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From the 7/16/2021 release of VAERS data:

Found 479,813 cases where Vaccine is COVID19 and Patient Did Not Die



Case Details (Reverse Sorted by Onset Date)

This is page 31 out of 4,799

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VAERS ID: 1446998 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 RA / IM

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

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

Write-up: Administered vaccine from vial that''s BUD was 6-26-21 at 10:15 A.M. Vial was kept in refrigerator entire time prior to administration.


VAERS ID: 1447000 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

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

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

Write-up: Administered vaccine from vial that''s BUD was 6-26-21 at 10:15 A.M. Vial was kept in refrigerator entire time prior to administration.


VAERS ID: 1447002 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Maine  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 1 LA / IM

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

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

Write-up: Administered vaccine from vial that''s BUD was 6-26-21 at 10:15 A.M. Vial was kept in refrigerator entire time prior to administration.


VAERS ID: 1447006 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-01
Onset:2021-07-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036C21A / 1 LA / IM

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

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

Write-up: Bad Rash that cover from my neck ,down both arms , both chest and back area . Under arms and breast


VAERS ID: 1447048 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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: when patient was a child
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient passed out on and off for 2-3 minutes


VAERS ID: 1447102 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Guam  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Condition aggravated, Fatigue, Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Myalgia, Oropharyngeal pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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:
Other Medications: N/A
Current Illness: None.
Preexisting Conditions: Mild asthma
Allergies: Ammoxicilin, shellfish, dust, & heat
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: 1st dose only had very mild symptoms, mostly fatigue. 2nd dose: 5 hrs post injection, injection site began swelling (size of mosquito bite) and has progressed since then. On 07/06/21, it is now the same circumference size of an apple. Symptoms also include fever, fatigue, muscle/joint ache, slight redness to entire swollen injection site, tenderness to touch, heated area, and throat tenderness.


VAERS ID: 1447113 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Unknown  
Location: Tennessee  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / 1 LA / IM

Administered by: Unknown       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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness:
Preexisting Conditions: Cognitive Impairment
Allergies: NKDA
Diagnostic Lab Data: 07/03/21 @ 3:34pm Bp( 119/80) Pulse ( 80) PulseOx ( 100%) per EMT device
CDC Split Type:

Write-up: Pt Given vaccine at 1:14 pm with father in room. Father asked to receive his vaccination while his son was in the room as the mother was watching the daughter who also has cognitive impairment. Pharmacist complied with the parents request. Upon completion of the father vaccination. Pt became synoptic. Pharmacist braced patient maintining him in the chair while the father rotated to the rear of patient to support his head. Pharmacy team provided water and monitored BP until EMT arrived, cleared patient as stable. The Patient declined EMT Transport as parents did not have POA.


VAERS ID: 1447144 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Male  
Location: Oregon  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Muscle spasms, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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: NOT KNOWN
Current Illness: NONE TO KNOWLEDGE
Preexisting Conditions: NONE KNOWN
Allergies: NONE
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: after about 10 minutes patient went weak and muscles went into tetani for a brief time .911 was called .Patient recovered well in a sitting position bu then some minutes later p[resented with syncopy. He was placed on floor with legs raised and did recover some time later. The para medics put up a drip and took him away . Patient does not return my calls to find out status


VAERS ID: 1447157 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Dysphagia, Fatigue, Lymphadenopathy, Oropharyngeal pain, Pain, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (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 (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: DPT - over 50 years ago
Other Medications:
Current Illness: None
Preexisting Conditions: Arthritis
Allergies: Penicillin
Diagnostic Lab Data: None, everything cleared after about 24 hours (except rash which is still clearing).
CDC Split Type:

Write-up: Swollen glands in neck, left side (fairly significant swelling) Extremely sore throat, difficult to swallow Fever around 100 - typical issues that with fever (tired, achy, etc.) Rash on chest


VAERS ID: 1447162 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-07-01
Onset:2021-07-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine phosphokinase increased, Chest X-ray, Chest pain, Dyspnoea, Echocardiogram, Electrocardiogram, Myocarditis, Rhabdomyolysis, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 1/3/21 ECHO EKG CXR CK $g500 Troponin 5
CDC Split Type:

Write-up: Chest pain, shortness of breath, severe myocarditis, rhabdomyolysis developed 2 days after his second shot.


VAERS ID: 1447342 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fatigue, Headache, Menstruation irregular, Pain in extremity
SMQs:, Fertility disorders (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: Motrin for headaches
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Early mental cycle not typical and early by 2weeks. Sharp pain in outer legs. Headaches. Fatigue.


VAERS ID: 1448000 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Doctor diagnose 07/06/2021
CDC Split Type:

Write-up: Shingles left leg outbreak burning and itching


VAERS ID: 1449721 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Decreased appetite, Facial paralysis, Pain, Peripheral swelling, Pyrexia
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hearing impairment (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:
Current Illness: Hypertensive
Preexisting Conditions: Spine problems, asthma
Allergies: Penicillin, sulfa and albuterol
Diagnostic Lab Data: General check up by my primary doctor, I was negative about 2 months ago.
CDC Split Type:

Write-up: Swelling in arm, fever up to 39C, no appetite, decline and pain all over body, partial paralysis of face right side.


VAERS ID: 1449979 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-22
Onset:2021-07-03
   Days after vaccination:103
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chills, Diarrhoea, Headache, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: PSORIATIC ARTHRITIS HTN STEMI CAD
Allergies:
Diagnostic Lab Data: POSITIVE COVID RESULT 7/3/21
CDC Split Type:

Write-up: FEVER, CHILLS, DIARRHEA, HEADACHE


VAERS ID: 1449983 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-04-01
Onset:2021-07-03
   Days after vaccination:93
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Concussion, Eye discharge, Fatigue, Foreign body sensation in eyes, Headache, Lacrimation increased, Ocular hyperaemia, Tear discolouration
SMQs:, Anaphylactic reaction (broad), Accidents and injuries (narrow), Glaucoma (broad), Corneal disorders (broad), Lacrimal disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin; vitamin C; iron; calcium; fish oil; green tea extract; elderberry
Current Illness:
Preexisting Conditions: Asthma; high blood pressure (resolved)
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type: vsafe

Write-up: I originally was fatigued and had some headaches. That dissapated pretty quickly. That went away within a couple days of my vaccine. I started feeling better. I would occasionally get headaches. I was still able to work and everything. Then I got a concussion. It made my headaches much worse. I do not consider that to be an adverse effect. This past Friday, I felt like my eye had some grit in it. My right eye felt like I had something in it. It started to tear up and it was getting really red. Saturday, it got quite a bit worse. I was tearing quite a bit. Sunday, it was oozing and extremely red. Some of the tears had a pink tint to them. Monday, I had a Telehealth appointment and took a picture of my eye to send to the doctor. He prescribed an optomic solution. I started taking that the same day. I started feeling better. I take 2 drops every four hours that I am awake. It is still pink, but definitely feeling better. A couple of weeks ago, I did see a doctor, but it was just a physical.


VAERS ID: 1450007 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-01-26
Onset:2021-07-03
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3302 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cough, Diarrhoea, Dyspnoea, Fatigue, Headache, Nausea, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes, Hypertension, Cardiovascular Disease
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 7/3/21 in early morning, case was hospitalized due to Covid symptoms including Shortness of Breath, Fever, Cough, Nausea, Vomiting, Diarrhea, Headache, Fatigue.


