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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 30 out of 8,010

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VAERS ID: 1785023 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-18
Onset:2021-10-06
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

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

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

Write-up: breakthrough COVID-19 case


VAERS ID: 1785101 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-09-22
Onset:2021-10-06
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

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

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

Write-up: breakthrough COVID-19 case


VAERS ID: 1785181 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-25
Onset:2021-10-06
   Days after vaccination:223
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 2 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain lower, COVID-19, Chest pain, Chills, Dyspnoea, Malaise, Oropharyngeal pain, Pain, Productive cough, SARS-CoV-2 test positive, Weight decreased
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Hospital Acute Lower Respiratory Infection Due To COVID-19 Non-Hospital Coronary Artery Disease Without Angina Pectoris Stenosis Aortic Valve Acquired Lesion Adrenal Gland Long Term Use Of Insulin Active Diabetes Mellitus Type 2 With Diabetic Chronic Kidney Disease Hyperglycemic Pacemaker Cardiac Status Post Hyperlipidemia Mixed Diabetes Mellitus Type 2 With Other Circulatory Complication Aneurysm Thoracic Aortic Without Rupture Gout Anemia Chronic Diastolic (Congestive) Heart Failure Do Not Resuscitate Status Hypertensive Heart With Heart Failure And Chronic Kidney Disease (CKD) Stage 3a Glomerular Filtration Rate (GFR) 45 To 59 Obesity Body Mass Index 30-39.9 Adult Onychomycosis Long Term (Current) Anticoagulant Treatment Ingrown Nail Chronic Diastolic (Congestive) Heart Failure Replacement Intraocular Lens Status Post Atrial Fibrillation Permanent History Of Falling Myocardial Infarction Type 2 Deconditioned Monitoring For Therapeutic Drug Therapy Coronary Arterial Bypass Graft Status Post Personal History Fasciitis Plantar Failure Renal Acute (Acute Kidney Injury) Edema Other Specified Disorders Of Kidney And Ureter Failure Heart COVID-19 Infection
Allergies: NKA
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE
CDC Split Type:

Write-up: CHIEF COMPLAINT/REASON FOR VISIT Chest Pain (started several days ago, pt states his doctor called him and told him to come in) HISTORY OF PRESENT ILLNESS an 86-year-old gentleman who is brought in by EMS from home. He states 1 week ago he developed this productive cough. He also noted right-sided chest pain that radiates into the right lower abdomen. He had had chills. He states he just was not feeling well. Yesterday he went in for COVID testing and it came back positive. Today the outpatient COVID team had contacted the patient about ongoing care. At that time patient had reported that he was feeling worse. He continued to have the right-sided chest pain that radiated into the abdomen and at times felt short of breath. Based on the symptoms he was directed to come into the emergency department. Patient states that he did not want to come in but because the provider recommended and he came in for evaluation. On arrival he denies any shortness of breath currently. He states that the shortness of breath comes and goes. The right-sided chest pain that radiates into the abdomen is always there and minimally. Denies any exacerbating or relieving factors. He denies ever having this type of pain in the past. He continues to have a productive cough. Denies any new back pain. No fevers. Has noted the sore throat occasionally. Patient has chronic heart failure. He states that he is actually down 2 lb. Has not noticed any unusual swelling.


VAERS ID: 1785189 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-09-24
Onset:2021-10-06
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011F211A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Proctalgia, Pyrexia, Rectal abscess
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Rectal pain and fever.


VAERS ID: 1785328 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-20
Onset:2021-10-06
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Anticoagulant therapy, COVID-19 pneumonia, Computerised tomogram thorax abnormal, Electrocardiogram ST-T segment abnormal, Pulmonary embolism, Sepsis
SMQs:, Embolic and thrombotic events, venous (narrow), Cardiomyopathy (broad), Other ischaemic heart disease (broad), Infective pneumonia (narrow), Sepsis (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, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Dementia, osteoporosis, depression
Allergies: NKA
Diagnostic Lab Data: RV strain on CT 10/6; pulmonary embolism
CDC Split Type:

Write-up: Hospitalized for7 days for severe sepsis secondary to COVID 19 pneumonia. Received IV Rocephin, azithromycin,oxygen, remdesivir, decadron, albuterol, encouraged to self prone. Acute ulmonary emboli on lovenox. Discharged on home health


VAERS ID: 1785353 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Minnesota  
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 30155BA / 3 RA / IM

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

Write-up: Received booster dose earlier than 6 months after 2nd dose of Pfizer COVID vaccine.


VAERS ID: 1785418 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Illinois  
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 / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 3NA4M / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Burning sensation, Lymphadenopathy, Pain, Skin warm, Somnolence
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rrizatriptan, Emgality and drospirenone-ethinyl estradiol OCP
Current Illness: Denies
Preexisting Conditions: Migraine Headaches
Allergies: Denies
Diagnostic Lab Data: CBC/CMP ordered
CDC Split Type:

Write-up: 45-year-old female RN was received a flu shot and COVID shot on 10/05/2021. She reports she after the she developed pain with subsequent drowsiness and intense burning on the ventral surface of her proximal her upper extremities (in the proximity of the biceps brachi) and axilla?s She felt that she felt that her lymph nodes were swollen as well. She fells that he area is warm as well. She had not had reactions to immunizations previously. She tells me that she has been using Tylenol and Ibuprofen 800. She denies fevers or recent illness. She reports a Hx of Migraine headaches and uses Rrizatriptan, Emgality and drospirenone-ethinyl estradiol OCP. She denies possibility of pregnancy or allergies. She reports a 5/10 constant burning pain with no aggravating factors on the left and a 2/10 constant burning pain with no aggravating factors on the right.


VAERS ID: 1785435 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-05
Onset:2021-10-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dyspnoea, Fatigue, Pain, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D, zinc, probiotic
Current Illness: None
Preexisting Conditions: None
Allergies: Gluten intolerant, allergic to sulfur medications
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The morning after the shot I felt very tired, had the chills and body aches and felt in the morning like I couldn''t breathe. Shortly after waking up, I fainted for a few moments sand luckily my husband caught me so I didn''t fall. I had the chills for a good hour after that and was shaking all over, even though my temperature was only 98. I called my doctor but he never called me back. I drank a lot of waster, ate some pretzels, and then started to gradually feel better. The next day (two days after the shot) i felt fine.


VAERS ID: 1785591 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New York  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

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

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

Write-up: FEver, Chills, Headache, fatigue


VAERS ID: 1785607 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-02-06
Onset:2021-10-06
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Cough, Headache, Pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Venlafaxine HCl 75 mg 3 tablets daily Abilify 10 MG Tablet 1 tablet Orally Once a day BuPROPion HCl 300MG Tablet Tablet Extended Release 24 Hour 1 tablet daily Vitamin D High Potency 1000 UNIT Capsule 1 capsule Orally Once a day
Current Illness: none
Preexisting Conditions: diabetes type 2; GAD
Allergies: metformin and glimepiride
Diagnostic Lab Data:
CDC Split Type:

Write-up: cough, fever (Tylenol needed to keep temp from going up to 102), covid (+) test last Friday., body aches, headache, loss of taste, loss of smell starting on 10/6/21


VAERS ID: 1785626 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-01-24
Onset:2021-10-06
   Days after vaccination:255
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 007M20A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest X-ray abnormal, Colitis, SARS-CoV-2 test positive, Sepsis
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific inflammation (narrow), Ischaemic colitis (broad), Cardiomyopathy (broad), Noninfectious diarrhoea (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

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

Write-up: Pt has a history of dementia, COPD, DM2, and is being admitted for sepsis secondary to mild colitis. Chest xray showed possible infiltrate. Initial COVID testing was negative. Repeat testing done on 10/12 before discharge to HCF was positive.


