some antibiotic for my sore throat. They don''t believe that it was covid-19. I''m not sure if it''s a flu that I picked up or if it was an adverse reaction to the booster. The doctor said my throat was very red and raw. I am still feeling kind of bad. I am isolating for 10 days just in case. It is flu season and I have not had my flu shot yet.


VAERS ID: 1782371 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PAA166078 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Computerised tomogram normal, Dizziness, Dyspnoea, Electrocardiogram normal, Fibrin D dimer increased, Hypertension, Laboratory test, Pyrexia, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 10/08/21 at the Walk-in Clinic: Labs were drawn including the D-dimer test which was 892. EKG was done and normal. High blood pressure was 158/92. 10/08/21 Emergency Department: Labs and CT with contrast were done of lungs which showed no pulmonary embolus. It has been a week and I still feel the same with chest pain and shortness of breath. 10/13/21: Talked with Employee Health at the Hospital and let them know what all was going on with me. 10/13/21 Walk-In Clinic: pending results of Covid test to rule out.
CDC Split Type:

Write-up: High blood pressure, shortness of breath, dizziness, low-grade fever, and chest pain.


VAERS ID: 1782419 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Fatigue, Headache, Injection site pain, Lymphadenopathy, Malaise, Myalgia, Nausea, Pyrexia, Vaccine positive rechallenge, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (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: age 43, 2/16/21, Pfizer-Biontec EL9265, dose #2, same symptoms as this entry.
Other Medications:
Current Illness:
Preexisting Conditions: asthma, EDS
Allergies:
Diagnostic Lab Data:
CDC Split Type: v

Write-up: fever 104, severe nausea, frequent vomiting/heaving, headache, muscle aches, exhaustion, malaise, dizziness, arm pain at injection site, lymph node swelling on same side as injection site. Vomiting controlled after 5 hours with 8mg zofran. Acute symptoms resolved with zofran and OTC ibuprophin in 24 hours. Arm pain and lymph node swelling resolved in 7 days.


VAERS ID: 1782478 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Axillary pain, Chills, Discomfort, Disturbance in attention, Fatigue, Headache, Influenza like illness, Lymph node pain, Lymphadenopathy, Myalgia, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Humira, Hydroxychloroquine, Methotrexate, Sprintec, Omeprazole, Folic Acid, Vitamin D, diclofenac, tylenol, melatonin, montelukast
Current Illness:
Preexisting Conditions: Seronegative rheumatoid arthritis, osteo arthritis, seasonal allergies, obesity
Allergies: Ceclor, bee stings, celantro
Diagnostic Lab Data: No tests- just emailed PCP and she said this was normal.
CDC Split Type:

Write-up: The day after the vaccine, on 10/06/2021, I started getting a moderate headache around noon and felt very tired. Tylenol helped the headache a little. That evening I had chills but no fever 98.7. I was weak and felt like I had the flu. The next morning 10/7, I felt tired and had a headache but no chills until the afternoon and it continued into the evening, adding muscle aches and joint pain. My lymph nodes in my arm pit on my left side (vaccine arm) started to swell and become uncomfortable. 10/08 My arm pit became painful and swelling went into my neck and a lymph node on my left collar bone was swollen and painful. It was effecting my ability to concentrate at work. I emailed my primary care doctor and she told me this was a normal immune reaction to the vaccine and recommended using heat and tylenol to control symptoms, which I tried and did improve comfort. 10/9 I still had a headache and tired, moderate to severe joint pain, somewhat weak, and lymph nodes swollen. 10/11 both sides of my neck were mildly swollen, but not painful. All discomfort was mild for all symptoms. 10/12 mild head ache and joint pain. 10/13 just tired.


VAERS ID: 1782499 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-02
Onset:2021-10-06
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 062E21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Back pain, COVID-19, Cough, Dyspepsia, Hot flush, Nausea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: hashimotos hypothyroidism
Allergies: none
Diagnostic Lab Data: tested positive for COVID on 10/9/21
CDC Split Type:

Write-up: Started having mild nausea, heartburn, and hot flashes on 10/6/21; low back pain and mild cough on 10/9/21 and tested positive for COVID on 10/9/21