VAERS ID: 1450029 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / IM

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

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

Write-up: Pt was given vaccine from a vial that had been punctured over 12 hours, thus expired


VAERS ID: 1450046 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 2 LA / IM

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

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

Write-up: pt was given vaccine from a vial that had been punctured over 12 hours, thus expired.


VAERS ID: 1450054 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Guam  
Vaccinated:2021-07-01
Onset:2021-07-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Military       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram ST segment elevation, Inflammatory marker increased, Myocarditis, Troponin increased
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None reported
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: Azithromycin (rash), as per medical record
Diagnostic Lab Data: Elevated troponins and inflammatory markers, EKG with ST elevation, and clinical picture c/w myo/pericarditis. Remote engagement of Pediatric Cardiologist
CDC Split Type:

Write-up: Presented to Emergency Dept with acute chest pain, somewhat positional, on 03 July -- two days after reported receipt of 2nd dose Pfizer vaccine.


VAERS ID: 1450063 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / IM

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

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

Write-up: pt received vaccine from a vial that had been punctured over 12 hours, thus expired


VAERS ID: 1450085 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-26
Onset:2021-07-03
   Days after vaccination:99
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Electrocardiogram, Gastritis, Hyperhidrosis, Hyperlipidaemia, Laboratory test, Leukocytosis, Lipase increased, Magnetic resonance cholangiopancreatography, Muscle twitching, Myoclonus, Nausea, Pancreatitis, Tachypnoea, Urine analysis
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (narrow), Asthma/bronchospasm (broad), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Dyskinesia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Lipodystrophy (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EKG, MRCP, multiple lab draws, UA, oxygen, after hospital discharge, follow up with GI
CDC Split Type:

Write-up: chest pain, sweats, nausea, diaphoretci, tachypnea, possible V2 and V3 ST elevation, pancreatitis, gastroduodenitis, elevated lipase, leukocytosis, hyperlipidemia, myoclonus/twitching of face muscles


VAERS ID: 1450318 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Cough, Dizziness, Fatigue, Feeling cold, Headache, Injection site swelling, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

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

Write-up: Cold chills, cough, muscle aches, swelling at injection site, dizziness, body aches, headache, fatigue


VAERS ID: 1450407 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest pain, Dyspnoea, Electrocardiogram
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Abilify
Current Illness:
Preexisting Conditions: Endometriosis
Allergies: Vancomycin, citric acid
Diagnostic Lab Data: EKG, bloodwork and chest X-ray on July 5th.
CDC Split Type:

Write-up: Shortness of breath and chest pain 10 hrs after vaccination. Chest pain and shortness of breath worsened over the next 2 days. Went to ER on July 5th. Blood work,EKG and chest X-ray done. Sent home with 800mg IBU


VAERS ID: 1450502 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site pain, Injection site swelling, Musculoskeletal stiffness, Nausea
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)

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

Write-up: Soreness and swollen at the injection site, stiffness, numbness, and nausea.


VAERS ID: 1450624 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Chills, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, chills, hives. Fever and chills gone on 7/5/21. The hives are the reason for going to urgent healthcare on 7/5/21 where they prescribed prednisone and famotidine.


VAERS ID: 1450693 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

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

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

Write-up: Site: Bruising at Injection Site-Mild, Site: Itching at Injection Site-Medium, Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium


VAERS ID: 1450696 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-06-30
Onset:2021-07-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest pain, Dyspnoea, Electrocardiogram ST segment elevation, Troponin increased
SMQs:, Anaphylactic reaction (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Omeprazole 40mg daily
Current Illness: None
Preexisting Conditions: Obesity
Allergies: Amoxicillin, Penicillin, Sulfa drugs
Diagnostic Lab Data: ST elevations, troponin leak
CDC Split Type:

Write-up: Chest pain, shortness of breath.


VAERS ID: 1450716 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-03
Onset:2021-07-03
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 4/3/21 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 4/24/24 / 2 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: OPTISON 4/26/21
Current Illness:
Preexisting Conditions: HYPERTENSION DYSLIPIDEMIA ANEMIA OF CHRONIC DISEASE IRON DEFICIENY ANEMIA CHRONIC KIDNEY DISEASE, STAGE II TIA CHRONIC DIASTOLIC CHF EF CHRONIC DIASTOLIC HEATH FAILURE LUNG ABSCESS ATROPHY OF LEFT KIDNEY ACUTE KIDNEY INJURY GOUT CHRONIC ULCER OF LEFT LEG
Allergies: AMOXICILLIN
Diagnostic Lab Data: POSITIVE COVID RESULT 7/3/21
CDC Split Type:

Write-up: Asymptomatic


VAERS ID: 1450908 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037C21A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Chest pain, Cytomegalovirus test negative, Dizziness, Dyspnoea, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Epstein-Barr virus test negative, Fatigue, HIV test negative, Hypoacusis, Immunoglobulin therapy, Respiratory viral panel, Treponema test negative, Troponin increased, Urine analysis normal, Varicella virus test negative, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Anaphylactic reaction (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Previously healthy
Allergies: No known allergies
Diagnostic Lab Data: 7/4 EKG with ST elevation 7/4 OSH troponin of 8154 Serial troponins from 7/4-7/6 (14.23 $g 13.98 $g 13.06 $g 10.20 $g 14.67 $g 11.71 $g 9.23) UTox negative. Multiple myocarditis studies including CMV (negative), viral respiratory panel (negative), HIV (negative), RPR Syphilis (negative), VZV (negative), EBV (negative). Pending enterovirus stool culture and blood cultures
CDC Split Type:

Write-up: Received second dose of Moderna COVID vaccine on 7/2/21. 7/3 developed fatigue, dizziness, and decreased hearing. Symptoms progressed to difficulty breathing and chest pain. 7/4 chest pain localized to left side of chest. He was seen in local ED with elevated troponin of 8154, EKG with diffuse ST segment elevation. Transferred to another ED for further evaluation. He received IVIG on 7/5 and did develop V-tach lasting about 7 beats around 0500 on 7/5 but otherwise hemodynamically stable.


VAERS ID: 1450925 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-07-01
Onset:2021-07-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0180 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0167 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Echocardiogram normal, Myocarditis, Pain, Troponin increased
SMQs:, Myocardial infarction (narrow), 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? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed myocarditis with peak troponin of 6.4, normal echo. He required hospitalization for evaluation and management of pain.


VAERS ID: 1450939 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-05-18
Onset:2021-07-03
   Days after vaccination:46
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041C21A / 2 LA / IM

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

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

Write-up: This is a vaccination administration error. Patient received her 2nd Covid vaccine too soon. Her 1st dose was 5/4/21 and her 2nd dose was 5/18/21, which is 2 weeks apart. Moderna should be give 4 weeks apart.


VAERS ID: 1450942 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Brain natriuretic peptide increased, C-reactive protein increased, Chest pain, Dizziness, Echocardiogram normal, Magnetic resonance imaging heart, Myocarditis, Pyrexia, Red blood cell sedimentation rate normal, Troponin increased, Ventricular extrasystoles, Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Cardiac failure (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Unknown
Preexisting Conditions: Obesity, Autism Spectrum Disorder
Allergies: None
Diagnostic Lab Data: ESR 9, CRP 4.5, BNP 109. Troponin peaked at 28 on 7/5 before starting to downtrend, though variable thereafter (12.7 -$g 10.6 -$g 13.2 -$g 11.2). During stay had frequent PVCs and several bursts of NSVT which did not require intervention. Echocardiogram demonstrated normal biventricular systolic function, normal coronary artery size. Cardiac MRI was performed on 7/6 - results pending at time of this filing.
CDC Split Type:

Write-up: Developed dizziness and fever the morning following vaccination followed by chest pain around 48 hours after vaccination. Presented to outside urgent care where pt noted to have elevated troponin $g10, prompting transfer to ED. and admission for myocarditis. Symptoms improved over next several days and chest pain was well controlled with ibuprofen and tylenol.