VAERS ID: 1785652 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Colorado  
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 (MODERNA)) / MODERNA - / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Malaise and headache after second covid shot (Moderna)
Other Medications: Allegra
Current Illness:
Preexisting Conditions: None
Allergies: Allergies to cats, dogs, dust
Diagnostic Lab Data:
CDC Split Type:

Write-up: Day after administration: headache, fever of 101+, malaise. 2 days after administration to 4 days after administration: daily migraine


VAERS ID: 1785711 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: Kansas  
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 FC3184 / 2 RA / IM

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

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

Write-up: 2nd Pfizer Covid vaccination was given one week early. Foster Mom notified patient did not have any ill side effects. Notified patients PCP with no new orders.


VAERS ID: 1785736 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-03-05
Onset:2021-10-06
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 3 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Decreased appetite, Extra dose administered, Fatigue, Headache, Inappropriate schedule of product administration, Injection site pain, Loss of personal independence in daily activities, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cardio-Levodopa, Xanax, Lipitor, Aspirin, Lasix, B12, D, Folic Acid, Metamucil, Sennakot S.
Current Illness: None
Preexisting Conditions: Parkinson?s disease, panic disorder, PTSD
Allergies: Bactrim, epinephrine.
Diagnostic Lab Data: I had my flu shot the day before my booster.
CDC Split Type:

Write-up: Fever that was 3.5 higher than my normal temperature, severe headache that lasted for 5 days, extreme weakness, fatigue, nausea, no appetite. Could not do any of my normal chores, or exercise. My doctor had me take an 800mg of Motrin and that did nothing with the severe headache. Very bad chills. I had the two other Pfizer vaccines and just had a normal reaction. This was the booster. My arm hurt where the injection was, but that did not concern me. I was like this for a full week. I am still weak and very easily fatigued.


VAERS ID: 1786179 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Puerto Rico  
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 - / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Neck pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lotrel, metformin,syntroid
Current Illness: None
Preexisting Conditions: High blood pressure , diabetes, hipotiroidismo
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, intense pain in my left arm,pain in my neck and shoulder and hand


VAERS ID: 1786195 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Michigan  
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 30130BA / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PATIENT COMPLAINTS THAT LOT OF PAIN IN LEFT ARM AT THE SITE OF ADMINISTRATION , PHYSICALL SIGN OF REDNESS OR SWELLING WAS NOT OBSERVED.
Current Illness: NO
Preexisting Conditions: UNKNOWN
Allergies: NO KNOWN
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was advised to apply ice and use Tylenol as need basis and follow up with primary care doctor.


VAERS ID: 1786198 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-07
Onset:2021-10-06
   Days after vaccination:213
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Agitation, Anaemia, Aphasia, COVID-19, Cerebral small vessel ischaemic disease, Cognitive disorder, Computerised tomogram head normal, Condition aggravated, Confusional state, Encephalopathy, Haemoglobin decreased, Hyponatraemia, Hypophosphatasia, Hypoxia, Iron deficiency anaemia, Magnetic resonance imaging head normal, Memory impairment, Mental status changes, Pyrexia, Scan with contrast, Substance-induced psychotic disorder, Transferrin saturation decreased, Vitamin B12 deficiency, Vitamin B12 normal
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), 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), Dementia (broad), Congenital, familial and genetic disorders (narrow), Drug abuse and dependence (broad), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Hyponatraemia/SIADH (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81 MG enteric coated tablet atorvastatin (LIPITOR) 20 MG tablet cyanocobalamin 500 MCG tablet dexamethasone (DECADRON) 2 MG tablet docusate (COLACE) 100 MG capsule dulaglutide (TRULICITY) 0.75 MG/0.5ML injection ferrous sulfate 325
Current Illness: 9.22.21: Office visit with Pulmonary medicine: 66-year-old male history of prior tobacco use, pleural mesothelioma with right pleural effusion and Pleurx catheter on immunotherapy Who presents for follow-up. I reviewed most recent CT chest with patient and his wife today. His oncologist is previously notified him of results as well. They are planning to continue with current immunotherapy and have close follow-up with oncology. Discussed Pleurx drain outputs are stable and recommend continuing to drain every 4 to 6 days stopping when he develops increased chest pressure or coughing. Pleural effusion is complex and loculated but he has symptomatic improvement with his intermittent drainage. He will receive influenza vaccination today. Discussed recommendation for COVID-19 booster and recommend he talk to oncology about timing in relation to his immunotherapy.
Preexisting Conditions: B12 deficiency Iron deficiency anemia D-dimer, elevated Closed displaced fracture of shaft of right clavicle with routine healing, subsequent encounter Closed nondisplaced fracture of body of right scapula with routine healing, subsequent encounter Multiple fractures of pelvis with stable disruption of pelvic circle with routine healing Mesothelioma
Allergies: codeine - GI upset
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized; COVID-19 positive (10.6.21); Fully vaccinated. Admission Date: 10/6/2021 Discharge Date: Oct 9, 2021 PRESENTING PROBLEM: Hyponatremia Hypophosphatasia Encephalopathy COVID-19 Acute respiratory failure due to COVID-19 HOSPITAL COURSE: This is a 66-year-old gentleman with a history of progressing right chest mesothelioma, as well as type 2 diabetes mellitus. He has had some progressive memory problems and word-finding problems over the past months, but developed acute worsening mental status in the 3 days prior to admission. When he came to the emergency room he was found to have fever and was borderline hypoxemic. He was found to have COVID-19 infection. He had anemia with a hemoglobin of 10.4, and subsequent anemia workup revealed an iron saturation of 3% consistent with iron deficiency anemia, as well as of vitamin B12 level of 189 consistent with vitamin B12 deficiency. He was treated with IV iron sucrose, of which he received 2 doses of 200 mg during his hospital stay. He was also treated with 1000 mcg of vitamin B12 IM. For his COVID-19 infection he was started on remdesivir and dexamethasone. He developed acute agitated confusion after admission requiring IV Haldol. This was thought to be a steroid psychosis, and it resolved with discontinuation of the IV Decadron. He is on oral Decadron 2 mg daily as an outpatient which was resumed. He also seemed to develop some confusion from remdesivir dosing so this was stopped as well. By discharge she was at his baseline mental status. He was breathing comfortably without oxygen. For his altered mental status he had a head CT on admission which was negative, and also an MRI of the brain with and without contrast which was normal except for evidence of small-vessel cerebrovascular disease. Discharge medications include the addition of ferrous sulfate 325 mg daily and vitamin B12 500 mcg daily. Follow-up recommendations include consideration Neurology consultation to evaluate cognitive dysfunction. For his vitamin B12 deficiency and iron deficiency recommend follow-up complete blood count, B12 levels, and iron levels to determine if IM B12 maintenance is necessary or IV iron infusions are necessary.