VAERS ID: 1782580 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-06-07
Onset:2021-10-06
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Diarrhoea, Ear discomfort, Headache, Pain, SARS-CoV-2 test positive, Sinus congestion
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Baclofen 10 MG Tablet 1 tablet as needed Orally three times a day Xolair , Notes: injection once a month per pt ZyrTEC Allergy 10 MG Tablet 1 tablet as needed Orally up to 4 times a day Allegra Patanol 0.1 % Solution 1 drop into
Current Illness: none
Preexisting Conditions: Seasonal allergies. Asthma. Hx of irritable bowel syndrome. anorexia nervosa - in recovery 2012 Anxiety and depression - followed by psychiatry. Bipolar disorder - followed by psychiatry. PTSD - followed by psychiatry. Insomnia. Sexual assault 2/2012. Hyperhidrosis. Hyperlipidemia. Genital herpes. Thyroiditis - 1/2017.
Allergies: Amoxicillin: hives - Allergy Augmentin: skin itching - Allergy Cefzil: rash - Allergy Cipro: rash - Allergy Drysol: Itchy - Allergy Geodon: psycotic - Allergy Lamictal: Rash - Allergy Septra: rash/fever as infant - Allergy Dye, Red: hives - Allergy NSAIDs: hives - Allergy
Diagnostic Lab Data:
CDC Split Type:

Write-up: headache, sinus congestion, right ear plugged, body aches, diarrhea, chills. starting 10/6/2021. Lives with mother and grandmother who both recently tested positive (all vaccinated)


VAERS ID: 1782690 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Back pain, Chest pain, Extra dose administered, Full blood count, Lipids, Metabolic function test, Pain, Pain in extremity, Red blood cell sedimentation rate
SMQs:, Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC, ESR, CMP, CRP, Lipid ordered on 10/13/21. No results yet.
CDC Split Type:

Write-up: Arm, back, and chest pain. Patient received the Covid vaccine booster 8 days ago and about a day later he started having pain in his left arm where he received the vaccine that moves down to his hands, pain in his back, and chest pain. Patient said it feels like sharp pains shooting through his body.


VAERS ID: 1782710 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2021-03-04
Onset:2021-10-06
   Days after vaccination:216
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anticoagulant therapy, Atrial fibrillation, Bacteraemia, Bacterial test, COVID-19, Cardiac failure congestive, Cardiomegaly, Chest X-ray abnormal, Condition aggravated, Confusional state, Coronary artery disease, Decreased appetite, Diarrhoea, Dyspnoea, Echocardiogram normal, Escherichia infection, Feeling abnormal, Hypertensive crisis, Hypothermia, Hypoxia, Imaging procedure, Nausea, Pyrexia, SARS-CoV-2 test positive, Type 2 diabetes mellitus, Wheezing
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Dementia (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID-19 test positive on 10/5/2021
CDC Split Type:

Write-up: 78 y/o male with history of combined CHF, HTN, CAD who p/w increased sob. The patient states he has been feeling poorly for some time, cannot remember exactly how long. Has had increased sob and has had increased confusion. He was here on 10/2 in the ER with similar complaints. At that time, it was deduced that he had not been taking his medications as prescribed. He was given 80 mg of IV lasix and felt improved, so was sent home. It is of note that he was afebrile at that time (actually mildly hypothermic), and was on room air, and a covid swab at that time was negative. Today he comes in febrile to 101.2, still on room air. CXR shows some cardiomegaly with chf pattern vs possible atypical pneumonia. CXR on 10/2 just showed cardiomegaly. In the ER, the patient was started on sepsis IVF, receiving almost 5L. Covid swab then came back positive and his fluids were immediately stopped, and he has been given 80 mg of IV lasix. He currently is wheezing audibly, and states that he has been doing so at home as well. He does have a history of asthma. He is currently on room air. He does endorse diarrhea and lack of appetite with nausea, but he denies any emesis. He lives at Assisted Living and his wife lives with him. He states she has no symptoms and denies any sick contacts. It is of note that he had his full covid vaccine series in March 2021, has not yet had a booster. Admission is requested. Discharged on 10/9/2021. Acute hypoxia- not likely covid driven, may be more related to heart failure based on imaging . We increased diuresis to BID 80mg furosemide. Chronic combined heart failure with possible acute exacerbation -- echo done, looks OK. as above bump up diuresis. -- gram neg bacteremia - E Coli, does appear to be urine source, await ID/sensitivities from blood to make sure match, de-escalated to cefazolin after 3 days IV therapy and can transition to PO if afebrile can go to oral abx after today''s afternoon dose - rx sent to his pharmacy. ----Covid-19 positive status- he is febrile with GI symptoms however also bacteremic - He is not hypoxic and so does not warrant any specific treatment for covid at this time. Likely exposed and positive in nasopharynx but vaccine worked. Received monoclonal antibodies 10/6 due to risk factors and has not received booster - recommend getting it in 90 days now. ----CAD- continue statin, ----pAfib- continue eliquis, sotalol, ---- HTN crisis - continue hydralazine and norvasc, resume losartan and prns, SBP up to 200, ----DM II- low dose ssi - all CBgs 181 or less, ----DVT ppx- on eliquis. Procedures and Treatment Provided. Physical Exam, Vitals & Measurements, T: 97.7 ?F (Oral) TMIN: 96.5 ?F (Oral) TMAX: 97.8 ?F (Oral) HR: 92(Peripheral) HR: 98(Monitored) RR: 23 BP: 124/64 SpO2: 93%, VITAL SIGN, LAST CHARTED, MINIMUM, MAXIMUM, Blood Pressure 124/64 (10/09 13:00) 106/62 (10/09 01:00) 174/72 (10/09 09:00) Heart Rate 92 (10/09 13:00) 60 (10/08 23:22) 92 (10/09 13:00), Respirations 23 (10/09 13:00) 19 (10/09 05:00) 26 (10/09 07:00) Temperature 96.7 (10/09 09:16) 96.7 (10/09 09:16) 96.7 (10/09 09:16) SpO2 93 (10/09 13:00) 91 (10/09 10:00) 95 (10/08 20:52) Discharge Plan Home health.