VAERS ID: 1450951 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-26
Onset:2021-07-03
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Erythema, Nodule, Pain in extremity, Palpitations, Peripheral swelling, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (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: albuterol inhaler, prednisone, amlodipine, gabapentin, Tylenol, venlafaxine , duloxetine , Ibuprofen, hydrochlorothiazide , nervive nerve relief,
Current Illness: none
Preexisting Conditions: HTN, asthma, neuropathy
Allergies: NKA
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient received her first COVID-19 shot on 6/26/21 and called today to report that the swelling, redness, knot, heat, and pain in her arm still persist. She also said she has pain in her leg as well as heart palpitations. She did say that she''s had heart palpitations in the past. These symptoms started about 2-3 days ago, she also said. I advised her to take Tylenol and to use a cold compress. She said she did not have plain Tylenol on hand and would take Tylenol, which she takes for arthritis. I advised her to try to get some plain Tylenol but to take what she had if she was in pain and could not wait. I also advised her to follow up with her doctor, especially regarding the palpitations. She said she would follow the above recommendations.


VAERS ID: 1451966 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Breast pain, Sensory disturbance
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Lipodystrophy (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: SULFA
Diagnostic Lab Data:
CDC Split Type:

Write-up: PAIN IN LEFT BREAST. PATIENT DESCRIBES AS A PAIN THAT FEELS LIKE ROCKS ARE IN HER LEFT BREAST. SHE FEELS IT MORE WHEN MOVING.


VAERS ID: 1451992 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-06-26
Onset:2021-07-03
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939676 / UNK LA / SYR

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Somatuline Depot 90 MG injection every 4 weeks Zoloft 150mg Multi vitamin
Current Illness:
Preexisting Conditions: Recurring pituitary tumor, acromegaly
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Covid arm, red, swollen, itchy and painful rash at injection site. Started 6 days after the shot.


VAERS ID: 1452185 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pelvic pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin E, Magnesium 1000mg
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Sharp pain in the pelvic area. The pain was steady for a few hours.


VAERS ID: 1452416 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Concussion, Dizziness, Electrocardiogram, Fall, Feeling abnormal, Head injury, Loss of consciousness, Vertigo
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), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Vestibular 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D, Vitamin C, Zinc
Current Illness: None
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: bood work, CT scan and EKG, all conducted on July 3rd
CDC Split Type:

Write-up: Woke up, felt strange, went to get a drink of water, lost consciousness and hit head on tile kitchen floor. Still dealing with vertigo and persistent dizziness due to sustained concussion.


VAERS ID: 1452571 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Burns second degree
SMQs:, Accidents and injuries (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: Adderall XR
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Small burning blisters on neck, behind ears. Under chin/jaw. Up cheeks. Around hair line, brows/eyes.


VAERS ID: 1454054 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Dyspnoea, Fatigue, Feeling abnormal, Headache
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall, Atorvastatin, Nexium, Vascepa, Celebrex, Ativan, Verapamil, Cymbalta, Glucosamine Chondroitin, Probiotic, Zyrtec, Qudexy, Elavil, Vitamin D, Flexeril, Reglan, Compazine, Carafate, Toradol, Excedrin, Reyvow, Benadryl, Singulair
Current Illness: Asthma, Migraines, Sinus infection, Hypoglycemia, Osteoarthritis, Gastroparesis, High cholesterol
Preexisting Conditions: Asthma, Migraine, Osteoarthritis, Hypoglycemia, Gastroparesis, High Cholesterol, Gluten Intolerance, Barrett?s esophagus, GERD, low GI motility
Allergies: Latex, Imitrex
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue the next day, then extreme joint pain, extreme headache, difficulty in breathing, foggy feeling in brain, allergy symptoms, weakness


VAERS ID: 1454067 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0183 / 2 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Swelling face, Swelling of eyelid
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none known
Diagnostic Lab Data: none, did not see a doctor, called the nurse hotline, they advised to watch the symptom and to go to emergency if the symptom got worse
CDC Split Type:

Write-up: facial swelling especially around the lower eyelids, subsided through the next 48 hours and is the swelling is now gone, pictures available


VAERS ID: 1454120 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWOBO / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cough, Oropharyngeal pain, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (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: N/a
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/a
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: sore throat, fever, cough following injection.


VAERS ID: 1454171 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Fatigue, Headache, Pain, Pyrexia, Somnolence, Suicide attempt
SMQs:, Suicide/self-injury (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol
Current Illness:
Preexisting Conditions: Ptsd
Allergies: Pine trees, grass
Diagnostic Lab Data: Unknown at this time
CDC Split Type:

Write-up: Fever, fatigue, headache, sleepiness, chest pain, and. pain during days 1-4 , after that she was not herself. She had taken 9 tylenol and did not want to live anymore. She is admitted to hospital at this time.


VAERS ID: 1454186 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-02-27
Onset:2021-07-03
   Days after vaccination:126
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asymptomatic COVID-19, Back pain, COVID-19, Compression fracture, Condition aggravated, SARS-CoV-2 RNA
SMQs:, Retroperitoneal fibrosis (broad), Accidents and injuries (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Hospitalized for back pain secondary to compression fractures.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 6/29/21 COVID19, SARS-CoV-2/2019-nCoV RNA XXX NAA+probe-Imp NEGATIVE 7/3/21 COVID19, SARS-CoV-2/2019-nCoV RNA XXX NAA+probe-Imp POSITIVE 7/4/21 COVID19, SARS-CoV-2/2019-nCoV RNA XXX NAA+probe-Imp NEGATIVE 7/6/21 COVID19, SARS-CoV-2/2019-nCoV RNA XXX NAA+probe-Imp NEGATIVE
CDC Split Type:

Write-up: Patient admitted to hospital on 06/29/2021 with non COVID reasons (compression fractures). Was (-) on admission. Discharged and readmitted on 07/03/2021 with admission screen of COVID (+). Asymptomatic. Hospital admission for non COVID reasons (back pain due to compression fractures). Had 2 subsequent (-) COVID tests on 7/4 & 7/6. Per clinic, patient still considered a (+) case but does not have to isolate. Being discharged to long term care on 7/7/21 to the rehab unit.


VAERS ID: 1454194 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-27
Onset:2021-07-03
   Days after vaccination:98
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, COVID-19, Compression fracture, SARS-CoV-2 test positive
SMQs:, Retroperitoneal fibrosis (broad), Accidents and injuries (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Hospitalized for back pain secondary to compression fractures.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 6/29/21 COVID19, SARS-CoV-2/2019-nCoV RNA XXX NAA+probe-Imp NEGATIVE 7/3/21 COVID19, SARS-CoV-2/2019-nCoV RNA XXX NAA+probe-Imp POSITIVE 7/4/21 COVID19, SARS-CoV-2/2019-nCoV RNA XXX NAA+probe-Imp NEGATIVE 7/6/21 COVID19, SARS-CoV-2/2019-nCoV RNA XXX NAA+probe-Imp NEGATIVE
CDC Split Type:

Write-up: Patient admitted to hospital on 06/29/2021 with non COVID reasons (compression fractures). Was (-) on admission. Discharged and readmitted on 07/03/2021 with admission screen of COVID (+). Asymptomatic. Hospital admission for non COVID reasons (back pain due to compression fractures). Had 2 subsequent (-) COVID tests on 7/4 & 7/6. Per WI DHS patient still considered a (+) case but does not have to isolate. Being discharged on 7/7/21 to the rehab unit.