VAERS ID: 1786354 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-19
Onset:2021-10-06
   Days after vaccination:229
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 AR / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Cerebral small vessel ischaemic disease, Cerebrovascular accident, Confusional state, Conjunctivitis, Facial paralysis, Hypoxia, Magnetic resonance imaging head abnormal, Neurological symptom, SARS-CoV-2 test positive
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), 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), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Hearing impairment (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet acetaminophen (TYLENOL) 500 MG tablet aspirin 81 MG enteric coated tablet donepezil (ARICEPT) 10 MG tablet latanoprost (XALATAN) 0.005 % ophthalmic solution Omega-3 Fatty Acids (OMEGA-3 FISH OIL) 1200 M
Current Illness:
Preexisting Conditions: AVM (arteriovenous malformation) 2009 CKD (chronic kidney disease) Dementia (HCC) Tremor
Allergies: Atorvastatin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized 10/6/2021; COVID-19 positive 10/6/2021; fully vaccinated Discharge Summary Health professional (Physician) ? ? Hospitalist BRIEF OVERVIEW: Discharge Provider: Health professional Primary Care Provider: None Physician, MD Admission Date: 10/6/2021 Discharge Date: Oct 14, 2021 Active Hospital Problems Diagnosis Date Noted POA ? COVID-19 10/06/2021 Yes Resolved Hospital Problems No resolved problems to display. There are no active non-hospital problems to display for this patient. Discharge Disposition: custodial care facility Active Issues Requiring Follow-up: DETAILS OF HOSPITAL STAY: PRESENTING PROBLEM: Confusion Hypoxia Conjunctivitis, unspecified conjunctivitis type, unspecified laterality Pneumonia due to COVID-19 virus COVID-19 HOSPITAL COURSE: Patient is a 74 y.o. male with h/o dementia, left arm tremor, AVM, current COVID infection admitted for CVA/neuro symptoms, CoVID 19 PNA and acute hypoxic respiratory failure.. He had a CC of left sided facial drop that resolved by admission time. He wast treated with decardron, remdisivir and Lovenox. His acute hypoxic respiratory failure resolved quickly MRI brain found severe chronic small vessel ischemic disease but no acute findings. Neurology recommended outpatient follow. He was cleared from isolation restrictions on 10/13 PT/OT recommended SNF 10/14/2021 Pt S+E. Alert, NAD,RA, Stable at discharge RN provided signout/instructiosn to accepting facility


VAERS ID: 1786369 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Oregon  
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 30155BA / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Culture urine, Dysuria, Extra dose administered, Haematuria, Urinary tract infection, Urine analysis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Tubulointerstitial diseases (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 3 weeks after 2nd Pfizer-BioNTech Covid-19 vaccine, I went to ED with severe abd pain - CT and colonoscopy revealed ischemic col
Other Medications: venlafaxine 300 mg daily, vitamin D3 2000 units daily, PremPro 0.45-1.5 mg daily, levothyroxine 50 mcg daily, vitamin B12 1000 mcg daily, ibuprofen 600mg daily as needed
Current Illness: none
Preexisting Conditions: depression
Allergies: none
Diagnostic Lab Data: UA, urine culture
CDC Split Type:

Write-up: unusually severe UTI - with severe symptoms including dysuria and hematuria just 3 hours after initial episode of mild dysuria.


VAERS ID: 1786560 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-22
Onset:2021-10-06
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 1 LA / IM

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

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

Write-up: Muscle twitching that started at two weeks post vaccination. Still ongoing.


VAERS ID: 1787042 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ??? / UNK RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ??? / UNK LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ??? / UNK RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Fall, Gait disturbance, Gait inability, Nausea
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I had the first vaccine 1/13/21 and the second 2/4/21 and debilitating dizzinezz at one time had to crawl across floor to let my dogs out. Didn?t know it was a side effect. Those symptoms took until April to go away. Now 10/6/31 I got a boo
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dizzy falling stumbling as to crawl across floor to let dogs out so I didn?t fall. Some nausea.


VAERS ID: 1765697 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-27
Onset:2021-10-06
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2595 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Polymenorrhoea
SMQs:

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

Write-up: My period ended on Sunday September 26,2021. Today October 6,2021 my period started again when I should be ovulating. Not bleeding.


VAERS ID: 1771708 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-10-06
Onset:2021-10-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / N/A LA / IM

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

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

Write-up: PATIENT FAINTED ABOUT 5 MINUTES AFTER RECEIVING VACCINE. WE CALLED 911, CHECKED AIRWAYS AND BREATHING AND BEFORE CPR COULD BE ADMINISTERED, SHE CAME TO. SHE WAITED FOR PARAMEDICS TO ARRIVE, WAS EVALUATED AND THEN RELEASED.


VAERS ID: 1777193 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
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: Adverse event, Disability
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: COJNJFOC20211015404

Write-up: INCAPACITATION; UNSPECIFIED ADVERSE EVENT; This spontaneous report received from a patient via a company representative concerned a female of unspecified age, race and ethnicity. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of administration not reported, batch number: Unk) with frequency as 1 total, 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/lot number. No concomitant medications were reported. On 06-OCT-2021, the patient experienced unspecified adverse event and incapacitation. The reporter reported that, the patient had adverse effects with the vaccine, which incapacitated her. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the unspecified adverse event and incapacitation was not reported. This report was serious (Disability Or Permanent Damage).; Sender''s Comments: V0;20211015404-covid-19 vaccine ad26.cov2. Incapacitation. This event is considered unassessable. The event has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event.


VAERS ID: 1760476 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Dizziness, Eye movement disorder, Loss of consciousness, Tremor
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), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Patient states he has passed out with needles in the past
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: VSS taken X3
CDC Split Type:

Write-up: Patient received vaccination, walked to waiting room. His coworker stated about 5 minutes later he passed out in the chair and they helped him to floor. His friend said his eyes rolled back and he started to shake. He came back around 1 minute later. His VSS, stated he felt dizzy but no other symptoms.


VAERS ID: 1761221 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest discomfort, Dizziness, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), 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? Yes
Hospitalized? No
Previous Vaccinations: influenza vaccination
Other Medications: Cetirizine 10 mg 60 minutes prior and ranitidine 60 minutes prior
Current Illness: none
Preexisting Conditions:
Allergies: Influenza vaccine
Diagnostic Lab Data: O2 saturation normal
CDC Split Type:

Write-up: At 25 minutes patient reported finger tingling, chest tightening. Observed for additional 15 minutes and patient began to report sensation of chest tightness and lightheadedness. Transported to ED without epinephrine administration. BP164/88 pulse 96. O2 sat normal at ED triage station.


VAERS ID: 1761262 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0186 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 LA / SYR

Administered by: Military       Purchased by: ?
Symptoms: Fatigue, Pyrexia, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Nasal Flu shot in 2015, unknow type or maker.
Other Medications: Zyrtec, Fish Oil, and Ambien. Monthly Allergy shots
Current Illness: Seasonal Allergies
Preexisting Conditions: Bad back and bad kidneys, genetic. Several other undiagnosed afflictions as well.
Allergies: NASIDS
Diagnostic Lab Data: None
CDC Split Type:

Write-up: First Shot: Mild fatigue Second Shot: Mild fatigue and approximately 10 hours later convulsions with fever reaching over 100 degrees per oral testing.