VAERS ID: 1782713 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-01-30
Onset:2021-10-06
   Days after vaccination:249
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 3518 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN 6200 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Ear pain, Fatigue, Pain, Respiratory disorder
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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

Write-up: Breakthrough COVID case. Onset was Wed. October 5. Felt like a respiratory infection that escalated. I had severe ear pain, fatigue and body aches. I received antibodies via stomach injections on Monday, Oct 11th in the evening. Starting feeling better 24-48 hours after treatment.


VAERS ID: 1782816 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-09
Onset:2021-10-06
   Days after vaccination:180
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Headache, Lymphadenopathy, Nasal congestion, Pyrexia, SARS-CoV-2 test positive, Sneezing, Vaccine breakthrough infection
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tarina Fe 24 birth control Probiotics Aloe supplement Biotin Multi vitamin Grapefruit seed extract
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID Check PCR test showed positive result. Administered October 08, 2021 1:25 PM
CDC Split Type:

Write-up: I attended an ?all vaccinated? event on Friday, 10/1. I had a mild headache beginning Monday, 10/4. On Wednesday, 10/6 I developed a severe headache, followed by nasal congestion, sneezing, swollen lymph node in throat, elevated temperature up to 99.5, and loss of smell and taste. I have been taking Advil, grapefruit seed extract, oregano oil, and xylitol nose spray to cope with symptoms. I stopped having a fever as of 10/11. I still cannot smell or taste as of 10/13.


VAERS ID: 1782867 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-02-07
Onset:2021-10-06
   Days after vaccination:241
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Polymerase chain reaction
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: cycle threshold of 20.6 on 10/6
CDC Split Type:

Write-up: Hospitalization due to COVID 19 Reported per Moderna COVID-19 Vaccine EUA


VAERS ID: 1782983 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-30
Onset:2021-10-06
   Days after vaccination:190
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Fatigue, Headache, Pain, Pyrexia, Respiratory tract congestion
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: adapalene topical HS gabapentin 100mg prn medroxyprogesterone 400mg IM q3months naratriptan daily ondansetron 4mg with migraine medication Effexor XR 150mg daily venlafaxine 75mg daily
Current Illness: 3/25/2021 ER visit for flank pain - kidney stone. 3/15/2021 ER visit for flank and back pain - kidney stone
Preexisting Conditions: Seasonal allergic rhinitis migraines anxiety
Allergies: Seasonal allergies Augmentin - Rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient contracted COVID after being fully vaccinated Cough, Congestion, Fever, Headache, Fatigue, Body Aches


VAERS ID: 1783167 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-04
Onset:2021-10-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Hallucination
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (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: none
Allergies: no
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Hallucinations (auditory). no treatment. sent to psychiatry. continue 3 times since the vaccination. last episode 10/12/21.


VAERS ID: 1783824 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Female  
Location: Virginia  
Vaccinated:0000-00-00
Onset:2021-10-06
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ear discomfort, Tinnitus
SMQs:, Hearing impairment (narrow)

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

Write-up: Last week I experienced a very big blockage pressure in both my ears it was very uncomfortable felt like something was stuck inside. It did happen couple times following the vaccine but last week was the longer lasting tried cleaning it with those ear scraper but the walls was clean. Then today I seen on the news about this condition tittius Vaccine one 7/12/21 Vaccine two 8/3/21 It was after second dose I would experience this stuffy hear but last week oct 2021 was the worse because it was ringing for short while and the stuffiness lasted about an hour unlike the other days it comes and goes