VAERS ID: 1454202 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-30
Onset:2021-07-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Headache, Impaired work ability, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Itch on webbing of fingers (between 3rd and 4th), severe fatigue, severe headache. Missed work due to side effects


VAERS ID: 1454251 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Axillary vein thrombosis, Blood creatinine increased, Deep vein thrombosis, Fibrin D dimer increased, Glomerular filtration rate decreased, Jugular vein thrombosis, Subclavian vein thrombosis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Haemorrhage laboratory terms (broad), Retroperitoneal fibrosis (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Chronic kidney disease (broad), Tumour lysis 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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: famotidine (PEPCID) 20 mg tablet Take 1 tablet (20 mg total) by mouth nightly.Patient taking differently: Take 20 mg by mouth as needed. ibuprofen (ADVIL,MOTRIN) 600 mg tablet Take 1 tablet (600 mg total) by mouth every 6 (six) hours as
Current Illness: None at the time of vaccination. Deep vein thrombosis involving the left internal jugular, axillary, subclavian and brachial veins developed 1-2 days after vaccination.
Preexisting Conditions: Malignancy of the gastroesophageal junction status post chemoradiation and surgical resection in 2013. History of Crohn''s, GERD, pulmonary embolism coincident with cancer and chemotherapy.
Allergies: NKDA
Diagnostic Lab Data: D-dimer: 735 Creatinine 1.40, GFR 55 (both aberrant compared to multiple recent normal baseline readings) Above studies were obtained 7/5/21
CDC Split Type:

Write-up: Deep vein thrombosis affecting the left internal jugular, axillary, subclavian and brachial veins.


VAERS ID: 1454260 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0168 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood glucose normal, Dizziness, Hyperhidrosis, Loss of consciousness, Nausea
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), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: B/P 70/40, pulse 58, Glucose 88, Respiration 16, normal mentation.
CDC Split Type:

Write-up: Patient is a 25 y/o male whom after being vaccinated and being informed about 15 min. observation period, lost consciousness. Client''s head was supported until he regained consciousness and was helped into a wheelchair and taken to the private recovery area where EMS took his vitals. BP 70/40, pulse 58, Glucose 88, Resp. 16, normal mentation. Patient diaphoretic, complaining of nausea and dizziness. Client was then transported by EMS staff from recovery area @ 12:33pm and taken to Coral Springs Hospital Emergency Room.


VAERS ID: 1454505 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anticoagulant therapy, C-reactive protein increased, Cardiac imaging procedure abnormal, Dyspnoea, Ejection fraction normal, Fibrin D dimer, Magnetic resonance imaging heart, Malaise, Myocarditis, Pyrexia, Troponin
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: tylenol
Current Illness: none
Preexisting Conditions: Factor V Leiden (unknown whether homozygous
Allergies: penicillin
Diagnostic Lab Data: Troponin 2.15 CRP 3.29 Ddimer 821 MRI cardiac stress: EF 60%, no ischemia. Small amount of late gadolinium enhancement in the epicardium at the base of the inferior well and in the distal segment. Also epicardial gadolinium enhancement in the basal lateral wall and along the distal lateral wall. Findings consistent with myocarditis
CDC Split Type:

Write-up: Patient developed fevers and malaise within 10 hours of the vaccine and then subsequently developed progressive shortness of breath and presented to the ED locally. Was thought to have a PE and underwent CT images which was equivocal. Transferred to our hospital where an MRI cardiac stress indicated myocarditis. Started on aspirin and colchicine and will require cardiology outpatient follow up. Patient is feeling better


VAERS ID: 1454575 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-03-27
Onset:2021-07-03
   Days after vaccination:98
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Condition aggravated, Diabetic ketoacidosis, SARS-CoV-2 test positive
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: 1. Metformin 500 mg po BID 2. Montelukast 10 mg po daily 3. Propranolol 20 mg po BID 4. Fluticasone 50 micrograms, nasally BID
Current Illness: 1. History of Diabetes, recent elevated control - admitted 7/2/2021 with DKA and found to be COVID 19 +
Preexisting Conditions: As above
Allergies: NKDA
Diagnostic Lab Data: COVID-19 Antigen ++ 7/2/2021
CDC Split Type:

Write-up: Patient vaccinated with 2 doses of Pfizer mRNA. Admitted to hospital for DKA on 7/2/2021 and Tested Positive for COVID-19 (Post vaccination positivity). Did receive remdesivir when admitted.


VAERS ID: 1454624 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-04-14
Onset:2021-07-03
   Days after vaccination:80
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8727 / 1 - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0153 / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Chest pain, Cough, Diarrhoea, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN gastric bypass chronic back pain
Allergies: contrast dye, Percocet, shellfish, sulfadiazine
Diagnostic Lab Data: SARS COVID19 PCR positive on 7/3/21
CDC Split Type:

Write-up: She completed the series of Pfizer vaccines on 4/14/21. She was tested covid positive as outpatient on 6/21/21. She developed chest pain, dyspnea, dry cough watery diarrhea, and she was admitted to the hospital on 7/3/21. She is currently still hospitalized.


VAERS ID: 1454625 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-22
Onset:2021-07-03
   Days after vaccination:72
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ill-defined disorder
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Based on Report stored on patient''s file: Chronic kidney disease, hyperlipidemia, hypertension, right spastic hemiparesis, multi nodular thyroid, solitary left kidney, single chamber ICD-Medtronic, dermatophytosis of nail, and hemiparesis, right.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Based on documentation from case manager''s interview notes on 07/06/2021, "Advised of test results. Client states he was asymptomatic when tested (pre-screening for a colonoscopy) and continues asymptomatic. Client confirmed prior vaccination." Got tested on 07/03/2021.


VAERS ID: 1454647 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-06-27
Onset:2021-07-03
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Bell's palsy, Facial paralysis
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft 100mg
Current Illness: N/A
Preexisting Conditions: Depression
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Left sided facial drooping - started 07/03/2021. Patient diagnosed with Bell''s palsy 07/07/2021. Treated with acyclovir 800mg (1 tab orally 5 times a day for 10 days) and prednisone 10mg (7 tabs day 1, decreasing by 1 tab/day until gone)


VAERS ID: 1454656 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / IM

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

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

Write-up: I''ve developed several tender, itchy bumps at various spots on my body at this time. It''s been 5 days since my 2nd injection of Moderna. I''m currently just applying hot compresses on the bumps to relieve the itch. I don''t know the outcome, since I may develop more bumps. I have 3 of them currently, and none are at the injection site.