VAERS ID: 1761268 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-02
Onset:2021-10-05
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

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

Write-up: MYOCARDITIS


VAERS ID: 1761323 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-07
Onset:2021-10-05
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Cough, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt comes with generalized weakness, cough, and increased shortness of breath for 1 weak. He tested positive for COVID 6 days ago. CXR consistent with COVID-19 pneumonia.


VAERS ID: 1761334 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: This was a new nurse that was hired. She told me she received Pfizer at previous employer but did not have card with her. She requested a dose of Pfizer at the end of our clinic so as not to waste. When she got home and pulled her vaccine card out she realized she had received Moderna from previous employment. She had no adverse side effects or reactions.


VAERS ID: 1761339 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Kansas  
Vaccinated:2021-09-30
Onset:2021-10-05
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site laceration
SMQs:, Extravasation events (injections, infusions and implants) (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 did not take off his bandaid until today (10/5/21) after receiving vaccine on Thursday (09/30/2021). When he took the bandaid off this morning, it was very red and the skin was broken open. He did report that he has gone swimming twice (Friday and Monday)and not showered since before last Thursday. He did not shower after swimming either and did not remove bandaid at any time between. Patient is going to try leaving the bandaid off and keeping an eye on it. He will contact his PCP if it doesn''t look better in a day or so.


VAERS ID: 1761384 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-09
Onset:2021-10-05
   Days after vaccination:118
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 RA / IM

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

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

Write-up: no Event or symptoms reported by patient. Went to 10/5/21 and saw she received Pfizer in feb/march 2021. Per patient no adverse events experienced.


VAERS ID: 1761405 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Heart rate increased, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

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

Write-up: Reports reaction started 10/5 upon waking with feeling of rapid heart beat, lightheadedness and shaky. Was referred to local urgent care for evaluation.


VAERS ID: 1761414 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Chills, Nausea
SMQs:, Acute pancreatitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: asthma, seasonal allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: chills, weakness, and mild nausea


VAERS ID: 1761423 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Chills, Decreased appetite, Fatigue, Immunodeficiency, Injection site pain, Malaise, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (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: 02/18/2021, Pfizer EM9807
Other Medications: Levothyroxine 50 mcg po QD Vit C 1000 mg po QD Vit D 2000 iu po QD
Current Illness: None
Preexisting Conditions: None
Allergies: EES, Codeine, Doxycycline
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Injection site pain, Chills, Fever 100.7, Muscle pain, Joint pain, Feeling unwell, Tiredness, Decreased appetite


VAERS ID: 1761439 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-05-07
Onset:2021-10-05
   Days after vaccination:151
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 18020608 / 1 - / -

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

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

Write-up: COVID vaccine breakthrough case


VAERS ID: 1761463 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-05
Onset:2021-10-05
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Condition aggravated, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (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:
Allergies:
Diagnostic Lab Data: Coronavirus 2 PCR Detect, V symptomatic POSITIVE
CDC Split Type:

Write-up: PT comes to the ER due to shortness of breath which has been progressing over 1-2 weeks. Sats when EMS arrived in the high 90''s, pt requested O2 for comfort (does not use regularly). Pt is also much more weak but has hx left sided weakness from past stroke.


VAERS ID: 1761480 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Kansas  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Exposure during pregnancy, Fatigue, Headache, Nausea, Pain, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypoglycaemia (broad)

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

Write-up: Uncontrollable shakes, chills, nausea, body aches, headache, onset in middle of night suddenly. Treatment with rest and hydration. Body aches and headaches and fatigue lasted all next day. Uncomplicated pregnancy. Edd 10/31/2021.


VAERS ID: 1761508 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-04-22
Onset:2021-10-05
   Days after vaccination:166
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Dysgeusia, Erythema, Paraesthesia oral, Swollen tongue, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Taste and smell disorders (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (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: Atenolol, losartin, amlodapine, rosuvastatin, cardio for life
Current Illness: Aneurysms. HBP.
Preexisting Conditions: HBP
Allergies: Amoxicillin and sulpha
Diagnostic Lab Data: Had dr advise on whether there is reliable allergy testing for other vaccine.
CDC Split Type:

Write-up: Metallic taste then tongue tingle then skin turned red the throat tighten up and tongue felt enlarged. Lasted 4 hours.


VAERS ID: 1761520 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
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: Tylenol, Losartan, Omeprazole, Ondansetron, Klor Con, Xarelto, Zocor, Calcium, Colace, Gabapentin, HCTZ, Magnesium, Sucralfate
Current Illness: No new illness
Preexisting Conditions: 1. Nausea 2. Dysphagia, unspecified type 3. Abnormal digestive tract function 4. New onset type 2 diabetes mellitus (H) 5. Acute deep vein thrombosis (DVT) of distal vein of both lower extremities (H) 6. Essential hypertension 7. Age-related cataract of both eyes, unspecified age-related cataract type 8. Decreased visual acuity 9. Ptosis of both eyelids
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Pt received 0.3ml of Pfizer vaccine, believe Vial was not reconstituted as was only dose in vial


VAERS ID: 1761522 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Aphasia, Disturbance in attention, Dyspnoea, Epistaxis, Feeling abnormal, Headache, Injection site pain, Irritability, Nasal congestion, Oropharyngeal discomfort
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Perscription:Valtrex-1GM Vitamins: Hair, Skin & Nails Gummies-5000mcg, Super Collagen-36g, Vitamin D3-1000IU, Vitamin C-2000mg, Fish Oil-2400mg, Potassium-99mg, B12-1000mcg, Vitamin E-400IU, Cranberry-8400mg, B6-100mg
Current Illness: none
Preexisting Conditions: Herpes
Allergies: I am allergic to cajun seasoning
Diagnostic Lab Data: none
CDC Split Type:

Write-up: About an hour after the shot, was extremely irritated and couldn''t really speak. The words were just not coming out. Then my brain was foggy, really couldn''t keep focus. Around 3pm, I started to get a clearer head. Had a normal night. Around 7pm, my right arm started to hurt at the injection site. Around 10:30pm, I started to get a headache. I took ibuprofen to help deal with the pain in the arm and my headache. Around 6am, I woke up on my right side, not able to breathe. My nose was completely full of stuff, my throat was clogged. I rolled over on my back to see it would help and felt my nose starting to bleed. I got up and rushed to the bathroom, where my nose continued to run. I would call it a steady stream of blood coming out of my left nostril. I blew my nose hoping it would stop, it didn''t. Around 7am, I shoved a tampon up my nose, hoping it would stop. Around 7:30am, took the tampon out and blew my nose again. Got more blood clots. Stoved another tampoon up my left nostril. Around 8am, I could taste the blood dripping down my throat. I took out the tampon, my nose was no longer bleeding, but now it was dripping down my throat. At 9:30am, called the clinic, where I talked to a nurse, where she advised me to go to urgent care to have them stop the bleeding. As of 10am, it is still dripping down my throat. I am not going to the urgent care to have them burn the vessels.