VAERS ID: 1784602 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-01
Onset:2021-10-06
   Days after vaccination:188
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8730 / 2 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6206 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, Back pain, COVID-19, COVID-19 pneumonia, Chemotherapy, Cough, Dyspnoea, Headache, Hypokalaemia, Hypoxia, Magnetic resonance imaging, Nausea, Pain, Pyrexia, SARS-CoV-2 test positive, Scan with contrast
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 325 MG tablet acyclovir (ZOVIRAX) 400 MG tablet aspirin 81 MG enteric coated tablet dexamethasone (DECADRON) 4 MG tablet Elotuzumab (EMPLICITI IV) ezetimibe (ZETIA) 10 MG tablet guaiFENesin (MUCINEX) 600 MG 12 hr tab
Current Illness: 9.17.21: reported body aches, HA, mid back pain, nausea x 4 days (to Hematology office) 9.30.21: ZOMETA INFUSION, DECADRON STEROID IV, EMPLICITY CHEMOTHERAPY INFUSION, WITH PEPCID, TYLENOL, AND BENADRYL PILLS BEFOREHAND, hypokalemic 10.6.21: MRI with contrast and COVID-19 positive
Preexisting Conditions: Dyslipidemia LBBB (left bundle branch block) GERD (gastroesophageal reflux disease) Hernia, hiatal Obesity, unspecified BPH (benign prostatic hyperplasia) HTN (hypertension) Anemia, unspecified Multiple myeloma (HCC) Stem cell transplant candidate Supraventricular arrhythmia Status post autologous bone marrow transplant (HCC) CAD (coronary artery disease) Pericardial effusion PSVT (paroxysmal supraventricular tachycardia) (HCC) Type 2 diabetes mellitus without complication, without long-term current use of insulin (HCC) Multiple myeloma in relapse (HCC) IPMN (intraductal papillary mucinous neoplasm) Dysphagia Malaise and fatigue Non-intractable vomiting with nausea
Allergies: LisinoprilCough StatinsMyalgia
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized for COVID; COVID-19 positive (10.6.21); fully vaccinated DATE OF ADMISSION: 10/06/2021 DATE OF DISCHARGE: 10/09/2021 DISCHARGE DIAGNOSES 1. COVID pneumonia. 2. Acute hypoxic respiratory failure secondary to #1. 3. Multiple myeloma, status post autologous stem cell transplant. 4. Hypertension. 5. Dyslipidemia. 6. Diabetes mellitus type 2. 7. Benign prostatic hypertrophy. HOSPITAL COURSE A 74-year-old gentleman presented to the ER with fever, weakness, and cough. See H and P for full details. Tested positive for COVID. Fully vaccinated. Received monoclonal antibody in the emergency room. Sometime after this, he developed dyspnea and hypoxia. He was then admitted to the hospital service. He was started on Solu-Medrol (has been intolerant to Decadron) and Remdesivir. Completed only 1 dose of Remdesivir as new information obtained about the duration of symptoms and was felt to be outside the window. Continued on Solu-Medrol. The patient had rapid improvement in his symptoms. He was able to eat and drink by the day of discharge. On the day of discharge, he was ambulating on room air with O2 sats no lower than 93%. He felt well and ready for discharge. He had had 3 days of Solu-Medrol and was discharged on 7 days of prednisone 40 mg daily (equivalent to 6 mg Decadron daily).


VAERS ID: 1784789 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-01
Onset:2021-10-06
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 155BA / 3 LA / IM

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

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

Write-up: Swollen lymph node, supraclavicular Saturday -Tuesday followed by rash on left side of neck extending down chest


VAERS ID: 1784815 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chemical burn, Nasal discomfort, Rhinalgia
SMQs:, Accidents and injuries (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: Birth Control
Current Illness: No
Preexisting Conditions: No
Allergies: Oral Allergy Syndrom
Diagnostic Lab Data:
CDC Split Type:

Write-up: I flipped my head over to blow dry my hair. A rush of chemicals flew up my right nostril and a strong burning occurred for a few minutes. I jumped up and down in pain yellow "OW OW OW" Then it stopped.


VAERS ID: 1784832 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pifzer COVD-19 Vaccination
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Client received 3rd dose 1 month too early.


VAERS ID: 1784904 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Mississippi  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / UNK LA / IM

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

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

Write-up: Patient filled out a Pfizer consent form and I pulled and gave a Pfizer vaccine to the patient and then realized that his first dose was Moderna and he should have gotten Moderna the second time as well. My manager came in and spoke with the patient letting him know what had happened and the patient sat with us for 15 mins without complications and then left.


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