VAERS ID: 1454685 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-06-27
Onset:2021-07-03
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Cerebral haemorrhage, Cerebral mass effect, Computerised tomogram head abnormal, Computerised tomogram neck, Craniotomy, Hydrocephalus, Hypertension, Intraventricular haemorrhage, Nodule, Ventricular drainage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None to the knowledge of the writer
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: No known allergies
Diagnostic Lab Data: CT head + neck on 7/3: IMPRESSION: 1. Large parenchymal hemorrhage in the right posterior basal ganglia extending to the right frontal region. Intraventricular extension. Reactive hydrocephalus. Midline shift to the left 8.3 mm. Likely hypertensive. 2. Indeterminate nodule superior segment left lower lobe. Recommend CT chest. 3. No significant stenosis or occlusion of the major arteries of the head and neck. No abnormal enhancement involving the parenchymal hemorrhage.
CDC Split Type:

Write-up: Patient admitted with a significant intaparenchymal bleed in the right fronto-parietal lobe with intraventricular extension and significant reight-to-left midline shift status post craniotomy and EVD placement.


VAERS ID: 1454898 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad)

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

Write-up: My throat started to close. Difficulty breathing


VAERS ID: 1454914 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-06-04
Onset:2021-07-03
   Days after vaccination:29
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Chest pain, Computerised tomogram, Dysstasia, Gait disturbance, Hyperhidrosis, Muscle twitching, Neuralgia, Paraesthesia, Skin warm, Tremor
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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:
Current Illness:
Preexisting Conditions: Bi-Polar Disorder; asthma.
Allergies: Sulfa; aspirin; Zithromax.
Diagnostic Lab Data: CT scan; Blood Work
CDC Split Type: vsafe

Write-up: The night of July 3rd, I started getting severe chest pain, that was worse than before. As well as full body nerve pain, obsessive sweating, shaking, my back was twitching, which led to uncontrollable shaking that went into my legs like they were vibrating. It went all over my body, hands, feet, legs, arms, all over. When I tried to stand up I could barely walk, I went to the ER. They took at CT Scan, blood tests, and just sent me home to get checked by a Neurologist. Since then I continue to have these symptoms. Such as trimmers, in my hands and feet. Heat on my skin all over my body at random times of the day. As well as the sensation that I have water or sweat on random parts of my body. I go to the Neurologist, July 15th to do further testing.


VAERS ID: 1455555 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-26
Onset:2021-07-03
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Injection site erythema, Injection site induration, Injection site warmth, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Red, hot, hard spot at injection site. Skin is itchy, and it feels like the area below the skin is itchy. The red spot/itchiness has moved some towards my inner arm.


VAERS ID: 1455745 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-26
Onset:2021-07-03
   Days after vaccination:68
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abortion spontaneous
SMQs:, Termination of pregnancy and risk of abortion (narrow)

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: Miscarriage


VAERS ID: 1456783 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-02
Onset:2021-07-03
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Catheterisation cardiac, Chest pain, Electrocardiogram, Magnetic resonance imaging, Myocarditis, Ultrasound scan
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Amoxicillin
Diagnostic Lab Data: I had Acute Myocarditis (Inflammation of the heart muscle). They ran several tests when I first arrived on 7/4/2021 including EKG, Catheterization, and then on 7/5/2021 did an ultrasound and an MRI.
CDC Split Type:

Write-up: I would wake up at around 3 to 4am with severe inner chest pain and it would take around 2 hours to calm down. I am now taking Colchicine to reduce inflammation.


VAERS ID: 1456974 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0185 / 2 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0179 / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Haemoptysis
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Infective pneumonia (broad)

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

Write-up: Coughing up a little bit of blood. It?s not much but enough to worry me.


VAERS ID: 1457035 (history)  
Form: Version 2.0  
Age: 33.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-04-15
Onset:2021-07-03
   Days after vaccination:79
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001321A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abortion spontaneous, Exposure during pregnancy, Ultrasound scan abnormal, Uterine dilation and curettage
SMQs:, Malignancy related therapeutic and diagnostic procedures (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? Yes
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Singlulair, Cymbalta, Imitrex, Flonase, Atrovent
Current Illness: Gluten, Milk, amytriptiline
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 7/7/21 - ultrasound 7/8/21 - D&C
CDC Split Type:

Write-up: Patient was pregnant but not known at at time of first shot. She then got the second vaccine and had a miscarriage diagnosed 7/7/21 at 8w6d


VAERS ID: 1457161 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-06-28
Onset:2021-07-03
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

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

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

Write-up: Patient has a rash on 7/3/21 that started off as localized to right flank area then became diffuse


VAERS ID: 1457208 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-01
Onset:2021-07-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Feeling abnormal, Hypoaesthesia, Limb discomfort, Mobility decreased, Musculoskeletal stiffness, Pain in extremity, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), 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: no
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: I didn''t do any laboratory tests, didn''t visit to the doctor because I am not insured and the severe pain disappeared the next day
CDC Split Type:

Write-up: 48 hours after vaccination of 1st dose (Phizer), I felt discomfort in my feet: numbness, tingling, pulling pains. Within 2 hours after the first symptoms, the pain in the left foot began to increase and became so severe that it was not possible to step on the left leg or make any movements with the foot. This state continued for a whole day (about 24 hours). After that, the sharp pain in left foot disappeared, but unpleasant sensations in the legs still remained - heaviness, tension, numbness, periodic pulling pain (not severe)


VAERS ID: 1457292 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-05-28
Onset:2021-07-03
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Hypoaesthesia oral
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? 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: tounge numbness a month after vaccine. no trouble breathing, no pain, just weird numb sensation on top and bottom of the tounge


VAERS ID: 1457344 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-07-01
Onset:2021-07-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Fatigue, Pain
SMQs:

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

Write-up: 24 hours after shot, chills, body aches, extreme fatigue


VAERS ID: 1457474 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0172 / 1 LA / IM

Administered by: Public       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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient denied receiving previous COVID vaccine at registration and vaccination station. Patient confirmed it was their first dose of Pfizer, Pfizer 0.3ml administered. While the patient was in observation, team member identified that the patient had two different profiles and patient had previously received the Johnson & Johnson vaccine at clinic on 4/10/21 at 8:30 am (lot # 202A21A) under a different profile. Patient was notified that cross vaccinating is not recommended by the CDC at this time and to follow up with their doctor. Patient waited in in observation for 30 minutes and denied experiencing any adverse reactions,


VAERS ID: 1457620 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-01
Onset:2021-07-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047B21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Bell's palsy, Extraocular muscle paresis, Facial paralysis, Facial paresis, Hypoaesthesia, Ophthalmoplegia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), Ocular motility disorders (narrow), Immune-mediated/autoimmune disorders (broad)

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

Write-up: Patient states reporting numbness, weakness, with paralysis to the left side of the face and left eye. He states he first noticed his left eye not closing and drooping of the mouth when brushing his teeth on 07/03/2021. Patient was seen by a provider and was palced on medication and diagnosed with Bells Palsy.


VAERS ID: 1457885 (history)  
Form: Version 2.0  
Age: 24.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-06-01
Onset:2021-07-03
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Heavy menstrual bleeding, Menstrual disorder
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

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

Write-up: Change in menstrual cycles (extremely heavy periods for extended amount of time)


VAERS ID: 1458114 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / IM

Administered by: Pharmacy       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: Multi-vitamin, Vitamin C
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: None yet.
CDC Split Type:

Write-up: Tinnitus began spontaneously in the left ear 18 hours post-vaccination, followed by tinnitus in the right ear 12 hours later. Tinnitus is high pitched and constant. Symptoms have persisted without change. No associated ear pain, dizziness, headache or systemic symptoms. No prior history of tinnitus, no environmental risk (eg, loud noises) and no predisposing medical conditions.