VAERS ID: 1761552 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

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

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

Write-up: Patient is a 29 year old male Patient identified using 2 identifiers Name and date of birth S: (situation) : 0753 patient was wheeled to observation by RN manger Verbal report "Pt had a syncope episode after vaccine" Today covid vaccine Janssen B: (background) Past Medical History reviewed, NO KNOWN DRUG ALLERGIES No current medical conditions Takes MVI daily Never had covid Awake and alert, assisted to gurney by LVN, diaphoretic, appeared pale Able to speak clearly Any pain- reported tingling to hands bilaterally "I was not looking forward to this shot, do not like needles", stated patient A: Assessment Vitals: 10/05/21 0815 10/05/21 0823 10/05/21 0830 10/05/21 0835 BP: 101/62 105/65 109/65 104/64 BP Patient Position: SITTING SITTING SITTING SITTING BP Location: LA-LEFT ARM LA-LEFT ARM LA-LEFT ARM LA-LEFT ARM Cuff Size: Standard Adult Standard Adult Pulse: 55 53 65 64 Resp: 18 18 18 SpO2: 100% 100% 98% Weight: 155 lb (70.3 kg) 155 lb (70.3 kg) 155 lb (70.3 kg) Height: 6'' 2" (1.88 m) 6'' 2" (1.88 m) 6'' 2" (1.88 m) Vitals monitored Denies any chest pain or shortness of breath Denies any difficulty swallowing Patient lying on gurney, legs elevated Ice pack placed under neck Removed mask Elevated HOB 45 degress 0801 provided with water Denies any nausea Patient vitals improving Denies dizziness while HOB elevated Talkative Skin color pink No longer clammy 0815 Tolerated apple juice 0835 standing denies dizziness Last set of vitals Patient verbalized feeling "feel like I did when I walked in now" Instructed patient to stay hydrated, drink plenty of fluid today, reviewed the side effects of vaccine And to report any further side effects to pcp Patient verbalized understanding All questions answered he has the janssen paper work from CDC 8:59 AM


VAERS ID: 1761596 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Extra dose administered, Interchange of vaccine products
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: omeprazole, metalaxone, cyclobenzaprime
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient received two doses of moderna prior to receiving a booster dose of pfizer. Moderna feb 26 2021 and jan 8 2021


VAERS ID: 1761613 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 RA / IM

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

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

Write-up: Patient received first shot of Moderna on 8/3 and we administered Pfizer as their second shot 10/5.


VAERS ID: 1761686 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Heart rate increased, Impaired work ability, Malaise, Muscle contractions involuntary, Photophobia, Sleep disorder, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Propranolol 10mg (one in morning), Escitalopram 10mg (one in morning), Garden of Life Raw Enzymes Men, Garden of Life Vitamin Code Raw D3 2000IU
Current Illness: Ear infection. I finished taking the antibiotics for it three days ago.
Preexisting Conditions: Unsure if fully healed, had a bacterial prostate infection back in July/August of 2020 that lasted for several months.
Allergies: Unsure
Diagnostic Lab Data: None as of yet
CDC Split Type:

Write-up: I was trying to sleep last night after drinking a glass of water before bed, which is my usual routine. After going to bed, I woke up with my body vigorously shaking, starting from the location of the injection site. I had to hold onto my neck oh the left side for support due to all the muscles, spreading from the injection site, wanting to vigorously contract and pull hard towards the injection location. My heart rapidly beat and I had to take the time to try and calm the body by doing deep breathing exercises. When it got to a comfortable time to move, I went to use the restroom and had to drink lots of water due to feeling a temperature, light sensitivity, a head ache, and body fatigue. This pattern happened throughout the night several times to the point where I felt sick. After my body calmed mostly down, I called the pharmacist at Genoa to share my experience. They mentioned how it was normal and to take a Tylenol to help with the symptoms. I also had to call in sick to work and request a substitute teacher to help with my classes today.


VAERS ID: 1761700 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Limb injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Patient experienced syncope while exiting the store. He fell over and suffered the skin on his chin split open


VAERS ID: 1761711 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Headache, Pain, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Head aches, body aches, pain on my finger joints and hands.


VAERS ID: 1761727 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Interchange of vaccine products, No adverse event
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 was given a booster vaccine of Pfizer. His first 2 doses were Moderna. This was caught before the patient left the clinic. He was informed and was having no symptoms or signs of a reaction.


VAERS ID: 1761781 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Dry mouth, Dysphagia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (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 (broad), Hypersensitivity (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamins
Current Illness: None
Preexisting Conditions: None
Allergies: Latex, oral contraception, seafood (unsure which one); all outdoors
Diagnostic Lab Data: None
CDC Split Type:

Write-up: patient reported difficulty swallowing , tightness to Right side of throat and dry mouth


VAERS ID: 1761784 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA OJ3E21A / 2 LA / IM

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

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

Write-up: Itchy rash in the whole body, NO anaphylaxis. Pharmacist administer Benadryl Intramuscular ( 50mg)


VAERS ID: 1761796 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

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

Write-up: Error: Wrong Dose of Vaccine - Too High-


VAERS ID: 1761813 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Extra dose administered, 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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Booster vaccine given on day 58


VAERS ID: 1761817 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-09-26
Onset:2021-10-05
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / 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? 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 presented to our pharmacy on 9/26 saying this was first vaccine and requested Janssen vaccine, stating this was her first vaccine. Vaccine was administered. Received call from local vaccine program on 10/5 letting us know she had received Moderna vaccine in March. Employee with vaccine program said no need to call patient, as it was already discussed, but file VAERs report.


VAERS ID: 1761819 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-09-27
Onset:2021-10-05
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Muscular weakness, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad)

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

Write-up: There is tingling from my fingertips to my shoulders in both arms. My arms are weak, feel like they''ve fallen asleep.


VAERS ID: 1761839 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: No adverse event, Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

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

Write-up: Patient is 12 years old and was given the Moderna vaccine instead of the Pfizer vaccine by the nurse, patient is not having any adverse reaction at this time.


VAERS ID: 1761850 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood pressure increased, Condition aggravated, Tinnitus
SMQs:, Neuroleptic malignant syndrome (broad), Hypertension (narrow), Hearing impairment (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None
Preexisting Conditions: Tinnitus
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type: CA134B1001

Write-up: Patient was sitting in Post vaccination clinic and asked if we could take his blood pressure because He has tinnitus and the ringing in his ear is a bit louder. Patient reports his normal blood pressure is 135/85. RN took blood pressure 142/86, HR 72, rr 18. Pt reports he had a banana for breakfast. Pt stated he was okay and just wanted to go back to work. Signed understanding that he should call his doctor or go to the ER if symptoms get worse. Left at approximately 10:55


VAERS ID: 1761855 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / UNK UN / IM

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

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

Write-up: Unknown


VAERS ID: 1761867 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hypersensitivity, Paraesthesia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (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: Tingling, throat tightness, allergy-like symptoms starting about 1 days after vaccine administration. Very similar to beginnings of anaphylactic reaction. Relieved by diphenhydramine.