VAERS ID: 1458122 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-06-30
Onset:2021-07-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033B218 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Patient said swelling is still there like bee sting, feeling warm. no pain no fever


VAERS ID: 1458375 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Nevada  
Vaccinated:2021-06-30
Onset:2021-07-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH PAA165969 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal pain upper, Cardiac flutter, Dizziness, Fatigue, Head injury, Headache, Nausea, Syncope, Vertigo
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Tachyarrhythmia terms, nonspecific (narrow), Vestibular disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Day 1 fatigue and dizzy Day 2 nauseous and dizzy. Extremely tired heart fluttering. Day 3 headache. Dizzy. Vertigo. Nausea. Got up from a chair and fainted. Boyfriend shaking me woke me up. I got off the ground and immediately fainted again. Smacked my head on the garage floor both times. Day 4 So tired I can?t keep my eyes open. Heart is fluttering and punchy. Fatigue is unreal. Vertigo is debilitating. Day 5 same as above. Almost passed out in shower. Day 6 same as above Day 7 severe stomach ache after eating dinner. Had to lay down to avoid vomiting. Dizzy and vertigo so bad I?m holding on to walls to walk. Day 8 (Today) I?m so fatI


VAERS ID: 1458609 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Erythema, Hypoaesthesia, Mobility decreased, Nodule, Pain in extremity, Skin warm, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra, montelask, prenatal vitamin
Current Illness: N/a
Preexisting Conditions: Asthma
Allergies: Augmentin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm is sore, cannot lift above head, golf ball sized knot, red welt the size of a softball, warm to the touch, numbness, has lasted now almost a week


VAERS ID: 1459454 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Confusional state, Dizziness, Injection site pain, Nausea, Syncope, Tremor, Unresponsive to stimuli
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), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: Site: Pain at Injection Site-Mild, Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Nausea-Medium, Systemic: Shakiness-Mild


VAERS ID: 1459724 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-30
Onset:2021-07-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 051C21A / 1 RA / IM

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

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

Write-up: Soars that looks like big mosquito bites located on the upper part of hands, elbows, knees and legs


VAERS ID: 1460011 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-31
Onset:2021-07-03
   Days after vaccination:94
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048B21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Fatigue, Influenza A virus test, Influenza B virus test, Pyrexia, SARS-CoV-2 test positive
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Sensipar, Pepcid, Cellcept, Deltason, Demadex
Current Illness:
Preexisting Conditions: major depression, stage 3a kidney disease, status post kidney transplant, hyperlipidemia, chronic back pain
Allergies: codeine, hydrocodone-acetaminophen, sevelamer, tomato
Diagnostic Lab Data: SARS-CoV-2 and influenza AB antigens, POC positive for SARS on 7/3/21
CDC Split Type:

Write-up: Pt received Moderna vaccines on 3/31/21 and 4/28/21. Pt presented to the ED with complaints of diffused fatigue and fever. On 7/3/21 pt was found to be COVID-19 positive.


VAERS ID: 1460143 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-17
Onset:2021-07-03
   Days after vaccination:108
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: SARS-CoV-2 RdRp Resp Ql NAA+probe~COVID-19 rapid diagnostic test (nucleic acid amplification test NAAT); positive
CDC Split Type:

Write-up: Started symptoms on 7/3, nasal congestion and fatigue


VAERS ID: 1460158 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-06-30
Onset:2021-07-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Adenovirus test, Blood thyroid stimulating hormone normal, Blood triglycerides normal, Cardiac imaging procedure abnormal, Chest discomfort, Chest pain, Coxsackie virus test negative, Cytomegalovirus test negative, Echocardiogram, Ejection fraction, Electrocardiogram ST segment elevation, Epstein-Barr virus test negative, Herpes simplex test negative, Magnetic resonance imaging heart, Myocarditis, Prohormone brain natriuretic peptide increased, Thyroxine free normal, Troponin increased
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Troponins peaked at 14 . Negative HSV, EBV, Coxsackie, CMV, adenovirus. TSH, free T4, triglycerides wnl. Pro-BNP elevated to 224. Cardiac MRI: IMPRESSION: 1. Subepicardial delayed gadolinium enhancement of the left ventricular inferolateral wall which is characteristic of myocarditis. 2. Normal size and function of the left ventricle. LVEF = 56%.
CDC Split Type:

Write-up: COVID vaccine-associated myocarditis. 3 days after his second Pfizer COVID vaccine, pt presented for chest pain and pressure. Troponin was initially elevated to 4.2, EKG showed ST elevations in lateral leads. Over the course of his stay, troponin dropped, then rose to peak of 14, then dropped again. He was treated with Naproxen 500 mg BID and Pepcid 20 mg BID for gastroprotection. As chest pain resolved, troponins improved, and EKGs improved. Echo and Cardiac MRI were done.


VAERS ID: 1460229 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-05-22
Onset:2021-07-03
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Hydrosalpinx, Laboratory test normal, Nausea, Ovarian cyst, Ovarian mass, Ultrasound pelvis abnormal, Urine analysis, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: Ferrous Gluconate; probiotic
Current Illness: No
Preexisting Conditions: No
Allergies: Aspirin; ibuprofen; Ceptra; Macrodantin
Diagnostic Lab Data: ER - Ultrasound; Urinalyses - negative ; bloodwork - everything was normal in bloodwork and I had no fever. Just pelvic exam at OB/GYN exam - there is a mass on ovaries - was able to feel it on the exam. Will repeat the Ultrasound in six to 8 weeks.
CDC Split Type: vsafe

Write-up: I had pretty extreme abdominal pain with vomiting. They did a pelvic ultrasound at ER - complex ovarian cyst and fluid in Fallopian tube. Zofran for nausea and two weeks of Doxycycline. And they had me follow up with OB/GYN which I did yesterday. The vomiting has resolved. I still have abdominal pain - but it''s not as severe as it was on the 3rd of July.


VAERS ID: 1460331 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Chills, Discomfort, Fatigue, Feeding disorder, Lymphadenopathy, Musculoskeletal stiffness, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Burning with fever, shivering, 101 degree fever, lyphnodes in arm, size of small mushroom, very uncomfortable , stiff arm, lypnodes in neck swollen, stiff neck, extremely pain, painful back (feels like sunburn), couldn''t eat or drink for 3 days, threw up water. Symptoms lasted for 3 days. Back pain, swollen lympnodes, stiff arm and neck still ongoing. Doctor made a house call, prescribed tylonol and ibopropin. Ongoing fatique.


VAERS ID: 1460338 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 LA / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none known at the moment
Diagnostic Lab Data: none. We just visited a doctor
CDC Split Type:

Write-up: Rash that covers her whole body, more prominent in hands and feet. Swollen shot area that looks blistery, about 3 inches big..


VAERS ID: 1460388 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Condition aggravated, Sleep disorder
SMQs:, Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metformin, tramadol, levoxothyrine
Current Illness: none, however since the vaccine was given I have not been able to sleep more than 45 minutes during the night. My hip pain has only since the vaccine.
Preexisting Conditions: hip pain from bursitis in both hips, cyatica on right side, cronic lower back pain
Allergies: flu vaccine, pollen, grass
Diagnostic Lab Data: I tried to get in to see my doctor but was unable to see get an appointment. So no tests have been done.
CDC Split Type:

Write-up: Since my injection my hip pain at night us such that I cannot sleep more than 45 minutes at a time. Since I got the vaccine I have not slept more than 3 hours a night or in a 24 hour period. Yesterday July 8, 2021 was the first time I have slept for six hours during the night.