VAERS ID: 1761902 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Iowa  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017F21A / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Fatigue, Feeling hot, Hyperhidrosis, Malaise, Posture abnormal, Tremor, Vision blurred, Visual impairment
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

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

Write-up: Within a minute of getting vaccine, patient stated not feeling well. Patient''s spouse was with and alerted pharmacy. Patient states lost vision (dark and blurry), felt very warm, had slight tremor, and was unable to hold head up. Patient leaned head against booth and closed eyes. Was able to respond to questions, but wasn''t able to make complete sentences. Patient then started to sweat and shiver. Patient wasn''t able to open eyes and couldn''t hold head up. Patient was drenched in sweat. Offered cold compress and kept talking with patient. Patient did not fully respond and continued to say was tired and unable to focus eyes. Took patient 15 minutes and like an on/off switch was suddenly fine. Patient could see again, no longer shivering, sweats stopped and felt normal.


VAERS ID: 1761914 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Idaho  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / UNK OT / IM

Administered by: Private       Purchased by: ?
Symptoms: Intentional product use issue
SMQs:, Drug abuse and dependence (broad), Depression (excl suicide and self injury) (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: Aspirin, Chantix, Claritin, cyanocobalamin, estradiol, gabapentin, losartan, metoprolol, MS Contin, Vitamin D2, and Zoloft
Current Illness: Crohn''s disease, chronic pain syndrome, essential hypertension, depression, vitamin D deficiency.
Preexisting Conditions:
Allergies: Cephalexin, iodine, monosodium glutamate, penicillin, and promethazine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient requested vaccine be given in gluteal upper outer quadrant as she can''t have any injections in her deltoids because of her history of abscesses in that area from previous injections. Patient received her first dose in this site. States her PCP recommended all injections in this site including vaccines. Vaccine was given in left gluteal upper outer quadrant.


VAERS ID: 1761918 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 2 RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Pharyngeal swelling, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: throat swelling, hives, itching


VAERS ID: 1761932 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD8448 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure decreased, Loss of consciousness, Nausea, Seizure
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: HEB B BOOSTER,FLU,COVID 19 PFIZER
Other Medications: N/A
Current Illness: NA
Preexisting Conditions: NA
Allergies: PATIENT STATED THAT SHE HAS HAD SEIZURES WITH THE FLU VACCINE AND WAS ADMITTED TO THE HOSPITAL FOLLOWING A HEP B BOOSTER AND HER BLOOD PRESSURE DROPP[ED AFTER FISRT DOSE OF PFIZER COVID 19 VACCINE BUT WAS ADVISE BY NEUROLOGIST TO GET THE SECOND DOSE
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT STATED THAT SHE HAS HAD SEIZURES WITH THE FLU VACCINE AND WAS ADMITTED TO THE HOSPITAL FOLLOWING A HEP B BOOSTER AND HER BLOOD PRESSURE DROPPED AFTER FISRT DOSE OF PFIZER COVID 19 VACCINE BUT WAS ADVISED BY NEUROLOGIST TO GET THE SECOND DOSE . ABOUT 30 SECONDS AFTER ADMINISTRATION OF THE VACCINE WHICH WAS THE PFIZER COVID 19 VACCINE PATINENT PASSED OUT AT WHICH TIME A CODE WAS CALLED IN THE HOSPITAL AND WHILE AWAINTING MEDICAL HELP THE PATIENT APPEARED TO HAVE A SMALL SEIZURE AFTER WHICH SHE CAME TO AND PRESENTED WITH NAUSEA BUT NO VOMITING AT WHICH POINT THE ER STAFF FROM THE HOSPITAL SHOWED UP TO TRANSPORT HER TO ER. SHE WAS RELEASED AFTER EVALUATION WHICH SHOWED HER BLOOD PRESSURE HAD DROPPED BUT SHE WAS NOT ADMITTED TO THE HOSPITAL.PATIENT STATES SHE IS FEELING FINE.


VAERS ID: 1761944 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-09-16
Onset:2021-10-05
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 2 LA / IM

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

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

Write-up: According to clinic patient received J+J COVID vaccine on 4/5/2021 and again on 9/16/2021 as documented in this report.


VAERS ID: 1761975 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-14
Onset:2021-10-05
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3180 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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 received J+J vaccine on 4/1/2021 from different vendor and received Pfizer on 8/14/2021 as documented in this report.


VAERS ID: 1761976 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 4 RA / IM

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

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

Write-up: Patient was accidentally given a 4th Pfizer dose instead of the flu vaccine.


VAERS ID: 1761983 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Dysphagia, Eye swelling, Headache, Mouth swelling, Swelling face, Swollen tongue, Throat tightness
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Severe, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Headache-Mild, Additional Details: pt began having symptoms 30-45 min after injection of 2 nd dose, ambulance summoned and pt taken to er


VAERS ID: 1761984 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Malaise, Tachycardia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: BP; Pules 10/05 WNL
CDC Split Type:

Write-up: 15 min after vaccination patient complains of tachycardia, headache and general feeling unwell. Instructed patient to put head between knees and to lie down if need be. Patient requested we call 911. Advised pt to sit until paramedics arrived. Went they arrived pt walked up to them at the front of the store. Patient states he did not need to go to hospital because vitals were WNL. Followed up with patient @ 1300 and patient is fine, no more side effects.


VAERS ID: 1761987 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 RA / IM

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

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

Write-up: Systemic: Numbness (specify: facial area, extremities)-Mild


VAERS ID: 1762001 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 076CZ1A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Dizziness, Dyspnoea, Nausea, Palpitations, Tinnitus
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: i am having shortness of breath, ear ringing, nausea, feeling faint, dizziness, weakness, heart pounding and what feels like anxiety but unusual. if these persist ill need to go to the hospital


VAERS ID: 1762005 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-08-26
Onset:2021-10-05
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: According to clinic patient received Moderna COVID vaccine on 6/29/2021 and Pfizer COVID vaccine on 8/26/2021 as documented on this report.


VAERS ID: 1762023 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-01-31
Onset:2021-10-05
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9264 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest pain, Eye swelling, Mouth swelling, Nausea, Pharyngeal swelling, Pruritus, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Cymbalta po Flonase
Current Illness: idiopathic allergy symptoms, fibromyalgia
Preexisting Conditions: fibromyalgia, seasonal allergies, monitoring ovarian cysts
Allergies: narcotics
Diagnostic Lab Data: Allergy panel ordered. Allergies to grasses, trees. No allergy to Beef or pork.
CDC Split Type:

Write-up: I don''t know if this has anything to do with the vaccine or not. Also the dates given in this report may be approximate. There are additional visits to ERs and DRs. not reported there. No intent to mislead just hard to recall. Before the vaccine I was having occasional idiopathic allergic reactions. Since I have received the vaccine they have escalated in frequency and severity. Terrible hives, itching, chest pain, nausea, vomiting and swelling of mouth eyes and throat. Happening very frequently. Sometimes multiple times a week. Having to use epipens and going to the ER. Initially thought to be associated with red wine or beer, possibly red meat but has since been shown to happen without those things on board. Even after eating vegetarian for days. Idiopathic and unpredictable. Wondering if this has been reported by anyone else. I have since had my second Pfizer shot on 2/21/21. I do not regret getting the vaccines and plan on getting my booster 10/21/2021. Again the dates are approximate and the medical visits are multiple.


VAERS ID: 1762041 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN #211A21A / UNK RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Chest discomfort, Chills, Cough, Crying, Decreased appetite, Fatigue, Headache, Injection site pain, Irritability, Malaise, Pain, Parosmia, Pollakiuria, Pyrexia, Sleep disorder
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Unusual and unexpected side effects of the vaccine. About 12 hours after vaccine administration: waking through the night, irritability and crying, overly frequent need to pee (within 30 seconds of fluid intake & at least once every 2 hours) ? along with the more common side effects body aching, weakness, soreness at injection site, and fever. Within 24 hours of receiving the vaccine, also experienced parosmia & ensuing total loss of appetite, severe malaise (urge to shiver, chest discomfort resulting in urge to cough), and the more common side effects fatigue and headaches.


VAERS ID: 1762059 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Chest X-ray normal, Chills, Electrocardiogram normal
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: DX WITH COVID IN EARLY SEPTEMBER 2021
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: CHEST X-RAY NORMAL 5 OCT 2021 EKG NORMAL 5 OCT 2021
CDC Split Type:

Write-up: HE RECEIVED THE COVID VACCINE AT APPROX 11:00 AM ON 4 OCT 2021. HE FELT FINE UNTIL HE AWOKE AT APPROX 2:00 AM ON 5 OCT 2021 WITH RIGORS. HE WENT TO THE ER AT HOSPITAL AND CHEST X-RAY AND EKG WERE UNREMARKABLE. LABS WERE NOT COLLECTED. HE WAS DISCHARGED TO HOME AND RECOMMENDED TO TAKE TYLENOL TO TREAT. I SPOKE WITH HIM AT 4:00 PM ON 5 OCT 2021 AND THE RIGORS HAVE STOPPED, HE IS OTHERWISE FEELING OKAY.


VAERS ID: 1762073 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Hyperhidrosis, Loss of consciousness, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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: N/A
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced syncope, momentary loss of consciousness, profuse sweating, and nausea minutes after vaccine administration.


VAERS ID: 1762077 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Mass
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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Lump in right clavicle. No treatment or outcome yet.


VAERS ID: 1762088 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 4 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions: Diabetes type 2
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received a fourth dose of Pfizer


VAERS ID: 1762090 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Pain, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Woke up at 2:00am with a sore arm and could not lift arm without pain. By 10am had fever, chills and body aches. Alternating Tylenol and Advil for pain and fever


VAERS ID: 1762105 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: South Carolina  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 2 LA / 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: allopurinol, amlodipine, atorvastatin
Current Illness: none
Preexisting Conditions: hypertension, hyperlipidemia, gout
Allergies: none
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: We gave the patient a dose of Pfizer when they should''ve received their second dose of Moderna.


VAERS ID: 1762108 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301558A / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Fatigue, Joint stiffness, Lethargy, Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: March 4, 2021. Covid 19 and Pfizer
Other Medications: Flonase
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Stiff neck and jaw. Stiff upper body muscles. Fatigue and lethargy.


VAERS ID: 1762136 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30135BA / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Loss of consciousness, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Around 12:30, patient came in for her FIRST Pfizer COVID-19 vaccine. About 5 minutes after (Pharmacist) gave the patient the vaccine, patient told pharmacist she had is having "side effects". pharmacist promptly move the patient from the 15 minute waiting area to the consultation room. Upon patient siting down, the patient passed out for a few minutes. After the patient woke up, pharmacist asked if she could state her name and where she was at. Patient was able to answer both question correctly. After another few minutes, Patient started to throw up and state that she is having shortness of breath. At this point, the warehouse manager was called and came over AND one of the pharmacy technician called 911. When the paramedic arrived, the patient was still having shortness of breath and still throwing up. A few minutes later the patient was taken with the paramedic to the hospital. Pt also did mentioned to pharmacist that she did not eat this morning.


VAERS ID: 1762156 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:2021-09-01
Onset:2021-10-05
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Dizziness, Extra dose administered, Head injury, Headache, Illness, Inappropriate schedule of product administration, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Medication errors (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol Losartan Amlodipine Atorvistatin
Current Illness: Arthritis
Preexisting Conditions: High blood pressure. Chronic kidney disease
Allergies: No
Diagnostic Lab Data: None to date
CDC Split Type:

Write-up: I began to feel very nauseated and dizzy, headache and chills about 12 hours after receiving the PFIZER booster. I went to the restroom to regurgitate but couldn''t and ended up fainting. I don''t know how long I laid on the floor but came to and went back to bed. I have been dizzy since Oct 1 and it is now Oct 6. I also took a flu shot at the same time I got the Booster which I did not mark on your above form as I do not know the quadrivalent. I was able to get my shots at Health Clinic. I have never fainted in my life. The dizziness is bothersome to me and while it has lessened, it is concerning, and I hope it eventually subsides. I got sicker with this 3rd dose more so than the other 2 and I doubt I will take any more in the future. It''s very scary to wake up on the floor after passing out, alone and wondering how you got there. I had a goose egg on the left side of my head for a couple of days, but it has gone down.


VAERS ID: 1762158 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 62E21A / 2 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? 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 HAD STATED THAT SHE HAD RECEIVED MODERNA AS A FIRST DOSE AND WAS DUE FOR THE SECOND DOSE, PATIENT COULD NOT FIND HER VACCINATION CARD, MODERNA VACCINE SECOND DOSE WAS ADMINISTERED, LATER THE CARD WAS FOUND AND IT INDICATED THAT SHE HAD RECEIVED PFIZER AS A FIRST DOSE, CDC WAS CONTACTED AND AS PER THEIR RECOMMENDATION NO OTHER DOSE WAS NEEDED, PATIENT WAS OBSERVED FOR THE TIME REQUIRED AND DID NOT HAVE ANY ADVERSE EVENT AFTER ADMINISTRATION OF THE VACCINE. PATIENT IS TO CONTACT CDC REGARDING FUTURE RECOMENDATION FOR ANY FURTHER REQUIRED DOSES.


VAERS ID: 1762163 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dry throat, Dysphagia
SMQs:, Anticholinergic syndrome (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 (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: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: BEE STING AS A CHILD
Diagnostic Lab Data: VITALS ONLY
CDC Split Type:

Write-up: PATIENT HAD FIRST PFIZER VACCINE 11:58A. AFTER ABOUT 15 MINUTES IN OBSERVATION, PATIENT STATED HIS THROAT WAS DRY. RN GAVE PATIENT WATER. MINUTES LATER, PATEINT SAID HE FELT LIKE IT WAS HARD TO SWALLOW. RN CALLED (12:15P) AND: 12:17P - PROCEEDED TO TAKE BP AND SPO2. VITALS 120/86, 96%, HR 92. 12:20P - RT ARRIVED 12:20P - 130/83, 97%, HR 92 12:21P - Doctor arrived 12:25P - TRANSDERRED TO ER PER doctor


VAERS ID: 1762182 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Ageusia, Anosmia, Hypoaesthesia, Pain in extremity, Pyrexia
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, loss of taste and smell, left arm pain, hand numbness on left side


VAERS ID: 1762191 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Back pain, Biopsy, Blood test, Chest pain, Chills, Colonoscopy, Confusional state, Constipation, Culture stool, Diarrhoea, Dizziness, Electrocardiogram, Electrocardiogram ambulatory, Endoscopy, Fatigue, Headache, Irritability, Myalgia, Neck pain, Platelet count, Pyrexia, Thrombosis
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data: Blood tests, fecal tests, ekg tests, colonoscopy & endoscopy. 24h blood pressure holter. Platelet tests. Multiple trips to the ER. Doctors don''t find unusual results in tests. Endoscopy seemed to show infection but results of biopsy turn out normal.
CDC Split Type:

Write-up: Weakness dizziness chills confusion irritability fever muscle aches back ache headache neck pain fatigue. About a month after the 2nd dose of the vaccine I also experienced unusual symptoms (symptoms which are not regular for me, I have never experienced such symptoms before) including blood clots on legs, behind knee and by my ankle. Unexplained exhaustion and chest pain lasting for over a month. Diarrhea lasting on a constant basis for 3 months, which later calmed down and became fluctuations between constipation and diarrhea- lasting until today.