VAERS ID: 1461685 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO198 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: No illnesses at time of vaccination
Preexisting Conditions: No long-standing health conditions
Allergies: No Allergies
Diagnostic Lab Data: Lab tests normal.
CDC Split Type:

Write-up: Patient had syncope. Became dizzy and fell in and out of consciousness. Began perspiring and became clammy. Breathing was normal. Patient fully recovered after emergency room visit.


VAERS ID: 1461719 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Hypoaesthesia, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan, hydrochloride , metformin
Current Illness: None, my sugar is well controlled as well as blood pressure , I?m a very active person . I do have non alcoholic fatty liver . No meds to take diet and exercise are working .
Preexisting Conditions: Type 2 diabetic well controlled .
Allergies: Tylenol
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving my first shot , within 5 minutes my feet was numb and tingling . This lasted for 5 hours I kept checking my sugar and blood pressure every hour . They were fine . I?m waiting to hear back from my doctor as this is not a listed side affect but I have read about many others having these issues .


VAERS ID: 1461890 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040C21A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? 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: Rash on legs


VAERS ID: 1461967 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-01
Onset:2021-07-03
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / SYR

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

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

Write-up: Rash on tops of hands that hurts. Dr thinks contact dermatitis so she prescribed topical steroid cream.


VAERS ID: 1462040 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 LA / IM

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

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

Write-up: Redness, swelling, itching lasting 7 days


VAERS ID: 1462046 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Cardiac arrest, Cardiogenic shock, Coronary artery occlusion
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: carvedilol lisinopril atenolol gabapentin buspirone ferrous sulfate pantoprazole rivaraoxaban penteramine alprazolam cetirizine
Current Illness: - PE - CAD - GERD - Anxiety - Hypertension - Chronic hepatitis C - Factor V Leiden carrier - Substance use disorder
Preexisting Conditions: - PE - CAD - GERD - Anxiety - Hypertension - Chronic hepatitis C - Factor V Leiden carrier - Substance use disorder
Allergies: ibuprofen imitrex maxalt
Diagnostic Lab Data: the usual for STEMI and shock
CDC Split Type:

Write-up: Driving home (passenger) she suffered a cardiac arrest. Was found to have a total occlusion of her right coronary artery and an inferior ST elevation myocardial infarction and cardiogenic shock


VAERS ID: 1462148 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-06-30
Onset:2021-07-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Contusion
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (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: Irregular bruising


VAERS ID: 1462169 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-06-05
Onset:2021-07-03
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW 0187 / 2 RA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Herpes zoster, Ophthalmic herpes zoster
SMQs:, Ocular infections (narrow), Opportunistic infections (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: Enalapril Rosuvastatin
Current Illness: None
Preexisting Conditions: High blood pressure Chlorestrol
Allergies: None
Diagnostic Lab Data: 07/08/2021. Office visit to Dr.
CDC Split Type:

Write-up: Herpes Zoster ophthalmicus


VAERS ID: 1462174 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-19
Onset:2021-07-03
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Migraine, Musculoskeletal discomfort, Vertigo
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Vestibular disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sumatriptan on occasion, armour thyroid 90mg, multivitamin
Current Illness:
Preexisting Conditions: Multiple chemical sensitivity
Allergies: methylergonovine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Exactly two weeks after my first dose I got really dizzy and started spinning. It?s been one week and I?m still really dizzy. I also had a migraine for 5 days. I?m still having issues withy neck.


VAERS ID: 1462185 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Activated partial thromboplastin time normal, Angiogram, Antineutrophil cytoplasmic antibody negative, Beta-2 glycoprotein antibody, Blood immunoglobulin G normal, Computerised tomogram head normal, Electrocardiogram normal, Full blood count normal, Gait disturbance, Headache, Hypoaesthesia, Impaired work ability, Injection site pain, International normalised ratio normal, Metabolic function test normal, Oedema, Pain in extremity, Paraesthesia, Prothrombin time normal, Thrombin-antithrombin III complex normal, Ultrasound Doppler, Urine analysis normal
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: On July 6th I went to Emergency Room. Lab tests Completed: 1. Activated partial thromboplastin time 2. Complete Blood Count 3. Comprehensive metabolic panel 4. HcG qualitive, urine 5. Prothrombin time with INR 6. Urinalysis with microscopic reflex culture Lab Tests in Progress: 1. Anti-neutrophillic cytoplasm antibody 2. Antithrombin III activity 3. Beta 2 glycoprotien 1 antibodies, IGG,IGM,IGA 4. Complement, total 5. DNA antibody, double-stranded 6. Prothrombin 20210A mutation analysis Imaging Tests: 1. CT angio Head wo and/or w Contrast 2. CT Angio Neck wo and or w contrast 3. CT head wo contrast 4. ECG 12 lead 5. Vascular US duplex lower extremity venous righ ER Doctor said all test came back normal and that he didn''t have an answer as to what''s causing the sudden numbness. My discharge papers say Diagnoses: 1. Edema, unspecified type 2. Paresthesia of right lower extremity
CDC Split Type:

Write-up: I received my first vaccine dose on Friday July 2nd. I had a sore arm where it was injection and headache like they told me I would. Saturday July 3rd when I was on my way to work, my lower legs both felt very sore, very similar to how my arm felt. Sunday July 4th, I took my 2 year old twins for a walk at the lake. On our way back to the car, I suddenly started walking funny and it felt like I was dragging my right foot. When I got to the car, I went to rub my foot and noticed my entire right foot was numb along with half of my lower right leg. The feeling was similar to what happens when your foot or leg falls asleep. Come Tueaday July 6th my foot and leg were still numb. I work full time and I''m constantly on my feet and it was getting hard and uncomfortable to walk. After work I called my doctors office and they told me to call emergency services since the numbness came on suddenly. I didn''t call emergency services but did go to the ER where they ran a bunch of tests.


VAERS ID: 1463022 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-07-03
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Suspected COVID-19, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VASCEPA; FENOFIBRATE
Current Illness: LDL (take Vascepa and Fenofibrate to help try to control LDL); Triglycerides (Take Vascepa and Fenofibrate to help try to control Triglycerides.)
Preexisting Conditions: Comments: Normally in good health
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210713929

Write-up: SUSPECTED CLINICAL VACCINATION FAILURE; SUSPECTED COVID-19 INFECTION /ANOTHER VARIANT; This spontaneous report received from a patient via a company representative concerned a patient of unspecified age and sex. The patient''s height, and weight were not reported. The patient''s concurrent conditions included ldl (low density lipoprotein), and triglycerides, and other pre-existing medical conditions included normally in good health. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported)at a frequency of 1 total, dose was not reported, administered on 21-MAY-2021 for prophylactic vaccination. Concomitant medications included eicosapentaenoic acid ethyl ester for ldl, and triglycerides, and fenofibrate for ldl, and triglycerides. On 03-JUL-2021, the subject experienced suspected clinical vaccination failure and suspected covid-19 infection / another variant. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from suspected covid-19 infection / other variant, and the outcome of suspected clinical vaccination failure was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: 20210713929-covid-19 vaccine ad26.cov2.s-Suspected clinical vaccination failure. This event(s) is considered not related. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There are other factors more likely to be associated with the event(s) than the drug. Specifically: SPECIAL SITUATIONS