VAERS ID: 1762195 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Muscle spasms, Ovarian cyst ruptured
SMQs:, Dystonia (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:
Preexisting Conditions: Chronic ovarian cysts
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported cramping and a ruptured ovarian cyst post vaccination


VAERS ID: 1762209 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-22
Onset:2021-10-05
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3183 / 1 RA / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, Crestor, Aspirin, Estrogen patch, Estring
Current Illness: None
Preexisting Conditions: Secondary hypothyroidism; Familial Hypercholesterolemia; Menopause
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Neuralgia left groin area to left buttock on October 2, 2021. On October 5, 2021 morning red, itchy, hot, rash on left groin, mons pubis, and left buttock. Diagnosed with Shingles.


VAERS ID: 1762215 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Bradycardia, Hypotension, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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: Clindamycin, Ibuprofen
Current Illness: None known
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: Vitals taken several times.
CDC Split Type:

Write-up: Patient reported he was going to "blackout." He was conscious and able to answer all questions correctly. Patient moved to medical; then to the infirmary for further care. In the infirmary, under the care of a doctor, patient received 1.5L of NS, and low-flow O2 nasal cannula at 2L/min. Patient was bradycardic and hypotensive initially. After the treatment, (about 3 hours), patient felt much better and vitals were with in normal limits. Patient never reported any typical allergic reactions, such as airway swelling or difficulty breathing.


VAERS ID: 1762224 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cold sweat, Condition aggravated, Contusion, Fall, Head injury, Hyperhidrosis, Immediate post-injection reaction, Peripheral coldness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: 11$0am Patient completed getting vaccine and walked to Post observation. Patient sat down and right after he sat down, he immediately felled head first on the floor. Nurse sat patient up and vital signs were taken. AOX3. B/P 120/78. P86. Patient was cold, clammy and sweating. Assess patient noted left bruise on head, posterior left side abrasion of head. Pt. stated that he has not eaten today. History of fainting. Pt. continued to sit on floor and evaluated for additionally twenty minutes. Gave patient protein bars and water. Pt. stood up upon completed time and states he will make appointment with doctor.


VAERS ID: 1762227 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-10-01
Onset:2021-10-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Chills, Echocardiogram, Electrocardiogram normal, Magnetic resonance imaging heart, Pain, Pyrexia, Troponin increased
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Patient received second dose of murderer vaccine on October 1. That night he developed low-grade fevers, chills, body aches, which resolved after 2 days. However on the morning of October 5, he woke up with acute onset chest pain. He presented to the hospital with persistent chest pain and significant troponin elevation. EKG with nonspecific findings. Echocardiogram is still pending. Chest pain resolved spontaneously while in the emergency department. Awaiting echocardiogram and cardiac MRI results.


VAERS ID: 1762234 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: West Virginia  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 4 LA / IM

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

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

Write-up: The patient was given a fourth dose of Pfizer vaccine. The patient had received a booster dose for being immunocompromised on 9/24 but the facility didn''t have it documented so they requested us to given him his booster today 10/5. The nurse practitioner realized later that day that he had already received a booster dose and contacted us to let us know. The patient is tolerating well so far.


VAERS ID: 1762249 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: California  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: Immunization given early (one week early)


VAERS ID: 1762253 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-10-03
Onset:2021-10-05
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Diarrhoea, Immunisation, Nausea, Pain, Palpitations, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Itching, chills, body aches with first Pfizer shot in December 2020
Other Medications: Levothyroxine Celexa Benadryl taken 30 minutes prior to vaccine, had itching reaction with first vaccine shot
Current Illness: None
Preexisting Conditions: Hashimotos Thyroiditis
Allergies: Strawberries Sulfa Drugs
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heart palpitations, fever, body aches, nausea, diarrhea


VAERS ID: 1762280 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Dyspnoea, Full blood count, Heart rate increased, Influenza virus test negative, Metabolic function test, Pain, Pyrexia, SARS-CoV-2 test negative, Streptococcus test negative
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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: Aspirin 81mg daily, vitamin d.
Current Illness:
Preexisting Conditions: hx of autoimmunie type arthritis and hx of coagulation disorder
Allergies: Tetracycline
Diagnostic Lab Data: strep, flu and covid test both negative. cbc and cmp not available yet. Chest xray waiting for over read. Instructed if symptoms worsened or started having chest pain to go to nearest er.
CDC Split Type:

Write-up: Pt awoke this morning running fever of 101, dyspnea, hear rate up to 130 at home and severe body aches. Pt took motrin pta and temp down to 98.5 once arrived


VAERS ID: 1762289 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-09
Onset:2021-10-05
   Days after vaccination:57
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

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: 1762293 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Immediate post-injection reaction, Nausea, Seizure
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: THE PATIENT IMMEDIATELY HAD A SEIZURE UPON ADMINISTRATION. SHE DOES HAVE A SEIZURE DISORDER AND IS ON DEPAKOTE FOR THE CONDITION. THE PATIENT HAD NO PREVIOUS ISSUES WITH DOSES 1 AND 2. SHE HAD 2 SEIZURES, CAME OUT OF THEM PRETTY QUICKLY. SHE WAS THEN NAUSEOUS AND HAS BEEN NAUSEOUS THE REST OF THE DAY. I JUST CHECKED IN ON HER THIS EVENING. SHE IS RESTING AT HOME.


VAERS ID: 1762301 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-03-25
Onset:2021-10-05
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

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: 1762306 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-04
Onset:2021-10-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE8844 / 2 LA / SYR

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

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

Write-up: Ringing in ears


VAERS ID: 1762313 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature increased, Dyspnoea, Heart rate increased, Rash
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: did not report taking any medication at the time of vaccination
Current Illness: unknown
Preexisting Conditions: asthma
Allergies: NKDA Seasonal
Diagnostic Lab Data:
CDC Split Type:

Write-up: shortness of breath, temp, rapid pulse and rash.


VAERS ID: 1762327 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-10-05
Onset:2021-10-05
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Sensation of foreign body, Swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient felt like lump in throat, given benadryl at 15 minutes post administration. Patient continued to have swelling feeling. Brought to procedure room in clinic and given epinephrine 0.3 mg. Vitals monitored and patient sent via ambulance to hospital for further monitoring


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