VAERS ID: 1463060 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-03
Onset:2021-07-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA B04021A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure measurement, Dyspnoea, Feeling abnormal, Hypersensitivity, Pharyngeal swelling, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dementia (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: VITAMIN B1 [THIAMINE]
Current Illness:
Preexisting Conditions: Comments: NO medical history was reported by reporter.
Allergies:
Diagnostic Lab Data: Test Date: 20210703; Test Name: Blood pressure; Result Unstructured Data: Blood pressure 147 high
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Allergic Reaction; Tongue and throat swelled; Tongue and throat swelled; Feeling odd; Shortness of breath/not breathing as normal; This spontaneous case was reported by a patient and describes the occurrence of HYPERSENSITIVITY (Allergic Reaction), SWOLLEN TONGUE (Tongue and throat swelled) and PHARYNGEAL SWELLING (Tongue and throat swelled) in a 52-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. B04021A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. NO medical history was reported by reporter. Concomitant products included THIAMINE (VITAMIN B1 [THIAMINE]) for an unknown indication. On 03-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 03-Jul-2021, the patient experienced HYPERSENSITIVITY (Allergic Reaction) (seriousness criterion hospitalization), SWOLLEN TONGUE (Tongue and throat swelled) (seriousness criterion hospitalization) and PHARYNGEAL SWELLING (Tongue and throat swelled) (seriousness criterion hospitalization). On an unknown date, the patient experienced FEELING ABNORMAL (Feeling odd) and DYSPNOEA (Shortness of breath/not breathing as normal). The patient was treated with DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) at an unspecified dose and frequency. At the time of the report, HYPERSENSITIVITY (Allergic Reaction), SWOLLEN TONGUE (Tongue and throat swelled), PHARYNGEAL SWELLING (Tongue and throat swelled) and FEELING ABNORMAL (Feeling odd) outcome was unknown and DYSPNOEA (Shortness of breath/not breathing as normal) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 03-Jul-2021, Blood pressure measurement: 147 (High) Blood pressure 147 high. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Patient was suffered with Shortness of breath , feeling better. patient doesn''t have a main doctor but provides information of the hospital and Doctor that treat his allergic reaction after taking the vaccine, gives consent to safety follow up. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.


VAERS ID: 1463076 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-05-01
Onset:2021-07-03
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Artery dissection, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

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? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Couple of medications
Current Illness: No
Preexisting Conditions: No
Allergies: No
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had a heart attack due to a tear in artery.


VAERS ID: 1463529 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-06-26
Onset:2021-07-03
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray, Full blood count, Lymphadenopathy, Metabolic function test
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: No known allergies
Diagnostic Lab Data: Face to face visit with primary care on 7/8/21. Chest X-ray, CBC and CMP on 7/10/21
CDC Split Type:

Write-up: Right axillary lymphadenopathy


VAERS ID: 1463763 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: California  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EY0584 / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dehydration, Diarrhoea, Electrolyte imbalance, Malaise, White blood cell count normal
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: old age
Allergies: unknown, allergy to cats and dogs
Diagnostic Lab Data: about 14 test were done, we do not have the results other than the verbal info from the doctor that electrolytes were on the low side as result of 7 days of Diarrhea and white blood cell count was normal, indicating no other infections beside the vaccine reaction.
CDC Split Type:

Write-up: around 24 hours after receiving the second dose my wife became ill with Diarrhea which progressed to severe Diarrhea ever few minutes for hours at a time. This became progressively worse and since we are uninsured we trusted it would go away after a few days. After 7 days ( the maximum duration we saw on the internet for this side effect) things were not better and we visited the ER Doctor noted my wife was dehydrated and he ran blood tests Plus gave her 1 liter of Sodium Chloride, Ibuprofen and Simethicone and Aceminphen. He noted there was not much else he could do and we needed to be patient for things to get better plus gave advice on food ( which we already tried) AS of right now Sunday night 7/11/2021 my wife still has severe Diarrhea , no real improvement over the last 5 days.


VAERS ID: 1463916 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-06-02
Onset:2021-07-03
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anti-thyroid antibody, Anti-thyroid antibody negative, Blood thyroid stimulating hormone, Hypothyroidism, Thyroxine decreased, Thyroxine free decreased, Tri-iodothyronine normal
SMQs:, Hypothyroidism (narrow), Hyperthyroidism (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: dextro-amphetamine ER fluoxetine
Current Illness:
Preexisting Conditions: ADHD, autism
Allergies:
Diagnostic Lab Data: TSH 415, T4 <0.3, free T4 <0.1, T3 41, free T3 134, anti thyroglobulin Ab (-), anti thyroidperoxidase Ab (-)
CDC Split Type:

Write-up: patient presented with profound hypothyroidism within weeks of second COVID vaccine


VAERS ID: 1463993 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-05-01
Onset:2021-07-03
   Days after vaccination:63
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Skin discolouration
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth control: Drosperinone 3mg
Current Illness: High-grade squamous lesions in cervix - LEEP/cone biopsy on 4/29/21
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Symptoms: Significant bruising on bilateral legs and Left arm, dark red/purple spots on Left knee present 2 months after receiving vaccine. No physical activity, unexplainable bruising


VAERS ID: 1464045 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Bedridden, Fatigue, Headache, Loss of personal independence in daily activities, Mobility decreased, Nausea
SMQs:, Acute pancreatitis (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: flu vaccine makes me sick age 72, 73 , 74
Other Medications: Atenolol 25mg
Current Illness: none
Preexisting Conditions: none
Allergies: statins, antivert, meloxicam, aspercreme anesthesia
Diagnostic Lab Data: none
CDC Split Type:

Write-up: July 3 -I was completely bedridden , weak, and nauseous, -I had a piercing headache --I took migraine medication which did not help and ibuprophen for pain- July 4, I was better and able to function, headache went away in the morning-- , July 5th I was so tired I could not get up or do anything and had piercing headache took ibuprophen- -July 6th I was too tired to do anything and had piercing headache took ibuprofen-- July 6 - 11 I was better but very tired and still had headache took ibuprofen every day-- Today I am better and the headache is much less but I am very tired all the time.


VAERS ID: 1464088 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-07-02
Onset:2021-07-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, Illness, Impaired work ability, Oropharyngeal pain, SARS-CoV-2 test negative, Upper respiratory tract infection
SMQs:, Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D3; Aller-Tec; Rosuvastatin; Calcium; Pantoprazole; Levothyroxine.
Current Illness: None.
Preexisting Conditions: Thyroid issues; Intradural cystic neoplasm on my pancreas.
Allergies: Indomethacin; Darvon.
Diagnostic Lab Data: I was tested for COVID and the test results came back negative and I was later diagnosed with an upper respiratory infection. I was not prescribed any meds but he did tell me to take ibuprofen and drinks lots of fluids and get lots of rest.
CDC Split Type: vsafe

Write-up: July 3, 2021 I woke with 102 degree temperature and then I was sick throughout the week and on Tuesday, July 6, 2021, I called sick for work and on Wednesday, July 7th, 2021 I went into work and got sent home and sent to the doctors. I was tested for COVID and the test results came back negative and I was later diagnosed with an upper respiratory infection. I was not prescribed any meds but he did tell me to take ibuprofen and drinks lots of fluids and get lots of rest. I started to feel better July 8, 2021 but I still had a slight sour throat on Friday July 9, 2021, and was able to return to work. I finally feel normal.


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